Revolutionizing tumor detection and classification in multimodality imaging based on deep learning approaches: methods, applications and limitations.

BACKGROUND: The emergence of deep learning (DL) techniques has revolutionized tumor detection and classification in medical imaging, with multimodal medical imaging (MMI) gaining recognition for its precision in diagnosis, treatment, and progression tracking. OBJECTIVE: This review comprehensively examines DL methods in transforming tumor detection and classification across MMI modalities, aiming to provide insights into advancements, limitations, and key challenges for further progress. METHODS: Systematic literature analysis identifies DL studies for tumor detection and classification, outlining methodologies including convolutional neural networks (CNNs), recurrent neural networks (RNNs), and their variants. Integration of multimodality imaging enhances accuracy and robustness. RESULTS: Recent advancements in DL-based MMI evaluation methods are surveyed, focusing on tumor detection and classification tasks. Various DL approaches, including CNNs, YOLO, Siamese Networks, Fusion-Based Models, Attention-Based Models, and Generative Adversarial Networks, are discussed with emphasis on PET-MRI, PET-CT, and SPECT-CT. FUTURE DIRECTIONS: The review outlines emerging trends and future directions in DL-based tumor analysis, aiming to guide researchers and clinicians toward more effective diagnosis and prognosis. Continued innovation and collaboration are stressed in this rapidly evolving domain. CONCLUSION: Conclusions drawn from literature analysis underscore the efficacy of DL approaches in tumor detection and classification, highlighting their potential to address challenges in MMI analysis and their implications for clinical practice.

Enhancing accuracy in brain stroke detection: Multi-layer perceptron with Adadelta, RMSProp and AdaMax optimizers.

The human brain is an extremely intricate and fascinating organ that is made up of the cerebrum, cerebellum, and brainstem and is protected by the skull. Brain stroke is recognized as a potentially fatal condition brought on by an unfavorable obstruction in the arteries supplying the brain. The severity of brain stroke may be reduced or controlled with its early prognosis to lessen the mortality rate and lead to good health. This paper proposed a technique to predict brain strokes with high accuracy. The model was constructed using data related to brain strokes. The aim of this work is to use Multi Layer Perceptron (MLP) as a classification technique for stroke data and used multi-optimizers that include Adaptive moment estimation with Maximum (AdaMax), Root Mean Squared Propagation (RMSProp) and Adaptive learning rate method (Adadelta). The experiment shows RMSProp optimizer is best with a data training accuracy of 95.8% and a value for data testing accuracy of 94.9%. The novelty of work is to incorporate multiple optimizers alongside the MLP classifier which offers a comprehensive approach to stroke prediction, providing a more robust and accurate solution. The obtained results underscore the effectiveness of the proposed methodology in enhancing the accuracy of brain stroke detection, thereby paving the way for potential advancements in medical diagnosis and treatment.

Visual pollution real images benchmark dataset on the public roads.

The term quality of life (QoL) refers to a wide range of multifaceted concepts that often involve subjective assessments of both positive and negative aspects of life. It is difficult to quantify QoL as the word has varied meanings in different academic areas and may have different connotations in different circumstances. The five sectors most commonly associated with QoL, however, are Health, Education, Environmental Quality, Personal Security, Civic Engagement, and Work-Life Balance. An emerging issue that falls under environmental quality is visual pollution (VP) which, as detailed in this study, refers to disruptive presences that limit visual ability in public roads with an emphasis on excavation barriers, potholes, and dilapidated sidewalks. Quantifying VP has always been difficult due to its subjective nature and lack of a consistent set of rules for systematic assessment of visual pollution. This emphasizes the need for research and module development that will allow government agencies to automatically predict and detect VP. Our dataset was collected from different regions in the Kingdom of Saudi Arabia (KSA) via the Ministry of Municipal and Rural Affairs and Housing (MOMRAH) as a part of a VP campaign to improve Saudi Arabia's urban landscape. It consists of 34,460 RGB images separated into three distinct classes: excavation barriers, potholes, and dilapidated sidewalks. To annotate all images for detection (i.e., bounding box) and classification (i.e., classification label) tasks, the deep active learning strategy (DAL) is used where an initial 1,200 VP images (i.e., 400 images per class) are manually annotated by four experts. Images with more than one object increase the number of training object ROIs which are recorded to be 8,417 for excavation barriers, 25,975 for potholes, and 7,412 for dilapidated sidewalks. The MOMRAH dataset is publicly published to enrich the research domain with the new VP image dataset.

