Modeling and integrating interactions involving the CYP450 enzyme system in a multi-terminology server: Contribution to information extraction from a clinical data warehouse.

INTRODUCTION: The cytochrome P450 (CYP450) enzyme system is involved in the metabolism of certain drugs and is responsible for most drug interactions. These interactions result in either an enzymatic inhibition or an enzymatic induction mechanism that has an impact on the therapeutic management of patients. Detecting these drug interactions will allow for better predictability in therapeutic response. Therefore, computerized solutions can represent a valuable help for clinicians in their tasks of detection. OBJECTIVE: The objective of this study is to provide a structured data-source of interactions involving the CYP450 enzyme system. These interactions are aimed to be integrated in the cross-lingual multi-terminology server HeTOP (Health Terminologies and Ontologies Portal), to support the query processing of the clinical data warehouse (CDW) EDSaN (Entrepôt de Données de Santé Normand). MATERIAL AND METHODS: A selection and curation of drug components (DCs) that share a relationship with the CYP450 system was performed from several international data sources. The DCs were linked according to the type of relationship which can be substrate, inhibitor, or inducer. These relationships were then integrated into the HeTOP server. To validate the CYP450 relationships, a semantic query was performed on the CDW, whose search engine is founded on HeTOP data (concepts, terms, and relations). RESULTS: A total of 776 DCs are associated by a new interaction relationship, integrated in HeTOP, by 14 enzymes. These are CYP450 1A2, 2A6, 2B6, 2C8, 2C9, 2C18, 2C19, 2D6, 2E1, 3A4, 3A7, 11B1,11B2 mitochondrial and P-glycoprotein, constituting a total of 2,088 relationships. A general modelling of cytochromic interactions was performed. From this model, 233,006 queries were processed in less than two hours, demonstrating the usefulness and performance of our CDW implementation. Moreover, they showed that in our university hospital, the concurrent prescription that could cause a cytochromic interaction is Bisoprolol with Amiodarone by enzymatic inhibition for 2,493 patients. DISCUSSION: The queries submitted to the CDW EDSaN allowed to highlight the most prescribed molecules simultaneously and potentially responsible for cytochromic interactions. In a second step, it would be interesting to evaluate the real clinical impact by looking for possible adverse effects of these interactions in the patients' files. Other computational solutions for cytochromic interactions exist. The impact of CYP450 is particularly important for drugs with narrow therapeutic window (NTW) as they can lead to increased toxicity or therapeutic failure. It is also important to define which drug component is a pro-drug and to considerate the many genetic polymorphisms of patients. CONCLUSION: The HeTOP server contains a non-negligible number of relationships between drug components and CYP450 from multiple reference sources. These data allow us to query our Clinical Data Warehouse to highlight these cytochromic interactions. It would be interesting in the future to assess the actual clinical impact in hospital reports.

Informatics for One Health.

OBJECTIVES: To introduce the 2023 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: The editorial provides an introduction and overview to the 2023 IMIA Yearbook where the special topic is "Informatics for One Health". The special topic, survey papers and some best papers are discussed. The section changes in the Yearbook editorial committee are also described. RESULTS: IMIA Yearbook 2023 provides many perspectives on a relatively new topic called "One Digital Health". The subject is vast, and includes the use of digital technologies to promote the well-being of people and animals, but also of the environment in which they evolve. Many sections produced new work in the topic including One Health and all sections included the latest themes in many specialties in medical informatics. CONCLUSIONS: The theme of "Informatics for One Health" is relatively new but the editors of the IMIA Yearbook have presented excellent and thought-provoking work for biomedical informatics in 2023.

Inclusive Digital Health.

