Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model: A development and validation study.

BACKGROUND: Bayesian networks (BNs) are machine-learning-based computational models that visualize causal relationships and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. Preoperative identification of patients at risk for lymph node metastasis (LNM) is challenging in endometrial cancer, and although several biomarkers are related to LNM, none of them are incorporated in clinical practice. The aim of this study was to develop and externally validate a preoperative BN to predict LNM and outcome in endometrial cancer patients. METHODS AND FINDINGS: Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), we performed a retrospective multicenter cohort study including 763 patients, median age 65 years (interquartile range [IQR] 58-71), surgically treated for endometrial cancer between February 1995 and August 2013 at one of the 10 participating European hospitals. A BN was developed using score-based machine learning in addition to expert knowledge. Our main outcome measures were LNM and 5-year disease-specific survival (DSS). Preoperative clinical, histopathological, and molecular biomarkers were included in the network. External validation was performed using 2 prospective study cohorts: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) study cohort, including 446 Norwegian patients, median age 64 years (IQR 59-74), treated between May 2001 and 2010; and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study cohort, including 384 Dutch patients, median age 66 years (IQR 60-73), treated between September 2011 and December 2013. A BN called ENDORISK (preoperative risk stratification in endometrial cancer) was developed including the following predictors: preoperative tumor grade; immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), p53, and L1 cell adhesion molecule (L1CAM); cancer antigen 125 serum level; thrombocyte count; imaging results on lymphadenopathy; and cervical cytology. In the MoMaTEC cohort, the area under the curve (AUC) was 0.82 (95% confidence interval [CI] 0.76-0.88) for LNM and 0.82 (95% CI 0.77-0.87) for 5-year DSS. In the PIPENDO cohort, the AUC for 5-year DSS was 0.84 (95% CI 0.78-0.90). The network was well-calibrated. In the MoMaTEC cohort, 249 patients (55.8%) were classified with <5% risk of LNM, with a false-negative rate of 1.6%. A limitation of the study is the use of imputation to correct for missing predictor variables in the development cohort and the retrospective study design. CONCLUSIONS: In this study, we illustrated how BNs can be used for individualizing clinical decision-making in oncology by incorporating easily accessible and multimodal biomarkers. The network shows the complex interactions underlying the carcinogenetic process of endometrial cancer by its graphical representation. A prospective feasibility study will be needed prior to implementation in the clinic.

A probabilistic framework for predicting disease dynamics: A case study of psychotic depression.

Unsupervised learning is often used to obtain insight into the underlying structure of medical data, but it is not always clear how to use such structure in an effective way. In this paper, we propose a probabilistic framework for predicting disease dynamics guided by latent states. The framework is based on hidden Markov models and aims to facilitate the selection of hypotheses that might yield insight into the dynamics. We demonstrate this by using clinical trial data for psychotic depression treatment as a case study. The discovered latent structure and proposed outcome are then validated using standard depression criteria, and are shown to provide new insight into the heterogeneity of psychotic depression in terms of predictive symptoms for different interventions.

Understanding disease processes by partitioned dynamic Bayesian networks.

For many clinical problems in patients the underlying pathophysiological process changes in the course of time as a result of medical interventions. In model building for such problems, the typical scarcity of data in a clinical setting has been often compensated by utilizing time homogeneous models, such as dynamic Bayesian networks. As a consequence, the specificities of the underlying process are lost in the obtained models. In the current work, we propose the new concept of partitioned dynamic Bayesian networks to capture distribution regime changes, i.e. time non-homogeneity, benefiting from an intuitive and compact representation with the solid theoretical foundation of Bayesian network models. In order to balance specificity and simplicity in real-world scenarios, we propose a heuristic algorithm to search and learn these non-homogeneous models taking into account a preference for less complex models. An extensive set of experiments were ran, in which simulating experiments show that the heuristic algorithm was capable of constructing well-suited solutions, in terms of goodness of fit and statistical distance to the original distributions, in consonance with the underlying processes that generated data, whether it was homogeneous or non-homogeneous. Finally, a study case on psychotic depression was conducted using non-homogeneous models learned by the heuristic, leading to insightful answers for clinically relevant questions concerning the dynamics of this mental disorder.

Learning Bayesian networks for clinical time series analysis.

