Integration of modeling and simulation into hospital-based decision support systems guiding pediatric pharmacotherapy

<p>Abstract</p> <p>Background</p> <p>Decision analysis in hospital-based settings is becoming more common place. The application of modeling and simulation approaches has likewise become more prevalent in order to support decision analytics. With respect to clinical decision making at the level of the patient, modeling and simulation approaches have been used to study and forecast treatment options, examine and rate caregiver performance and assign resources (staffing, beds, patient throughput). There us a great need to facilitate pharmacotherapeutic decision making in pediatrics given the often limited data available to guide dosing and manage patient response. We have employed nonlinear mixed effect models and Bayesian forecasting algorithms coupled with data summary and visualization tools to create drug-specific decision support systems that utilize individualized patient data from our electronic medical records systems.</p> <p>Methods</p> <p>Pharmacokinetic and pharmacodynamic nonlinear mixed-effect models of specific drugs are generated based on historical data in relevant pediatric populations or from adults when no pediatric data is available. These models are re-executed with individual patient data allowing for patient-specific guidance via a Bayesian forecasting approach. The models are called and executed in an interactive manner through our web-based dashboard environment which interfaces to the hospital's electronic medical records system.</p> <p>Results</p> <p>The methotrexate dashboard utilizes a two-compartment, population-based, PK mixed-effect model to project patient response to specific dosing events. Projected plasma concentrations are viewable against protocol-specific nomograms to provide dosing guidance for potential rescue therapy with leucovorin. These data are also viewable against common biomarkers used to assess patient safety (e.g., vital signs and plasma creatinine levels). As additional data become available via therapeutic drug monitoring, the model is re-executed and projections are revised.</p> <p>Conclusion</p> <p>The management of pediatric pharmacotherapy can be greatly enhanced via the immediate feedback provided by decision analytics which incorporate the current, best-available knowledge pertaining to dose-exposure and exposure-response relationships, especially for narrow therapeutic agents that are difficult to manage.</p

CBR and MBR techniques: review for an application in the emergencies domain

The purpose of this document is to provide an in-depth analysis of current reasoning engine practice and the integration strategies of Case Based Reasoning and Model Based Reasoning that will be used in the design and development of the RIMSAT system. RIMSAT (Remote Intelligent Management Support and Training) is a European Commission funded project designed to: a.. Provide an innovative, 'intelligent', knowledge based solution aimed at improving the quality of critical decisions b.. Enhance the competencies and responsiveness of individuals and organisations involved in highly complex, safety critical incidents - irrespective of their location. In other words, RIMSAT aims to design and implement a decision support system that using Case Base Reasoning as well as Model Base Reasoning technology is applied in the management of emergency situations. This document is part of a deliverable for RIMSAT project, and although it has been done in close contact with the requirements of the project, it provides an overview wide enough for providing a state of the art in integration strategies between CBR and MBR technologies.Postprint (published version

Agile AI development for Real World Solutions

This keynote will analyse the importance of IoT, Blockchain and Edge Computing as contributors to the development of distributed intelligent systems that have the capacity to interact with the environment "Smart" infrastructures need to incorporate all added-value resources so they can offer useful services to the society, while reducing costs, ensuring reliability and improving the quality of life of the citizens. The combination of AI, IoT and Blockchain in an Edge Computing model or elsewhere, offers a world of possibilities and opportunities

Knowledge Management approaches to model pathophysiological mechanisms and discover drug targets in Multiple Sclerosis

Multiple Sclerosis (MS) is one of the most prevalent neurodegenerative diseases for which a cure is not yet available. MS is a complex disease for numerous reasons; its etiology is unknown, the diagnosis is not exclusive, the disease course is unpredictable and therapeutic response varies from patient to patient. There are four established subtypes of MS, which are segregated based on different characteristics. Many environmental and genetic factors are considered to play a role in MS etiology, including viral infection, vitamin D deficiency, epigenetical changes and some genes. Despite the large body of diverse scientific knowledge, from laboratory findings to clinical trials, no integrated model which portrays the underlying mechanisms of the disease state of MS is available. Contemporary therapies only provide reduction in the severity of the disease, and there is an unmet need of efficient drugs. The present thesis provides a knowledge-based rationale to model MS disease mechanisms and identify potential drug candidates by using systems biology approaches. Systems biology is an emerging field which utilizes the computational methods to integrate datasets of various granularities and simulate the disease outcome. It provides a framework to model molecular dynamics with their precise interaction and contextual details. The proposed approaches were used to extract knowledge from literature by state of the art text mining technologies, integrate it with proprietary data using semantic platforms, and build different models (molecular interactions map, agent based models to simulate disease outcome, and MS disease progression model with respect to time). For better information representation, disease ontology was also developed and a methodology of automatic enrichment was derived. The models provide an insight into the disease, and several pathways were explored by combining the therapeutics and the disease-specific prescriptions. The approaches and models developed in this work resulted in the identification of novel drug candidates that are backed up by existing experimental and clinical knowledge