Agent-based management of clinical guidelines

Les guies de pràctica clínica (GPC) contenen un conjunt d'accions i dades que ajuden a un metge a prendre decisions sobre el diagnòstic, tractament o qualsevol altre procediment a un pacient i sobre una determinada malaltia. És conegut que l'adopció d'aquestes guies en la vida diària pot millorar l'assistència mèdica als pacients, pel fet que s'estandarditzen les pràctiques. Sistemes computeritzats que utilitzen GPC poden constituir part de sistemes d'ajut a la presa de decisions més complexos amb la finalitat de proporcionar el coneixement adequat a la persona adequada, en un format correcte i en el moment precís. L'automatització de l'execució de les GPC és el primer pas per la seva implantació en els centres mèdics.Per aconseguir aquesta implantació final, hi ha diferents passos que cal solucionar com per exemple, l'adquisició i representació de les GPC, la seva verificació formal, i finalment la seva execució. Aquesta Tesi està dirigida en l'execució de GPC i proposa la implementació d'un sistema multi-agent. En aquest sistema els diferents actors dels centres mèdics coordinen les seves activitats seguint un pla global determinat per una GPC. Un dels principals problemes de qualsevol sistema que treballa en l'àmbit mèdic és el tractament del coneixement. En aquest cas s'han hagut de tractar termes mèdics i organitzatius, que s'ha resolt amb la implementació de diferents ontologies. La separació de la representació del coneixement del seu ús és intencionada i permet que el sistema d'execució de GPC sigui fàcilment adaptable a les circumstàncies concretes dels centres, on varien el personal i els recursos disponibles.En paral·lel a l'execució de GPC, el sistema proposat manega preferències del pacient per tal d'implementar serveis adaptats al pacient. En aquesta àrea concretament, a) s'han definit un conjunt de criteris, b) aquesta informació forma part del perfil de l'usuari i serveix per ordenar les propostes que el sistema li proposa, i c) un algoritme no supervisat d'aprenentatge permet adaptar les preferències del pacient segons triï.Finalment, algunes idees d'aquesta Tesi actualment s'estan aplicant en dos projectes de recerca. Per una banda, l'execució distribuïda de GPC, i per altra banda, la representació del coneixement mèdic i organitzatiu utilitzant ontologies.Clinical guidelines (CGs) contain a set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. It is widely accepted that the adoption of guideline-execution engines in daily practice would improve the patient care, by standardising the care procedures. Guideline-based systems can constitute part of a knowledge-based decision support system in order to deliver the right knowledge to the right people in the right form at the right time. The automation of the guideline execution process is a basic step towards its widespread use in medical centres.To achieve this general goal, different topics should be tackled, such as the acquisition of clinical guidelines, its formal verification, and finally its execution. This dissertation focuses on the execution of CGs and proposes the implementation of an agent-based platform in which the actors involved in health care coordinate their activities to perform the complex task of guideline enactment. The management of medical and organizational knowledge, and the formal representation of the CGs, are two knowledge-related topics addressed in this dissertation and tackled through the design of several application ontologies. The separation of the knowledge from its use is fully intentioned, and allows the CG execution engine to be easily customisable to different medical centres with varying personnel and resources.In parallel with the execution of CGs, the system handles citizen's preferences and uses them to implement patient-centred services. With respect this issue, the following tasks have been developed: a) definition of the user's criteria, b) use of the patient's profile to rank the alternatives presented to him, c) implementation of an unsupervised learning method to adapt dynamically and automatically the user's profile.Finally, several ideas of this dissertation are being directly applied in two ongoing funded research projects, including the agent-based execution of CGs and the ontological management of medical and organizational knowledge

An ontological framework for the formal representation and management of human stress knowledge