INTRODUCTION: Autonomous chronic disease management requires models that are able to interpret time series data from patients. However, construction of such models by means of machine learning requires the availability of costly health-care data, often resulting in small samples. We analysed data from chronic obstructive pulmonary disease (COPD) patients with the goal of constructing a model to predict the occurrence of exacerbation events, i.e., episodes of decreased pulmonary health status. METHODS: Data from 10 COPD patients, gathered with our home monitoring system, were used for temporal Bayesian network learning, combined with bootstrapping methods for data analysis of small data samples. For comparison a temporal variant of augmented naive Bayes models and a temporal nodes Bayesian network (TNBN) were constructed. The performances of the methods were first tested with synthetic data. Subsequently, different COPD models were compared to each other using an external validation data set. RESULTS: The model learning methods are capable of finding good predictive models for our COPD data. Model averaging over models based on bootstrap replications is able to find a good balance between true and false positive rates on predicting COPD exacerbation events. Temporal naive Bayes offers an alternative that trades some performance for a reduction in computation time and easier interpretation.

An autonomous mobile system for the management of COPD.

INTRODUCTION: Managing chronic disease through automated systems has the potential to both benefit the patient and reduce health-care costs. We have developed and evaluated a disease management system for patients with chronic obstructive pulmonary disease (COPD). Its aim is to predict and detect exacerbations and, through this, help patients self-manage their disease to prevent hospitalisation. MATERIALS: The carefully crafted intelligent system consists of a mobile device that is able to collect case-specific, subjective and objective, physiological data, and to alert the patient by a patient-specific interpretation of the data by means of probabilistic reasoning. Collected data are also sent to a central server for inspection by health-care professionals. METHODS: We evaluated the probabilistic model using cross-validation and ROC analyses on data from an earlier study and by an independent data set. Furthermore a pilot with actual COPD patients has been conducted to test technical feasibility and to obtain user feedback. RESULTS: Model evaluation results show that we can reliably detect exacerbations. Pilot study results suggest that an intervention based on this system could be successful.

Visual Assistance in Development and Validation of Bayesian Networks for Clinical Decision Support.

The development and validation of Clinical Decision Support Models (CDSM) based on Bayesian networks (BN) is commonly done in a collaborative work between medical researchers providing the domain expertise and computer scientists developing the decision support model. Although modern tools provide facilities for data-driven model generation, domain experts are required to validate the accuracy of the learned model and to provide expert knowledge for fine-tuning it while computer scientists are needed to integrate this knowledge in the learned model (hybrid modeling approach). This generally time-expensive procedure hampers CDSM generation and updating. To address this problem, we developed a novel interactive visual approach allowing medical researchers with less knowledge in CDSM to develop and validate BNs based on domain specific data mainly independently and thus, diminishing the need for an additional computer scientist. In this context, we abstracted and simplified the common workflow in BN development as well as adjusted the workflow to medical experts' needs. We demonstrate our visual approach with data of endometrial cancer patients and evaluated it with six medical researchers who are domain experts in the gynecological field.

Improved preoperative risk stratification in endometrial carcinoma patients: external validation of the ENDORISK Bayesian network model in a large population-based case series.

PURPOSE: Preoperative risk stratification of newly diagnosed endometrial carcinoma (EC) patients has been hindered by only moderate prediction performance for many years. Recently ENDORISK, a Bayesian network model, showed high predictive performance. It was the aim of this study to validate ENDORISK by applying the model to a population-based case series of EC patients. METHODS: ENDORISK was applied to a retrospective cohort of women surgically treated for EC from 2003 to 2013. Prediction accuracy for LNM as well as 5-year DSS was investigated. The model's overall performance was quantified by the Brier score, discriminative performance by area under the curve (AUC). RESULTS: A complete dataset was evaluable from 247 patients. 78.1% cases were endometrioid histotype. The majority of patients (n = 156;63.2%) had stage IA disease. Overall, positive lymph nodes were found in 20 (8.1%) patients. Using ENDORISK predicted probabilities, most (n = 156;63.2%) patients have been assigned to low or very low risk group with a false-negative rate of 0.6%. AUC for LNM prediction was 0.851 [95% confidence interval (CI) 0.761-0.941] with a Brier score of 0.06. For 5-year DSS the AUC was 0.698 (95% CI 0.595-0.800) as Brier score has been calculated 0.09. CONCLUSIONS: We were able to successfully validate ENDORISK for prediction of LNM and 5-year DSS. Next steps will now have to focus on ENDORISK performance in daily clinical practice. In addition, incorporating TCGA-derived molecular subtypes will be of key importance for future extended use. This study may support further promoting of data-based decision-making tools for personalized treatment of EC.