Multilayer perceptron-based self-care early prediction of children with disabilities.

Early identification of children with self-care impairments is one of the key challenges professional therapists face due to the complex and time-consuming detection process using relevant self-care activities. Due to the complex nature of the problem, machine-learning methods have been widely applied in this area. In this study, a feed-forward artificial neural network (ANN)-based self-care prediction methodology, called multilayer perceptron (MLP)-progressive, has been proposed. The proposed methodology integrates unsupervised instance-based resampling and randomizing preprocessing techniques to MLP for improved early detection of self-care disabilities in children. Preprocessing of the dataset affects the MLP performance; hence, randomization and resampling of the dataset improves the performance of the MLP model. To confirm the usefulness of MLP-progressive, three experiments were conducted, including validating MLP-progressive methodology over multi-class and binary-class datasets, impact analysis of the proposed preprocessing filters on the model performance, and comparing the MLP-progressive results with state-of-the-art studies. The evaluation metrics accuracy, precision, recall, F-measure, TP rate, FP rate, and ROC were used to measure performance of the proposed disability detection model. The proposed MLP-progressive model outperforms existing methods and attains a classification accuracy of 97.14% and 98.57% on multi-class and binary-class datasets, respectively. Additionally, when evaluated on the multi-class dataset, significant improvements in accuracies ranging from 90.00% to 97.14% were observed when compared to state-of-the-art methods.

Deep Active Learning for Automatic Mitotic Cell Detection on HEp-2 Specimen Medical Images.

Identifying Human Epithelial Type 2 (HEp-2) mitotic cells is a crucial procedure in anti-nuclear antibodies (ANAs) testing, which is the standard protocol for detecting connective tissue diseases (CTD). Due to the low throughput and labor-subjectivity of the ANAs' manual screening test, there is a need to develop a reliable HEp-2 computer-aided diagnosis (CAD) system. The automatic detection of mitotic cells from the microscopic HEp-2 specimen images is an essential step to support the diagnosis process and enhance the throughput of this test. This work proposes a deep active learning (DAL) approach to overcoming the cell labeling challenge. Moreover, deep learning detectors are tailored to automatically identify the mitotic cells directly in the entire microscopic HEp-2 specimen images, avoiding the segmentation step. The proposed framework is validated using the I3A Task-2 dataset over 5-fold cross-validation trials. Using the YOLO predictor, promising mitotic cell prediction results are achieved with an average of 90.011% recall, 88.307% precision, and 81.531% mAP. Whereas, average scores of 86.986% recall, 85.282% precision, and 78.506% mAP are obtained using the Faster R-CNN predictor. Employing the DAL method over four labeling rounds effectively enhances the accuracy of the data annotation, and hence, improves the prediction performance. The proposed framework could be practically applicable to support medical personnel in making rapid and accurate decisions about the mitotic cells' existence.

A Hybrid Multimodal Emotion Recognition Framework for UX Evaluation Using Generalized Mixture Functions.

Multimodal emotion recognition has gained much traction in the field of affective computing, human-computer interaction (HCI), artificial intelligence (AI), and user experience (UX). There is growing demand to automate analysis of user emotion towards HCI, AI, and UX evaluation applications for providing affective services. Emotions are increasingly being used, obtained through the videos, audio, text or physiological signals. This has led to process emotions from multiple modalities, usually combined through ensemble-based systems with static weights. Due to numerous limitations like missing modality data, inter-class variations, and intra-class similarities, an effective weighting scheme is thus required to improve the aforementioned discrimination between modalities. This article takes into account the importance of difference between multiple modalities and assigns dynamic weights to them by adapting a more efficient combination process with the application of generalized mixture (GM) functions. Therefore, we present a hybrid multimodal emotion recognition (H-MMER) framework using multi-view learning approach for unimodal emotion recognition and introducing multimodal feature fusion level, and decision level fusion using GM functions. In an experimental study, we evaluated the ability of our proposed framework to model a set of four different emotional states (Happiness, Neutral, Sadness, and Anger) and found that most of them can be modeled well with significantly high accuracy using GM functions. The experiment shows that the proposed framework can model emotional states with an average accuracy of 98.19% and indicates significant gain in terms of performance in contrast to traditional approaches. The overall evaluation results indicate that we can identify emotional states with high accuracy and increase the robustness of an emotion classification system required for UX measurement.