OBJECTIVES: To introduce the 2022 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: The editorial provides an introduction and overview to the 2022 IMIA Yearbook whose special topic is "Inclusive Digital Health: Addressing Equity, Literacy, and Bias for Resilient Health Systems". The special topic, survey papers, section editor synopses and some best papers are discussed. The sections' changes in the Yearbook Editorial Committee are also described. RESULTS: As shown in the previous edition, health informatics in the context of a global pandemic has led to the development of ways to collect, standardize, disseminate and reuse data worldwide. The Corona Virus Disease 2019 (COVID-19) pandemic has demonstrated the need for timely, reliable, open, and globally available information to support decision making. It has also highlighted the need to address social inequities and disparities in access to care across communities. This edition of the Yearbook acknowledges the fact that much work has been done to study health equity in recent years in the various fields of health informatics research. CONCLUSION: There is a strong desire to better consider disparities between populations to avoid biases being induced in Artificial Intelligence algorithms in particular. Telemedicine and m-health must be more inclusive for people with disabilities or living in isolated geographical areas.

Tracing and analyzing COVID-19 dissemination using knowledge graphs.

The COVID-19 (SARS-CoV-2) spread around the globe could have been halted if we had had a better understanding of the situation and applied more restrictive measures for travel adapted to each country. This is due to a lack of efficient tools to visualize, analyze and control the virus dissemination. In the context of virus proliferation, analyzing flight connections between countries and COVID-19 data seems helpful to understand spatial and temporal information about the virus and its possible spread. To manage these complex, massive, and heterogeneous data, we propose a methodology based on knowledge graphs models. Several analyses and visualization tools can be applied, and our results show that these knowledge graph models may be a promising way to study the dissemination of any virus. These graphs can also be easily enriched with additional information that could be useful in the future to analyze or predict other interesting indicators.

Analyzing SARS-CoV-2 Sequence Patterns by Semantic Trajectories.

Since the beginning of the pandemic due to the SARS-CoV-2 emergence, several variants has been observed all over the world. One of the last known, Omicron, caused a large spread of the virus in few days, and several countries reached a record number of contaminations. Indeed, the mutation in the Spike region of the virus played an important role in altering its behavior. Therefore, it is important to understand the virus evolution by extracting and analyzing the virus structure of each variant. In this work we show how patterns sequence could be analyzed and extracted by means of semantic trajectories modeling. To do so, we designed a graph-based model in which the genome organization is handled using nodes and edges to represent respectively the nucleotides and sequence connection (point of interest and routes for trajectories). The modeling choices and pattern extraction from the graph allowed to retrieve a region where a mutation occurred in Omicron (NCBI version:OM011974.1).

OntoBioStat: Supporting Causal Diagram Design and Analysis.

Suitable causal inference in biostatistics can be best achieved by knowledge representation thanks to causal diagrams or directed acyclic graphs. However, necessary and sufficient causes are not easily represented. Since existing ontologies do not fill this gap, we designed OntoBioStat in order to enable covariate selection support based on causal relation representations. OntoBioStat automatic ontological causal diagram construction and inferences are detailed in this study. OntoBioStat inferences are allowed by Semantic Web Rule Language rules and axioms. First, statements made by the users include outcome, exposure, covariate, and causal relation specification. Then, reasoning enable automatic construction using generic instances of Meta_Variable and Necessary_Variable classes. Finally, inferred classes highlighted potential bias such as confounder-like. Ontological causal diagram built with OntoBioStat was compared to a standard causal diagram (without OntoBioStat) in a theoretical study. It was found that confounding and bias were not completely identified by the standard causal diagram, and erroneous covariate sets were provided. Further research is needed in order to make OntoBioStat more usable.

Assisting Data Retrieval with a Drug Knowledge Graph.

The Normandy health data warehouse EDSaN integrates the medication orders from the University Hospital of Rouen (France). This study aims at describing the design and the evaluation of an information retrieval system founded on a complex and semantically augmented knowledge graph dedicated to EDSaN drugs' prescriptions. The system is intended to help the selection of drugs in the search process by health professionals. The manual evaluation of the relevance of the returned drugs showed encouraging results as expected. A deeper analysis in order to improve the ranking method is needed and will be performed in a future work.

OntoRepliCov: an Ontology-Based Approach for Modeling the SARS-CoV-2 Replication Process.