External validation study of endometrial cancer preoperative risk stratification model (ENDORISK).

Introduction: Among industrialized countries, endometrial cancer is a common malignancy with generally an excellent outcome. To personalize medicine, we ideally compile as much information as possible concerning patient prognosis prior to effecting an appropriate treatment decision. Endometrial cancer preoperative risk stratification (ENDORISK) is a machine learning-based computational Bayesian networks model that predicts lymph node metastasis and 5-year disease-specific survival potential with percentual probability. Our objective included validating ENDORISK effectiveness in our patient cohort, assessing its application in the current use of sentinel node biopsy, and verifying its accuracy in advanced stages. Methods: The ENDORISK model was evaluated with a retrospective cohort of 425 patients from the University Hospital Brno, Czech Republic. Two hundred ninety-nine patients were involved in our disease-specific survival analysis; 226 cases with known lymph node status were available for lymph node metastasis analysis. Patients were included undergoing either pelvic lymph node dissection (N = 84) or sentinel node biopsy (N =70) to explore the accuracy of both staging procedures. Results: The area under the curve was 0.84 (95% confidence interval [CI], 0.77-0.9) for lymph node metastasis analysis and 0.86 (95% CI, 0.79-0.93) for 5-year disease-specific survival evaluation, indicating quite positive concordance between prediction and reality. Calibration plots to visualize results demonstrated an outstanding predictive value for low-risk cancers (grades 1-2), whereas outcomes were underestimated among high-risk patients (grade 3), especially in disease-specific survival. This phenomenon was even more obvious when patients were subclassified according to FIGO clinical stages. Conclusions: Our data confirmed ENDORISK model's laudable predictive ability, particularly among patients with a low risk of lymph node metastasis and expected favorable survival. For high-risk and/or advanced stages, the ENDORISK network needs to be additionally trained/improved.

Automated color detection in orchids using color labels and deep learning.

The color of particular parts of a flower is often employed as one of the features to differentiate between flower types. Thus, color is also used in flower-image classification. Color labels, such as 'green', 'red', and 'yellow', are used by taxonomists and lay people alike to describe the color of plants. Flower image datasets usually only consist of images and do not contain flower descriptions. In this research, we have built a flower-image dataset, especially regarding orchid species, which consists of human-friendly textual descriptions of features of specific flowers, on the one hand, and digital photographs indicating how a flower looks like, on the other hand. Using this dataset, a new automated color detection model was developed. It is the first research of its kind using color labels and deep learning for color detection in flower recognition. As deep learning often excels in pattern recognition in digital images, we applied transfer learning with various amounts of unfreezing of layers with five different neural network architectures (VGG16, Inception, Resnet50, Xception, Nasnet) to determine which architecture and which scheme of transfer learning performs best. In addition, various color scheme scenarios were tested, including the use of primary and secondary color together, and, in addition, the effectiveness of dealing with multi-class classification using multi-class, combined binary, and, finally, ensemble classifiers were studied. The best overall performance was achieved by the ensemble classifier. The results show that the proposed method can detect the color of flower and labellum very well without having to perform image segmentation. The result of this study can act as a foundation for the development of an image-based plant recognition system that is able to offer an explanation of a provided classification.

Using local context information to improve automatic mammographic mass detection.

Despite their promising application, current Computer-Aided Detection (CAD) systems face difficulties, especially in the detection of malignant masses -a major mammographic sign for breast cancer. One of the main problems is the large number of false positives prompted, which is a critical issue in screening programs where the number of normal cases is considerably large. A crucial determinant for this problem is the dependence of the CAD output on the single pixel-based locations initially detected. To refine the initial detection step, in this paper, we propose a novel approach by considering the context information between the neighbouring pixel features and classes for every initially detected suspicious location. Our modelling scheme is based on the Conditional Random Field technique and the mammographic features extracted by image processing techniques. In experimental study, we demonstrated the practical application of the approach and we compared its performance to that of a previously developed CAD system. The results demonstrated the superiority of the context modelling in terms of significantly improved accuracy without increase in computation efforts.

Improved mammographic CAD performance using multi-view information: a Bayesian network framework.