Multiple Brain Tumor Classification with Dense CNN Architecture Using Brain MRI Images.

Brain MR images are the most suitable method for detecting chronic nerve diseases such as brain tumors, strokes, dementia, and multiple sclerosis. They are also used as the most sensitive method in evaluating diseases of the pituitary gland, brain vessels, eye, and inner ear organs. Many medical image analysis methods based on deep learning techniques have been proposed for health monitoring and diagnosis from brain MRI images. CNNs (Convolutional Neural Networks) are a sub-branch of deep learning and are often used to analyze visual information. Common uses include image and video recognition, suggestive systems, image classification, medical image analysis, and natural language processing. In this study, a new modular deep learning model was created to retain the existing advantages of known transfer learning methods (DenseNet, VGG16, and basic CNN architectures) in the classification process of MR images and eliminate their disadvantages. Open-source brain tumor images taken from the Kaggle database were used. For the training of the model, two types of splitting were utilized. First, 80% of the MRI image dataset was used in the training phase and 20% in the testing phase. Secondly, 10-fold cross-validation was used. When the proposed deep learning model and other known transfer learning methods were tested on the same MRI dataset, an improvement in classification performance was obtained, but an increase in processing time was observed.

Balancing Complex Signals for Robust Predictive Modeling.

Robust predictive modeling is the process of creating, validating, and testing models to obtain better prediction outcomes. Datasets usually contain outliers whose trend deviates from the most data points. Conventionally, outliers are removed from the training dataset during preprocessing before building predictive models. Such models, however, may have poor predictive performance on the unseen testing data involving outliers. In modern machine learning, outliers are regarded as complex signals because of their significant role and are not suggested for removal from the training dataset. Models trained in modern regimes are interpolated (over trained) by increasing their complexity to treat outliers locally. However, such models become inefficient as they require more training due to the inclusion of outliers, and this also compromises the models' accuracy. This work proposes a novel complex signal balancing technique that may be used during preprocessing to incorporate the maximum number of complex signals (outliers) in the training dataset. The proposed approach determines the optimal value for maximum possible inclusion of complex signals for training with the highest performance of the model in terms of accuracy, time, and complexity. The experimental results show that models trained after preprocessing with the proposed technique achieve higher predictive accuracy with improved execution time and low complexity as compared to traditional predictive modeling.

Clinical Concept Extraction with Lexical Semantics to Support Automatic Annotation.

Extracting clinical concepts, such as problems, diagnosis, and treatment, from unstructured clinical narrative documents enables data-driven approaches such as machine and deep learning to support advanced applications such as clinical decision-support systems, the assessment of disease progression, and the intelligent analysis of treatment efficacy. Various tools such as cTAKES, Sophia, MetaMap, and other rules-based approaches and algorithms have been used for automatic concept extraction. Recently, machine- and deep-learning approaches have been used to extract, classify, and accurately annotate terms and phrases. However, the requirement of an annotated dataset, which is labor-intensive, impedes the success of data-driven approaches. A rule-based mechanism could support the process of annotation, but existing rule-based approaches fail to adequately capture contextual, syntactic, and semantic patterns. This study intends to introduce a comprehensive rule-based system that automatically extracts clinical concepts from unstructured narratives with higher accuracy and transparency. The proposed system is a pipelined approach, capable of recognizing clinical concepts of three types, problem, treatment, and test, in the dataset collected from a published repository as a part of the I2b2 challenge 2010. The system's performance is compared with that of three existing systems: Quick UMLS, BIO-CRF, and the Rules (i2b2) model. Compared to the baseline systems, the average F1-score of 72.94% was found to be 13% better than Quick UMLS, 3% better than BIO CRF, and 30.1% better than the Rules (i2b2) model. Individually, the system performance was noticeably higher for problem-related concepts, with an F1-score of 80.45%, followed by treatment-related concepts and test-related concepts, with F1-scores of 76.06% and 55.3%, respectively. The proposed methodology significantly improves the performance of concept extraction from unstructured clinical narratives by exploiting the linguistic and lexical semantic features. The approach can ease the automatic annotation process of clinical data, which ultimately improves the performance of supervised data-driven applications trained with these data.