There is a great deal of information on the topic of human stress which is embedded within numerous papers across various databases. However, this information is stored, retrieved, and used often discretely and dispersedly. As a result, discovery and identification of the links and interrelatedness between different aspects of knowledge on stress is difficult. This restricts the effective search and retrieval of desired information. There is a need to organize this knowledge under a unifying framework, linking and analysing it in mutual combinations so that we can obtain an inclusive view of the related phenomena and new knowledge can emerge. Furthermore, there is a need to establish evidence-based and evolving relationships between the ontology concepts.Previous efforts to classify and organize stress-related phenomena have not been sufficiently inclusive and none of them has considered the use of ontology as an effective facilitating tool for the abovementioned issues.There have also been some research works on the evolution and refinement of ontology concepts and relationships. However, these fail to provide any proposals for an automatic and systematic methodology with the capacity to establish evidence-based/evolving ontology relationships.In response to these needs, we have developed the Human Stress Ontology (HSO), a formal framework which specifies, organizes, and represents the domain knowledge of human stress. This machine-readable knowledge model is likely to help researchers and clinicians find theoretical relationships between different concepts, resulting in a better understanding of the human stress domain and its related areas. The HSO is formalized using OWL language and Protégé tool.With respect to the evolution and evidentiality of ontology relationships in the HSO and other scientific ontologies, we have proposed the Evidence-Based Evolving Ontology (EBEO), a methodology for the refinement and evolution of ontology relationships based on the evidence gleaned from scientific literature. The EBEO is based on the implementation of a Fuzzy Inference System (FIS).Our evaluation results showed that almost all stress-related concepts of the sample articles can be placed under one or more category of the HSO. Nevertheless, there were a number of limitations in this work which need to be addressed in future undertakings.The developed ontology has the potential to be used for different data integration and interoperation purposes in the domain of human stress. It can also be regarded as a foundation for the future development of semantic search engines in the stress domain

Similarity Reasoning over Semantic Context-Graphs

Similarity is a central cognitive mechanism for humans which enables a broad range of perceptual and abstraction processes, including recognizing and categorizing objects, drawing parallelism, and predicting outcomes. It has been studied computationally through models designed to replicate human judgment. The work presented in this dissertation leverages general purpose semantic networks to derive similarity measures in a problem-independent manner. We model both general and relational similarity using connectivity between concepts within semantic networks. Our first contribution is to model general similarity using concept connectivity, which we use to partition vocabularies into topics without the need of document corpora. We apply this model to derive topics from unstructured dialog, specifically enabling an early literacy primer application to support parents in having better conversations with their young children, as they are using the primer together. Second, we model relational similarity in proportional analogies. To do so, we derive relational parallelism by searching in semantic networks for similar path pairs that connect either side of this analogy statement. We then derive human readable explanations from the resulting similar path pair. We show that our model can answer broad-vocabulary analogy questions designed for human test takers with high confidence. The third contribution is to enable symbolic plan repair in robot planning through object substitution. When a failure occurs due to unforeseen changes in the environment, such as missing objects, we enable the planning domain to be extended with a number of alternative objects such that the plan can be repaired and execution to continue. To evaluate this type of similarity, we use both general and relational similarity. We demonstrate that the task context is essential in establishing which objects are interchangeable

Enhancing the interactivity of a clinical decision support system by using knowledge engineering and natural language processing

Mental illness is a serious health problem and it affects many people. Increasingly,Clinical Decision Support Systems (CDSS) are being used for diagnosis and it is important to improve the reliability and performance of these systems. Missing a potential clue or a wrong diagnosis can have a detrimental effect on the patient's quality of life and could lead to a fatal outcome. The context of this research is the Galatean Risk and Safety Tool (GRiST), a mental-health-risk assessment system. Previous research has shown that success of a CDSS depends on its ease of use, reliability and interactivity. This research addresses these concerns for the GRiST by deploying data mining techniques. Clinical narratives and numerical data have both been analysed for this purpose.Clinical narratives have been processed by natural language processing (NLP)technology to extract knowledge from them. SNOMED-CT was used as a reference ontology and the performance of the different extraction algorithms have been compared. A new Ensemble Concept Mining (ECM) method has been proposed, which may eliminate the need for domain specific phrase annotation requirements. Word embedding has been used to filter phrases semantically and to build a semantic representation of each of the GRiST ontology nodes.The Chi-square and FP-growth methods have been used to find relationships between GRiST ontology nodes. Interesting patterns have been found that could be used to provide real-time feedback to clinicians. Information gain has been used efficaciously to explain the differences between the clinicians and the consensus risk. A new risk management strategy has been explored by analysing repeat assessments. A few novel methods have been proposed to perform automatic background analysis of the patient data and improve the interactivity and reliability of GRiST and similar systems