Understanding the replication machinery of viruses contributes to suggest and try effective antiviral strategies. Exhaustive knowledge about the proteins structure, their function, or their interaction is one of the preconditions for successfully modeling it. In this context, modeling methods based on a formal representation with a high semantic expressiveness would be relevant to extract proteins and their nucleotide or amino acid sequences as an element from the replication process. Consequently, our approach relies on the use of semantic technologies to design the SARS-CoV-2 replication machinery. This provides the ability to infer new knowledge related to each step of the virus replication. More specifically, we developed an ontology-based approach enriched with reasoning process of a complete replication machinery process for SARS-CoV-2. We present in this paper a partial overview of our ontology OntoRepliCov to describe one step of this process, namely, the continuous translation or protein synthesis, through classes, properties, axioms, and SWRL (Semantic Web Rule Language) rules.

Health Data, Information, and Knowledge Sharing for Addressing the COVID-19.

OBJECTIVES: To introduce the 2021 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: The editorial provides an introduction and overview to the 2021 IMIA Yearbook whose special topic is "Managing Pandemics with Health Informatics - Successes and Challenges". The Special Topic, the keynote paper, and survey papers are discussed. The IMIA President's statement and the IMIA dialogue with the World Health Organization are introduced. The sections' changes in the Yearbook Editorial Committee are also described. RESULTS: Health informatics, in the context of a global pandemic, led to the development of ways to collect, standardize, disseminate and reuse data worldwide: public health data but also information from social networks and scientific literature. Fact checking methods were mostly based on artificial intelligence and natural language processing. The pandemic also introduced new challenges for telehealth support in times of critical response. Next generation sequencing in bioinformatics helped in decoding the sequence of the virus and the development of messenger ribonucleic acid (mRNA) vaccines. CONCLUSIONS: The Corona Virus Disease 2019 (COVID-19) pandemic shows the need for timely, reliable, open, and globally available information to support decision making and efficiently control outbreaks. Applying Findable, Accessible, Interoperable, and Reusable (FAIR) requirements for data is a key success factor while challenging ethical issues have to be considered.

Patient and Graph Embeddings for Predictive Diagnosis of Drug Iatrogenesis.

In the context of the IA.TROMED project we intend to develop and evaluate original algorithmic methods that will rely on semantic enrichment of embeddings by combining new deep learning algorithms, such as models founded on transformers, and symbolic artificial intelligence. The documents' embeddings, the graphs' embeddings of biomedical concepts, and patients' embeddings, all of them semantically enriched with aligned formal ontologies and semantic networks, will constitute a layer that will play the role of a queryable and searchable knowledge base that will supply the IA.TROMED's clinical, predictive, and iatrogenic diagnosis support module.

Ontological Models Supporting Covariates Selection in Observational Studies.

In the context of causal inference, biostatisticians use causal diagrams to select covariates in order to build multivariate models. These diagrams represent datasets variables and their relations but have some limitations (representing interactions, bidirectional causal relations). The MetBrAYN project aims at building an ontological-based process to tackle these issues. The knowledge acquired by the biostatistician during a methodological consultation for a research question will be represented in a general ontology. In order to aggregate various forms of knowledge the ontology will act as a wrapper. Ontology-based causal diagrams will be semi-automatically built. Founded on inference rules, the global system will help biostatisticians to curate it and to visualize recommended covariates for their research question.

Transparency of Health Informatics Processes as the Condition of Healthcare Professionals' and Patients' Trust and Adoption: the Rise of Ethical Requirements.

OBJECTIVES: To provide an introduction to the 2020 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: This editorial provides an introduction and overview to the 2020 IMIA Yearbook which special topic is: "Ethics in Health Informatics". The keynote paper, the survey paper of the Special Topic section, and the paper about Donald Lindberg's ethical scientific openness in the History of Medical Informatics chapter of the Yearbook are discussed. Changes in the Yearbook Editorial Committee are also described. RESULTS: Inspired by medical ethics, ethics in health informatics progresses with the advances in biomedical informatics. With the wide use of EHRs, the enlargement of the care team perimeter, the need for data sharing for care continuity, the reuse of data for the sake of research, and the implementation of AI-powered decision support tools, new ethics requirements are necessary to address issues such as threats on privacy, confidentiality breaches, poor security practices, lack of patient information, tension on data sharing and reuse policies, need for more transparency on apps effectiveness, biased algorithms with discriminatory outcomes, guarantee on trustworthy AI, concerns on the re-identification of de-identified data. CONCLUSIONS: Despite privacy rules rooted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the USA and even more restrictive new regulations such as the EU General Data Protection Regulation published in May 2018, some people do not believe their data will be kept confidential and may not share sensitive information with a provider, which may also induce unethical situations. Transparency on healthcare data processes is a condition of healthcare professionals' and patients' trust and their adoption of digital tools.