Mammographic reading by radiologists requires the comparison of at least two breast projections (views) for the detection and the diagnosis of breast abnormalities. Despite their reported potential to support radiologists, most mammographic computer-aided detection (CAD) systems have a major limitation: as opposed to the radiologist's practice, computerized systems analyze each view independently. To tackle this problem, in this paper, we propose a Bayesian network framework for multi-view mammographic analysis, with main focus on breast cancer detection at a patient level. We use causal-independence models and context modeling over the whole breast represented as links between the regions detected by a single-view CAD system in the two breast projections. The proposed approach is implemented and tested with screening mammograms for 1063 cases of whom 385 had breast cancer. The single-view CAD system is used as a benchmark method for comparison. The results show that our multi-view modeling leads to significantly better performance in discriminating between normal and cancerous patients. We also demonstrate the potential of our multi-view system for selecting the most suspicious cases.

A comparison between discrete and continuous time Bayesian networks in learning from clinical time series data with irregularity.

BACKGROUND: Recently, mobile devices, such as smartphones, have been introduced into healthcare research to substitute paper diaries as data-collection tools in the home environment. Such devices support collecting patient data at different time points over a long period, resulting in clinical time-series data with high temporal complexity, such as time irregularities. Analysis of such time series poses new challenges for machine-learning techniques. The clinical context for the research discussed in this paper is home monitoring in chronic obstructive pulmonary disease (COPD). OBJECTIVE: The goal of the present research is to find out which properties of temporal Bayesian network models allow to cope best with irregularly spaced multivariate clinical time-series data. METHODS: Two mainstream temporal Bayesian network models of multivariate clinical time series are studied: dynamic Bayesian networks, where the system is described as a snapshot at discrete time points, and continuous time Bayesian networks, where transitions between states are modeled in continuous time. Their capability of learning from clinical time series that vary in nature are extensively studied. In order to compare the two temporal Bayesian network types for regularly and irregularly spaced time-series data, three typical ways of observing time-series data were investigated: (1) regularly spaced in time with a fixed rate; (2) irregularly spaced and missing completely at random at discrete time points; (3) irregularly spaced and missing at random at discrete time points. In addition, similar experiments were carried out using real-world COPD patient data where observations are unevenly spaced. RESULTS: For regularly spaced time series, the dynamic Bayesian network models outperform the continuous time Bayesian networks. Similarly, if the data is missing completely at random, discrete-time models outperform continuous time models in most situations. For more realistic settings where data is not missing completely at random, the situation is more complicated. In simulation experiments, both models perform similarly if there is strong prior knowledge available about the missing data distribution. Otherwise, continuous time Bayesian networks perform better. In experiments with unevenly spaced real-world data, we surprisingly found that a dynamic Bayesian network where time is ignored performs similar to a continuous time Bayesian network. CONCLUSION: The results confirm conventional wisdom that discrete-time Bayesian networks are appropriate when learning from regularly spaced clinical time series. Similarly, we found that time series where the missingness occurs completely at random, dynamic Bayesian networks are an appropriate choice. However, for complex clinical time-series data that motivated this research, the continuous-time models are at least competitive and sometimes better than their discrete-time counterparts. Furthermore, continuous-time models provide additional benefits of being able to provide more fine-grained predictions than discrete-time models, which will be of practical relevance in clinical applications.

Predicting pathogens causing ventilator-associated pneumonia using a Bayesian network model.

BACKGROUND: We previously validated a Bayesian network (BN) model for diagnosing ventilator-associated pneumonia (VAP). Here, we report on the performance of the model to predict microbial causes of VAP and to select antibiotics. METHODS: Pathogens were grouped into seven categories based upon the antibiotic susceptibility and epidemiological characteristics. Colonization of the upper respiratory tract was modelled in the BN and depended--in additional steps--on (i) duration of admission and ventilation, (ii) previous culture results and (iii) previous antibiotic use. A database with 153 VAP episodes and their microbial causes was used as reference standard. Appropriateness of antibiotic prescription, with fixed choices for pathogens predicted, was determined. RESULTS: One hundred and seven VAP episodes were monobacterial and 46 were caused by two pathogens. Using duration of admission and ventilation only, areas under the receiver operating curve (AUC) ranged from 0.511 to 0.772 for different pathogen groups, and model predictions significantly improved when adding information on culture results, but not when adding information on antibiotic use. The best performing model (with all information) had AUC values ranging from 0.859 for Acinetobacter spp. to 0.929 for Streptococcus pneumoniae. With this model, 91 (85%) and 29 (63%) of all pathogen groups were correctly predicted for monobacterial and polymicrobial VAP, respectively. With fixed antibiotic choices linked to pathogen groups, 92% of all episodes would have been treated appropriately. CONCLUSIONS: The BN models' performance to predict pathogens causing VAP improved markedly with information on colonization, resulting in excellent pathogen prediction and antibiotic selection. Prospective external validation is needed.

Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients.

OBJECTIVE: Bacterial respiratory tract colonization predisposes critically ill patients to intensive care unit (ICU)-acquired infections. It is unclear to what extent systemic antibiotics affect colonization persistence. Persistence of respiratory tract colonization, and the effects of systemic antibiotics hereon, were determined in a cohort of ICU patients. DESIGN: Clinical and microbiological data were collected from 715 admitted mechanically ventilated ICU patients with bacterial growth documented in respiratory tract samples. First day of colonization, persistence of colonization and antibiotic effects hereon were analyzed for six groups of pathogens: Pseudomonas aeruginosa, Acinetobacter species, Enterobacteriaceae, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae. Systemic antibiotics were grouped into 'effective' and 'ineffective' antibiotics, based on in-vitro susceptibility data for the relevant bacteria. The effects of antibiotics were quantified as relative risk (RR) of bacterial persistence in the absence of effective antibiotics. MEASUREMENTS AND RESULTS: Persistence of colonization differed significantly between pathogens, ranging from 4 days (median) for H. influenzae and Strep. pneumoniae to 8 days for P. aeruginosa. Systemic antibiotics were administered on 7,102 (61%) of patient days. Antibiotic use was associated with non-persistence for all pathogens, except Acinetobacter species and P. aeruginosa. RR for non-persistence (as compared to ineffective or no antibiotics) ranged from 3.1 (95% CI 1.4-6.6) for H. influenzae to 0.5 (0.3-1.0) for Acinetobacter species. CONCLUSIONS: In mechanically ventilated patients, persistence dynamics of bacterial respiratory tract colonization, and the effects of (in-vitro) effective antibiotics hereon, are pathogen-specific.

Dynamic Bayesian networks as prognostic models for clinical patient management.

Prognostic models in medicine are usually been built using simple decision rules, proportional hazards models, or Markov models. Dynamic Bayesian networks (DBNs) offer an approach that allows for the incorporation of the causal and temporal nature of medical domain knowledge as elicited from domain experts, thereby allowing for detailed prognostic predictions. The aim of this paper is to describe the considerations that must be taken into account when constructing a DBN for complex medical domains and to demonstrate their usefulness in practice. To this end, we focus on the construction of a DBN for prognosis of carcinoid patients, compare performance with that of a proportional hazards model, and describe predictions for three individual patients. We show that the DBN can make detailed predictions, about not only patient survival, but also other variables of interest, such as disease progression, the effect of treatment, and the development of complications. Strengths and limitations of our approach are discussed and compared with those offered by traditional methods.

A Bayesian decision-support system for diagnosing ventilator-associated pneumonia.

OBJECTIVE: To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP). DESIGN: A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a prospectively studied cohort of 872 ICU patients, VAP was diagnosed by two infectious-disease specialists using a decision tree (reference diagnosis). After internal validation daily BDSS predictions were compared with the reference diagnosis. For data analysis two approaches were pursued: using BDSS predictions (a) for all 9422 patient days, and (b) only for the 238 days with presumed respiratory tract infections (RTI) according to the responsible physicians. MEASUREMENTS AND RESULTS: 157 (66%) of 238 days with presumed RTI fulfilled criteria for VAP. In approach (a), median daily BDSS likelihood predictions for days with and without VAP were 77% [Interquartile range (IQR) = 56-91%] and 14% [IQR 5-42%, p < 0.001, Mann-Whitney U-test (MWU)], respectively. In receiver operating characteristics (ROC) analysis, optimal BDSS cut-off point for VAP was 46%, and with this cut-off point positive predictive value (PPV) and negative predictive value (NPV) were 6.1 and 99.6%, respectively [AUC = 0.857 (95% CI 0.827-0.888)]. In approach (b), optimal cut-off for VAP was 78%, and with this cut-off point PPV and NPV were 86 and 66%, respectively [AUC = 0.846 (95% CI 0.794-0.899)]. CONCLUSIONS: As compared with the reference diagnosis, the BDSS had good test characteristics for diagnosing VAP, and might become a useful tool for assisting ICU physicians, both for routinely daily assessment and in patients clinically suspected of having VAP. Empirical validation of its performance is now warranted.

Selecting treatment strategies with dynamic limited-memory influence diagrams.

