Applying clustering based on rules on WHO-DAS II for knowledge discovery on functional disabilities

The senior citizens represent a fast growing proportion of the population in Europe and other developed areas. This increases the proportion of persons with disability and reducing quality of life. The concept of disability itself is not always precise and quantifiable. To improve agreement on the concept of disability, the World Health Organization (WHO) developed a clinical test WHO Disability Assessment Schedule, (WHO-DASII) that is understood to include physical, mental, and social well-being, as a generic measure of functioning. From the medical point of view, the purpose of this work is to extract knowledge on the performance of the test WHO-DASII on the basis of a sample of neurological patients from an Italian hospital. This Knowledge Discovery problem has been faced by using clustering based on rules, a technique stablished on 1994 by Gibert which combines some Inductive Learning (from AI) methods with Statistics to extract knowledge on ill-structured domains (that is complex domains where consensus is not achieved, like is the case). So, in this paper, the results of applying this technique to the WHO-DASII results is presented.Postprint (published version

Determinación de factores influyentes sobre una respuesta en un dominio poco estructurado

This report focuses on results obtained from a classification technique applied to time series data in a medical ill-structured The statistical analysis and classification --in ill-structured-- of such data are often inadequate because of the intrinsic characteristics of those domains. The database in this analysis contains information relative to patients with major depressive disorders or esquizofrenia; as a consequence, a high quantity of database variables contain data corresponding to measures taken in different instant of time, making curves. For this reason we are motivated about how we can establish a useful classification technique of curves in a medical ill-structured domain.Postprint (published version

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support

<p>Abstract</p> <p>Background</p> <p>Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved.</p> <p>Method</p> <p>This paper introduces a new hybrid methodology <it>Expert-based Cooperative Analysis </it>(EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by <it>EbCA-Data Envelopment Analysis (EbCA-DEA)</it>, and 2) Case-mix of schizophrenia based on functional dependency using <it>Clustering Based on Rules (ClBR)</it>. In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases.</p> <p>Results</p> <p>EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here <it>Implicit Knowledg </it>-IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases.</p> <p>Discussion</p> <p>This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research.</p

Supporting the design of sequences of cumulative activities impacting on multiple areas through a data mining approach : application to design of cognitive rehabilitation programs for traumatic brain injury patients