Building a Semantic Health Data Warehouse in the Context of Clinical Trials: Development and Usability Study.

BACKGROUND: The huge amount of clinical, administrative, and demographic data recorded and maintained by hospitals can be consistently aggregated into health data warehouses with a uniform data model. In 2017, Rouen University Hospital (RUH) initiated the design of a semantic health data warehouse enabling both semantic description and retrieval of health information. OBJECTIVE: This study aimed to present a proof of concept of this semantic health data warehouse, based on the data of 250,000 patients from RUH, and to assess its ability to assist health professionals in prescreening eligible patients in a clinical trials context. METHODS: The semantic health data warehouse relies on 3 distinct semantic layers: (1) a terminology and ontology portal, (2) a semantic annotator, and (3) a semantic search engine and NoSQL (not only structured query language) layer to enhance data access performances. The system adopts an entity-centered vision that provides generic search capabilities able to express data requirements in terms of the whole set of interconnected conceptual entities that compose health information. RESULTS: We assessed the ability of the system to assist the search for 95 inclusion and exclusion criteria originating from 5 randomly chosen clinical trials from RUH. The system succeeded in fully automating 39% (29/74) of the criteria and was efficiently used as a prescreening tool for 73% (54/74) of them. Furthermore, the targeted sources of information and the search engine-related or data-related limitations that could explain the results for each criterion were also observed. CONCLUSIONS: The entity-centered vision contrasts with the usual patient-centered vision adopted by existing systems. It enables more genericity in the information retrieval process. It also allows to fully exploit the semantic description of health information. Despite their semantic annotation, searching within clinical narratives remained the major challenge of the system. A finer annotation of the clinical texts and the addition of specific functionalities would significantly improve the results. The semantic aspect of the system combined with its generic entity-centered vision enables the processing of a large range of clinical questions. However, an important part of health information remains in clinical narratives, and we are currently investigating novel approaches (deep learning) to enhance the semantic annotation of those unstructured data.

The MeSH-Gram Neural Network Model: Extending Word Embedding Vectors with MeSH Concepts for Semantic Similarity.

Eliciting semantic similarity between concepts remains a challenging task. Recent approaches founded on embedding vectors have gained in popularity as they have risen to efficiently capture semantic relationships. The underlying idea is that two words that have close meaning gather similar contexts. In this study, we propose a new neural network model, named MeSH-gram, which relies on a straightforward approach that extends the skip-gram neural network model by considering MeSH (Medical Subject Headings) descriptors instead of words. Trained on publicly available PubMed/MEDLINE corpus, MeSH-gram is evaluated on reference standards manually annotated for semantic similarity. MeSH-gram is first compared to skip-gram with vectors of size 300 and at several windows' contexts. A deeper comparison is performed with twenty existing models. All the obtained results with Spearman's rank correlations between human scores and computed similarities show that MeSH-gram (i) outperforms the skip-gram model and (ii) is comparable to the best methods that need more computation and external resources.

Artificial Intelligence in Health Informatics: Hype or Reality?

OBJECTIVES: To provide an introduction to the 2019 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: This editorial presents an overview and introduction to the 2019 IMIA Yearbook which includes the special topic "Artificial Intelligence in Health: New Opportunities, Challenges, and Practical Implications". The special topic is discussed, the IMIA President's statement is introduced, and changes in the Yearbook editorial team are described. RESULTS: Artificial intelligence (AI) in Medicine arose in the 1970's from new approaches for representing expert knowledge with computers. Since then, AI in medicine has gradually evolved toward essentially data-driven approaches with great results in image analysis. However, data integration, storage, and management still present clear challenges among which the lack of explanability of the results produced by data-driven AI methods. CONCLUSION: With more health data availability, and the recent developments of efficient and improved machine learning algorithms, there is a renewed interest for AI in medicine.The objective is to help health professionals improve patient care while also reduce costs. However, the other costs of AI, including ethical issues when processing personal health data by algorithms, should be included.