OBJECTIVE: The development of dynamic limited-memory influence diagrams as a framework for representing factorized infinite-horizon partially observable Markov decision processes (POMDPs), the introduction of algorithms for their (approximate) solution, and the application to a dynamic decision problem in clinical oncology. MATERIALS AND METHODS: A dynamic limited-memory influence diagram for high-grade carcinoid tumor pathophysiology was developed in collaboration with an expert physician. Three algorithms, known as single policy updating, single rule updating, and simulated annealing have been examined for approximating the optimal treatment strategy from a space of 10(19) possible strategies. RESULTS: Single policy updating proved intractable for finding a treatment strategy for carcinoid tumors. Single rule updating and simulated annealing both found the treatment strategy that is applied by physicians in practice. CONCLUSIONS: Dynamic limited-memory influence diagrams are a suitable framework for the representation of factorized infinite-horizon POMDPs, and the developed algorithms find acceptable solutions under the assumption of limited memory about past observations. The framework allows for finding reasonable treatment strategies for complex dynamic decision problems in medicine.

Predicting carcinoid heart disease with the noisy-threshold classifier.

OBJECTIVE: To predict the development of carcinoid heart disease (CHD), which is a life-threatening complication of certain neuroendocrine tumors. To this end, a novel type of Bayesian classifier, known as the noisy-threshold classifier, is applied. MATERIALS AND METHODS: Fifty-four cases of patients that suffered from a low-grade midgut carcinoid tumor, of which 22 patients developed CHD, were obtained from the Netherlands Cancer Institute (NKI). Eleven attributes that are known at admission have been used to classify whether the patient develops CHD. Classification accuracy and area under the receiver operating characteristics (ROC) curve of the noisy-threshold classifier are compared with those of the naive-Bayes classifier, logistic regression, the decision-tree learning algorithm C4.5, and a decision rule, as formulated by an expert physician. RESULTS: The noisy-threshold classifier showed the best classification accuracy of 72% correctly classified cases, although differences were significant only for logistic regression and C4.5. An area under the ROC curve of 0.66 was attained for the noisy-threshold classifier, and equaled that of the physician's decision-rule. CONCLUSIONS: The noisy-threshold classifier performed favorably to other state-of-the-art classification algorithms, and equally well as a decision-rule that was formulated by the physician. Furthermore, the semantics of the noisy-threshold classifier make it a useful machine learning technique in domains where multiple causes influence a common effect.

Exploiting Experts' Knowledge for Structure Learning of Bayesian Networks.

Learning Bayesian network structures from data is known to be hard, mainly because the number of candidate graphs is super-exponential in the number of variables. Furthermore, using observational data alone, the true causal graph is not discernible from other graphs that model the same set of conditional independencies. In this paper, it is investigated whether Bayesian network structure learning can be improved by exploiting the opinions of multiple domain experts regarding cause-effect relationships. In practice, experts have different individual probabilities of correctly labeling the inclusion or exclusion of edges in the structure. The accuracy of each expert is modeled by three parameters. Two new scoring functions are introduced that score each candidate graph based on the data and experts' opinions, taking into account their accuracy parameters. In the first scoring function, the experts' accuracies are estimated using an expectation-maximization-based algorithm and the estimated accuracies are explicitly used in the scoring process. The second function marginalizes out the accuracy parameters to obtain more robust scores when it is not possible to obtain a good estimate of experts' accuracies. The experimental results on simulated and real world datasets show that exploiting experts' knowledge can improve the structure learning if we take the experts' accuracies into account.

Smartphone-based analysis of biochemical tests for health monitoring support at home.

In the context of home-based healthcare monitoring systems, it is desirable that the results obtained from biochemical tests - tests of various body fluids such as blood and urine - are objective and automatically generated to reduce the number of man-made errors. The authors present the StripTest reader - an innovative smartphone-based interpreter of biochemical tests based on paper-based strip colour using image processing techniques. The working principles of the reader include image acquisition of the colour strip pads using the camera phone, analysing the images within the phone and comparing them with reference colours provided by the manufacturer to obtain the test result. The detection of kidney damage was used as a scenario to illustrate the application of, and test, the StripTest reader. An extensive evaluation using laboratory and human urine samples demonstrates the reader's accuracy and precision of detection, indicating the successful development of a cheap, mobile and smart reader for home-monitoring of kidney functioning, which can facilitate the early detection of health problems and a timely treatment intervention.