Gaining Insight into Determinants of Physical Activity using Bayesian Network Learning

Contains fulltext : 228326pre.pdf (preprint version ) (Open Access) Contains fulltext : 228326pub.pdf (publisher's version ) (Open Access)BNAIC/BeneLearn 202

Gesture and Speech in Interaction - 4th edition (GESPIN 4)

International audienceThe fourth edition of Gesture and Speech in Interaction (GESPIN) was held in Nantes, France. With more than 40 papers, these proceedings show just what a flourishing field of enquiry gesture studies continues to be. The keynote speeches of the conference addressed three different aspects of multimodal interaction:gesture and grammar, gesture acquisition, and gesture and social interaction. In a talk entitled Qualitiesof event construal in speech and gesture: Aspect and tense, Alan Cienki presented an ongoing researchproject on narratives in French, German and Russian, a project that focuses especially on the verbal andgestural expression of grammatical tense and aspect in narratives in the three languages. Jean-MarcColletta's talk, entitled Gesture and Language Development: towards a unified theoretical framework,described the joint acquisition and development of speech and early conventional and representationalgestures. In Grammar, deixis, and multimodality between code-manifestation and code-integration or whyKendon's Continuum should be transformed into a gestural circle, Ellen Fricke proposed a revisitedgrammar of noun phrases that integrates gestures as part of the semiotic and typological codes of individuallanguages. From a pragmatic and cognitive perspective, Judith Holler explored the use ofgaze and hand gestures as means of organizing turns at talk as well as establishing common ground in apresentation entitled On the pragmatics of multi-modal face-to-face communication: Gesture, speech andgaze in the coordination of mental states and social interaction.Among the talks and posters presented at the conference, the vast majority of topics related, quitenaturally, to gesture and speech in interaction - understood both in terms of mapping of units in differentsemiotic modes and of the use of gesture and speech in social interaction. Several presentations explored the effects of impairments(such as diseases or the natural ageing process) on gesture and speech. The communicative relevance ofgesture and speech and audience-design in natural interactions, as well as in more controlled settings liketelevision debates and reports, was another topic addressed during the conference. Some participantsalso presented research on first and second language learning, while others discussed the relationshipbetween gesture and intonation. While most participants presented research on gesture and speech froman observer's perspective, be it in semiotics or pragmatics, some nevertheless focused on another importantaspect: the cognitive processes involved in language production and perception. Last but not least,participants also presented talks and posters on the computational analysis of gestures, whether involvingexternal devices (e.g. mocap, kinect) or concerning the use of specially-designed computer software forthe post-treatment of gestural data. Importantly, new links were made between semiotics and mocap data

Cognitive Maps

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Reinforcement Learning

Brains rule the world, and brain-like computation is increasingly used in computers and electronic devices. Brain-like computation is about processing and interpreting data or directly putting forward and performing actions. Learning is a very important aspect. This book is on reinforcement learning which involves performing actions to achieve a goal. The first 11 chapters of this book describe and extend the scope of reinforcement learning. The remaining 11 chapters show that there is already wide usage in numerous fields. Reinforcement learning can tackle control tasks that are too complex for traditional, hand-designed, non-learning controllers. As learning computers can deal with technical complexities, the tasks of human operators remain to specify goals on increasingly higher levels. This book shows that reinforcement learning is a very dynamic area in terms of theory and applications and it shall stimulate and encourage new research in this field