A practical approach towards causality mining in clinical text using active transfer learning.

OBJECTIVE: Causality mining is an active research area, which requires the application of state-of-the-art natural language processing techniques. In the healthcare domain, medical experts create clinical text to overcome the limitation of well-defined and schema driven information systems. The objective of this research work is to create a framework, which can convert clinical text into causal knowledge. METHODS: A practical approach based on term expansion, phrase generation, BERT based phrase embedding and semantic matching, semantic enrichment, expert verification, and model evolution has been used to construct a comprehensive causality mining framework. This active transfer learning based framework along with its supplementary services, is able to extract and enrich, causal relationships and their corresponding entities from clinical text. RESULTS: The multi-model transfer learning technique when applied over multiple iterations, gains substantial performance improvements. We also present a comparative analysis of the presented techniques with their common alternatives, which demonstrate the correctness of our approach and its ability to capture most causal relationships. CONCLUSION: The presented framework has provided cutting-edge results in the healthcare domain. However, the framework can be tweaked to provide causality detection in other domains, as well. SIGNIFICANCE: The presented framework is generic enough to be utilized in any domain, healthcare services can gain massive benefits due to the voluminous and various nature of its data. This causal knowledge extraction framework can be used to summarize clinical text, create personas, discover medical knowledge, and provide evidence to clinical decision making.

COVID-19 Knowledge Resource Categorization and Tracking: Conceptual Framework Study.

BACKGROUND: Since the declaration of COVID-19 as a global pandemic by the World Health Organization, the disease has gained momentum with every passing day. Various private and government sectors of different countries allocated funding for research in multiple capacities. A significant portion of efforts has been devoted to information technology and service infrastructure development, including research on developing intelligent models and techniques for alerts, monitoring, early diagnosis, prevention, and other relevant services. As a result, many information resources have been created globally and are available for use. However, a defined structure to organize these resources into categories based on the nature and origin of the data is lacking. OBJECTIVE: This study aims to organize COVID-19 information resources into a well-defined structure to facilitate the easy identification of a resource, tracking information workflows, and to provide a guide for a contextual dashboard design and development. METHODS: A sequence of action research was performed that involved a review of COVID-19 efforts and initiatives on a global scale during the year 2020. Data were collected according to the defined structure of primary, secondary, and tertiary categories. Various techniques for descriptive statistical analysis were employed to gain insights into the data to help develop a conceptual framework to organize resources and track interactions between different resources. RESULTS: Investigating diverse information at the primary, secondary, and tertiary levels enabled us to develop a conceptual framework for COVID-19-related efforts and initiatives. The framework of resource categorization provides a gateway to access global initiatives with enriched metadata, and assists users in tracking the workflow of tertiary, secondary, and primary resources with relationships between various fragments of information. The results demonstrated mapping initiatives at the tertiary level to secondary level and then to the primary level to reach firsthand data, research, and trials. CONCLUSIONS: Adopting the proposed three-level structure allows for a consistent organization and management of existing COVID-19 knowledge resources and provides a roadmap for classifying future resources. This study is one of the earliest studies to introduce an infrastructure for locating and placing the right information at the right place. By implementing the proposed framework according to the stated guidelines, this study allows for the development of applications such as interactive dashboards to facilitate the contextual identification and tracking of interdependent COVID-19 knowledge resources.

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours.

Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.

Clinical Decision Support System Based on Hybrid Knowledge Modeling: A Case Study of Chronic Kidney Disease-Mineral and Bone Disorder Treatment.