Traumatic brain injury (TBI) is a leading cause of disability worldwide. It is the most common cause of death and disability during the first three decades of life and accounts for more productive years of life lost than cancer, cardiovascular disease and HIV/AIDS combined. Cognitive Rehabilitation (CR), as part of Neurorehabilitation, aims to reduce the cognitive deficits caused by TBI. CR treatment consists of sequentially organized tasks that require repetitive use of impaired cognitive functions. While task repetition is not the only important feature, it is becoming clear that neuroplastic change and functional improvement only occur after a number of specific tasks are performed in a certain order and repetitions and does not occur otherwise. Until now, there has been an important lack of well-established criteria and on-field experience by which to identify the right number and order of tasks to propose to each individual patient. This thesis proposes the CMIS methodology to support health professionals to compose CR programs by selecting the most promising tasks in the right order. Two contributions to this topic were developed for specific steps of CMIS through innovative data mining techniques SAIMAP and NRRMR methodologies. SAIMAP (Sequence of Activities Improving Multi-Area Performance) proposes an innovative combination of data mining techniques in a hybrid generic methodological framework to find sequential patterns of a predefined set of activities and to associate them with multi-criteria improvement indicators regarding a predefined set of areas targeted by the activities. It combines data and prior knowledge with preprocessing, clustering, motif discovery and classes` post-processing to understand the effects of a sequence of activities on targeted areas, provided that these activities have high interactions and cumulative effects. Furthermore, this work introduces and defines the Neurorehabilitation Range (NRR) concept to determine the degree of performance expected for a CR task and the number of repetitions required to produce maximum rehabilitation effects on the individual. An operationalization of NRR is proposed by means of a visualization tool called SAP. SAP (Sectorized and Annotated Plane) is introduced to identify areas where there is a high probability of a target event occurring. Three approaches to SAP are defined, implemented, applied, and validated to a real case: Vis-SAP, DT-SAP and FT-SAP. Finally, the NRRMR (Neurorehabilitation Range Maximal Regions) problem is introduced as a generalization of the Maximal Empty Rectangle problem (MER) to identify maximal NRR over a FT-SAP. These contributions combined together in the CMIS methodology permit to identify a convenient pattern for a CR program (by means of a regular expression) and to instantiate by a real sequence of tasks in NRR by maximizing expected improvement of patients, thus provide support for the creation of CR plans. First of all, SAIMAP provides the general structure of successful CR sequences providing the length of the sequence and the kind of task recommended at every position (attention tasks, memory task or executive function task). Next, NRRMR provides specific tasks information to help decide which particular task is placed at each position in the sequence, the number of repetitions, and the expected range of results to maximize improvement after treatment. From the Artificial Intelligence point of view the proposed methodologies are general enough to be applied in similar problems where a sequence of interconnected activities with cumulative effects are used to impact on a set of areas of interest, for example spinal cord injury patients following physical rehabilitation program or elderly patients facing cognitive decline due to aging by cognitive stimulation programs or on educational settings to find the best way to combine mathematical drills in a program for a specific Mathematics course.El traumatismo craneoencefálico (TCE) es una de las principales causas de morbilidad y discapacidad a nivel mundial. Es la causa más común de muerte y discapacidad en personas menores de 30 años y es responsable de la pérdida de más años de vida productiva que el cáncer, las enfermedades cardiovasculares y el SIDA sumados. La Rehabilitación Cognitiva (RC) como parte de la Neurorehabilitación, tiene como objetivo reducir el impacto de las condiciones de discapacidad y disminuir los déficits cognitivos causados (por ejemplo) por un TCE. Un tratamiento de RC está formado por un conjunto de tareas organizadas de forma secuencial que requieren un uso repetitivo de las funciones cognitivas afectadas. Mientras que el número de ejecuciones de una tarea no es la única característica importante, es cada vez más evidente que las transformaciones neuroplásticas ocurren cuando se ejecutan un número específico de tareas en un cierto orden y no ocurren en caso contrario. Esta tesis propone la metodología CMIS para dar soporte a los profesionales de la salud en la composición de programas de RC, seleccionando las tareas más prometedoras en el orden correcto. Se han desarrollado dos contribuciones para CMIS mediante las metodologías SAMDMA y RNRRM basadas en técnicas innovadoras de minería de datos. SAMDMA (Secuencias de Actividades que Mejoran el Desempeño en Múltiples Áreas) propone una combinación de técnicas de minería de datos y un marco de trabajo genérico híbrido para encontrar patrones secuenciales en un conjunto de actividades y asociarlos con indicadores de mejora multi-criterio en relación a un conjunto de áreas hacia las cuales las actividades están dirigidas. Combina el uso de datos y conocimiento experto con técnicas de pre-procesamiento, clustering, descubrimiento de motifs y post procesamiento de clases. Además, se introduce y define el concepto de Rango de NeuroRehabilitación (RNR) para determinar el grado de performance esperado para una tarea de RC y el número de repeticiones que debe ejecutarse para producir mayores efectos rehabilitadores. Se propone una operacionalización del RNR por medio de una herramienta de visualización llamada Plano Sectorizado Anotado (PAS). PAS permite identificar áreas en las que hay una alta probabilidad de que ocurra un evento. Tres enfoques diferentes al PAS se definen, implementan, aplican y validan en un caso real : Vis-PAS, DT-PAS y FT-PAS. Finalmente, el problema RNRRM (Rango de NeuroRehabilitación de Regiones Máximas) se presenta como una generalización del problema del Máximo Rectángulo Vacío para identificar RNR máximos sobre un FT-PAS. La combinación de estas dos contribuciones en la metodología CMIS permite identificar un patrón conveniente para un programa de RC (por medio de una expresión regular) e instanciarlo en una secuencia real de tareas en RNR maximizando las mejoras esperadas de los pacientes, proporcionando soporte a la creación de planes de RC. Inicialmente, SAMDMA proporciona la estructura general de secuencias de RC exitosas para cada paciente, proporcionando el largo de la secuencia y el tipo de tarea recomendada en cada posición. RNRRM proporciona información específica de tareas para ayudar a decidir cuál se debe ejecutar en cada posición de la secuencia, el número de veces que debe ser repetida y el rango esperado de resultados para maximizar la mejora. Desde el punto de vista de la Inteligencia Artificial, ambas metodologías propuestas, son suficientemente generales como para ser aplicadas a otros problemas de estructura análoga en que una secuencia de actividades interconectadas con efectos acumulativos se utilizan para impactar en un conjunto de áreas de interés. Por ejemplo pacientes lesionados medulares en tratamiento de rehabilitación física, personas mayores con deterioro cognitivo debido al envejecimiento y utilizan programas de estimulación cognitiva, o entornos educacionales para combinar ejercicios de cálculo en un programa específico de Matemáticas