Cimind: A phonetic-based tool for multilingual named entity recognition in biomedical texts.

BACKGROUND: Extracting concepts from biomedical texts is a key to support many advanced applications such as biomedical information retrieval. However, in clinical notes Named Entity Recognition (NER) has to deal with various types of errors such as spelling errors, grammatical errors, truncated sentences, and non-standard abbreviations. Moreover, in numerous countries, NER is challenged by the availability of many resources originally developed and only suitable for English texts. This paper presents the Cimind system, a multilingual system dedicated to named entity recognition in medical texts based on a phonetic similarity measure. METHODS: Cimind performs entity recognition by combining phonetic recognition using the DM phonetic algorithm to deal with spelling errors and string similarity measures. Three main steps are processed to identify terms in a controlled vocabulary: normalization, candidate selection by phonetic similarity and candidate ranking. RESULTS: Cimind was evaluated in the 2016 and 2017 editions of the CLEF eHealth challenge in the CépiDC/CDC tasks. In 2017, it obtained on each corpus the following results: English dataset: 83.9% P, 78.3% R, 81.0% F1; French raw dataset: 85.7% P, 68.9% R, 76.4% F1; French aligned dataset: 83.5% P, 77.5% R, 80.4% F1. It ranked first in French and fourth in English in officials runs.

A 21st Century Embarrassment of Riches: The Balance Between Health Data Access, Usage, and Sharing.

OBJECTIVES: To provide an introduction to the 2018 International Medical Informatics Association (IMIA) Yearbook by the editors. METHODS: This editorial provides an overview and introduction to the 2018 IMIA Yearbook which special topic is: "Between access and privacy: Challenges in sharing health data". The special topic editors and section are discussed, and the new section of the 2018 Yearbook, Cancer Informatics, is introduced. Changes in the Yearbook editorial team are also described. RESULTS: With the exponential burgeoning of health-related data, and attendant demands for sharing and using these data, the special topic for 2018 is noteworthy for its timeliness. Data sharing brings responsibility for preservation of data privacy, and for this, patient perspectives are of paramount importance in understanding how patients view their health data and how their privacy should be protected. CONCLUSION: With the increase in availability of health-related data from many different sources and contexts, there is an urgent need for informaticians to become aware of their role in maintaining the balance between data sharing and privacy.

Evaluation of the Terminology Coverage in the French Corpus LiSSa.

Extracting concepts from medical texts is a key to support many advanced applications in medical information retrieval. Entity recognition in French texts is moreover challenged by the availability of many resources originally developed for English texts. This paper proposes an evaluation of the terminology coverage in a corpus of 50,000 French articles extracted from the bibliographic database LiSSa. This corpus was automatically indexed with 32 health terminologies, published in French or translated. Then, the terminologies providing the best coverage of these documents were determined. The results show that major resources such as the NCI and SNOMED CT thesauri achieve the largest annotation of the corpus while specific French resources prove to be valuable assets.

An approach to compare bio-ontologies portals.

BACKGROUND: main biomedical information retrieval systems are based on controlled vocabularies and most specifically on terminologies or ontologies (T/O). These classification structures allow indexing, coding, annotating different kind of documents. Many T/O have been created for different purposes and it became a problem for finding specific concepts in the multitude of existing nomenclatures. The NCBO (National Center for Biomedical Ontologies) BioPortal and the CISMeF (Catalogue et Index des Sites Médicaux de langue Française) HeTOP projects have been developed to tackle this issue. OBJECTIVE: the present work consists in comparing both portals. METHODS: we hereby are proposing a set of criteria to compare bio-ontologies portals in terms of goals, features, technologies and usability. RESULTS: BioPortal and HeTOP have been compared based on the given criteria. While both portals are designed to store and make T/O available to the community and are sharing many basic features, they differ on several points mainly because of their basic purposes. CONCLUSION: thanks to the comparison criteria, we can assume that a merge between BioPortal and HeTOP is possible in terms of functionalities. The main difficulties will be about merging the data repositories and applying different policies on T/O content.