Clinical decision support systems (CDSSs) represent the latest technological transformation in healthcare for assisting clinicians in complex decision-making. Several CDSSs are proposed to deal with a range of clinical tasks such as disease diagnosis, prescription management, and medication ordering. Although a small number of CDSSs have focused on treatment selection, areas such as medication selection and dosing selection remained under-researched. In this regard, this study represents one of the first studies in which a CDSS is proposed for clinicians who manage patients with end-stage renal disease undergoing maintenance hemodialysis, almost all of whom have some manifestation of chronic kidney disease-mineral and bone disorder (CKD-MBD). The primary objective of the system is to aid clinicians in dosage prescription by levering medical domain knowledge as well existing practices. The proposed CDSS is evaluated with a real-world hemodialysis patient dataset acquired from Kyung Hee University Hospital, South Korea. Our evaluation demonstrates overall high compliance based on the concordance metric between the proposed CKD-MBD CDSS recommendations and the routine clinical practice. The concordance rate of overall medication dosing selection is 78.27%. Furthermore, the usability aspects of the system are also evaluated through the User Experience Questionnaire method to highlight the appealing aspects of the system for clinicians. The overall user experience dimension scores for pragmatic, hedonic, and attractiveness are 1.53, 1.48, and 1.41, respectively. A service reliability for the Cronbach's alpha coefficient greater than 0.7 is achieved using the proposed system, whereas a dependability coefficient of the value 0.84 reveals a significant effect.

An Empirical Method of Automatic Pattern Extraction for Clinical Text Classification.

Clinical text classification is an indispensable and extensively studied problem in medical text processing. Existing research primarily employs machine learning and pattern based approaches to address the stated problem. In general, pattern based approaches perform better than other methods. However, these approaches commonly require human intervention for pattern identification, which diminish their benefits and restrain their applications. In this study, we present a novel pattern extraction algorithm, which identifies and extracts patterns from clinical textual resources, automatically. The algorithm identifies the candidate concepts in the clinical text, finds the context of the concepts by discovering their context windows, and finally transforms each context window to a pattern. We evaluate our proposed algorithm on Hypertension, Rhinosinusitis, and Asthma guidelines. 70% of the hypertension guideline was used for pattern extraction while the remaining 30% and the other two guidelines were used for evaluations. The algorithm extracts 21 patterns that classify Hypertension, Rhinosinusitis, and Asthma guidelines sentences to the recommendation and non-recommendation sentences with 84.53%, 80.03%, and 84.62% accuracy, respectively. The initial results reveal the benefits and applicability of the algorithm for clinical text classification.

On computing critical factors based healthy behavior index for behavior assessment.

OBJECTIVE: Ubiquitous computing has supported personalized health through a vast variety of wellness and healthcare self-quantification applications over the last decade. These applications provide insights for daily life activities but unable to portray the comprehensive impact of personal habits on human health. Therefore, in order to facilitate the individuals, we have correlated the lifestyle habits in an appropriate proportion to determine the overall impact of influenced behavior on the well-being of humans. MATERIALS AND METHODS: To study the combined impact of personal behaviors, we have proposed a methodology to derive the comprehensive Healthy Behavior Index (HBI) consisting of two major processes: (1) Behaviors' Weight-age Identification (BWI), and (2) Healthy Behavior Quantification and Index (HBQI) modeling. The BWI process identifies the high ranked contributing behaviors through life-expectancy based weight-age, whereas HBQI derives a mathematical model based on quantification and indexing of behavior using wellness guidelines. RESULTS: The contributing behaviors are identified through text mining technique and verified by seven experts with a Kappa agreement level of 0.379. A real-world user-centric statistical evaluation is applied through User Experience Questionnaire (UEQ) method to evaluate the impact of HBI service. This HBI service is developed for the Mining Minds, a wellness management application. This study involves 103 registered participants (curious about the chronic disease) for a Korean wellness management organization. They used the HBI service over 12 weeks, the results for which were evaluated through UEQ and user feedback. The service reliability for the Cronbach's alpha coefficient greater than 0.7 was achieved using HBI service whereas the stimulation coefficient of the value 0.86 revealed significant effect. We observed an overall novelty of the value 0.88 showing the potential interest of participants. CONCLUSIONS: The comprehensive HBI has demonstrated positive user experience concerning the stimulation for adapting the healthy behaviors. The HBI service is designed independently to work as a service, so any other wellness management service-enabled platform can consume it to evaluate the healthy behavior index of the person for recommendation generation, behavior indication, and behavior adaptation.

Semantic preservation of standardized healthcare documents in big data.

BACKGROUND: Standardized healthcare documents have a high adoption rate in today's hospital setup. This brings several challenges as processing the documents on a large scale takes a toll on the infrastructure. The complexity of these documents compounds the issue of handling them which is why applying big data techniques is necessary. The nature of big data techniques can trigger accuracy/semantic loss in health documents when they are partitioned for processing. This semantic loss is critical with respect to clinical use as well as insurance, or medical education. METHODS: In this paper we propose a novel technique to avoid any semantic loss that happens during the conventional partitioning of healthcare documents in big data through a constraint model based on the conformance of clinical document standard and user based use cases. We used clinical document architecture (CDAR) datasets on Hadoop Distributed File System (HDFS) through uniquely configured setup. We identified the affected documents with respect to semantic loss after partitioning and separated them into two sets: conflict free documents and conflicted documents. The resolution for conflicted documents was done based on different resolution strategies that were mapped according to CDAR specification. The first part of the technique is focused in identifying the type of conflict in the blocks that arises after partitioning. The second part focuses on the resolution mapping of the conflicts based on the constraints applied depending on the validation and user scenario. RESULTS: We used a publicly available dataset of CDAR documents, identified all conflicted documents and resolved all the them successfully to avoid any semantic loss. In our experiment we tested up to 87,000 CDAR documents and successfully identified the conflicts and resolved the semantic issues. CONCLUSION: We have presented a novel study that focuses on the semantics of big data which did not compromise the performance and resolved the semantic issues risen during the processing of clinical documents.

A Multimodal Deep Log-Based User Experience (UX) Platform for UX Evaluation.

The user experience (UX) is an emerging field in user research and design, and the development of UX evaluation methods presents a challenge for both researchers and practitioners. Different UX evaluation methods have been developed to extract accurate UX data. Among UX evaluation methods, the mixed-method approach of triangulation has gained importance. It provides more accurate and precise information about the user while interacting with the product. However, this approach requires skilled UX researchers and developers to integrate multiple devices, synchronize them, analyze the data, and ultimately produce an informed decision. In this paper, a method and system for measuring the overall UX over time using a triangulation method are proposed. The proposed platform incorporates observational and physiological measurements in addition to traditional ones. The platform reduces the subjective bias and validates the user's perceptions, which are measured by different sensors through objectification of the subjective nature of the user in the UX assessment. The platform additionally offers plug-and-play support for different devices and powerful analytics for obtaining insight on the UX in terms of multiple participants.

Multi-model-based interactive authoring environment for creating shareable medical knowledge.

OBJECTIVE: Technologically integrated healthcare environments can be realized if physicians are encouraged to use smart systems for the creation and sharing of knowledge used in clinical decision support systems (CDSS). While CDSSs are heading toward smart environments, they lack support for abstraction of technology-oriented knowledge from physicians. Therefore, abstraction in the form of a user-friendly and flexible authoring environment is required in order for physicians to create shareable and interoperable knowledge for CDSS workflows. Our proposed system provides a user-friendly authoring environment to create Arden Syntax MLM (Medical Logic Module) as shareable knowledge rules for intelligent decision-making by CDSS. METHODS AND MATERIALS: Existing systems are not physician friendly and lack interoperability and shareability of knowledge. In this paper, we proposed Intelligent-Knowledge Authoring Tool (I-KAT), a knowledge authoring environment that overcomes the above mentioned limitations. Shareability is achieved by creating a knowledge base from MLMs using Arden Syntax. Interoperability is enhanced using standard data models and terminologies. However, creation of shareable and interoperable knowledge using Arden Syntax without abstraction increases complexity, which ultimately makes it difficult for physicians to use the authoring environment. Therefore, physician friendliness is provided by abstraction at the application layer to reduce complexity. This abstraction is regulated by mappings created between legacy system concepts, which are modeled as domain clinical model (DCM) and decision support standards such as virtual medical record (vMR) and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). We represent these mappings with a semantic reconciliation model (SRM). RESULTS: The objective of the study is the creation of shareable and interoperable knowledge using a user-friendly and flexible I-KAT. Therefore we evaluated our system using completeness and user satisfaction criteria, which we assessed through the system- and user-centric evaluation processes. For system-centric evaluation, we compared the implementation of clinical information modelling system requirements in our proposed system and in existing systems. The results suggested that 82.05% of the requirements were fully supported, 7.69% were partially supported, and 10.25% were not supported by our system. In the existing systems, 35.89% of requirements were fully supported, 28.20% were partially supported, and 35.89% were not supported. For user-centric evaluation, the assessment criterion was 'ease of use'. Our proposed system showed 15 times better results with respect to MLM creation time than the existing systems. Moreover, on average, the participants made only one error in MLM creation using our proposed system, but 13 errors per MLM using the existing systems. CONCLUSION: We provide a user-friendly authoring environment for creation of shareable and interoperable knowledge for CDSS to overcome knowledge acquisition complexity. The authoring environment uses state-of-the-art decision support-related clinical standards with increased ease of use.

Knowledge-Based Query Construction Using the CDSS Knowledge Base for Efficient Evidence Retrieval.

Finding appropriate evidence to support clinical practices is always challenging, and the construction of a query to retrieve such evidence is a fundamental step. Typically, evidence is found using manual or semi-automatic methods, which are time-consuming and sometimes make it difficult to construct knowledge-based complex queries. To overcome the difficulty in constructing knowledge-based complex queries, we utilized the knowledge base (KB) of the clinical decision support system (CDSS), which has the potential to provide sufficient contextual information. To automatically construct knowledge-based complex queries, we designed methods to parse rule structure in KB of CDSS in order to determine an executable path and extract the terms by parsing the control structures and logic connectives used in the logic. The automatically constructed knowledge-based complex queries were executed on the PubMed search service to evaluate the results on the reduction of retrieved citations with high relevance. The average number of citations was reduced from 56,249 citations to 330 citations with the knowledge-based query construction approach, and relevance increased from 1 term to 6 terms on average. The ability to automatically retrieve relevant evidence maximizes efficiency for clinicians in terms of time, based on feedback collected from clinicians. This approach is generally useful in evidence-based medicine, especially in ambient assisted living environments where automation is highly important.

H2RM: A Hybrid Rough Set Reasoning Model for Prediction and Management of Diabetes Mellitus.

Diabetes is a chronic disease characterized by high blood glucose level that results either from a deficiency of insulin produced by the body, or the body's resistance to the effects of insulin. Accurate and precise reasoning and prediction models greatly help physicians to improve diagnosis, prognosis and treatment procedures of different diseases. Though numerous models have been proposed to solve issues of diagnosis and management of diabetes, they have the following drawbacks: (1) restricted one type of diabetes; (2) lack understandability and explanatory power of the techniques and decision; (3) limited either to prediction purpose or management over the structured contents; and (4) lack competence for dimensionality and vagueness of patient's data. To overcome these issues, this paper proposes a novel hybrid rough set reasoning model (H2RM) that resolves problems of inaccurate prediction and management of type-1 diabetes mellitus (T1DM) and type-2 diabetes mellitus (T2DM). For verification of the proposed model, experimental data from fifty patients, acquired from a local hospital in semi-structured format, is used. First, the data is transformed into structured format and then used for mining prediction rules. Rough set theory (RST) based techniques and algorithms are used to mine the prediction rules. During the online execution phase of the model, these rules are used to predict T1DM and T2DM for new patients. Furthermore, the proposed model assists physicians to manage diabetes using knowledge extracted from online diabetes guidelines. Correlation-based trend analysis techniques are used to manage diabetic observations. Experimental results demonstrate that the proposed model outperforms the existing methods with 95.9% average and balanced accuracies.