Applying Process-Oriented Data Science to Dentistry

Background: Healthcare services now often follow evidence-based principles, so technologies such as process and data mining will help inform their drive towards optimal service delivery. Process mining (PM) can help the monitoring and reporting of this service delivery, measure compliance with guidelines, and assess effectiveness. In this research, PM extracts information about clinical activity recorded in dental electronic health records (EHRs) converts this into process-models providing stakeholders with unique insights to the dental treatment process. This thesis addresses a gap in prior research by demonstrating how process analytics can enhance our understanding of these processes and the effects of changes in strategy and policy over time. It also emphasises the importance of a rigorous and documented methodological approach often missing from the published literature. Aim: Apply the emerging technology of PM to an oral health dataset, illustrating the value of the data in the dental repository, and demonstrating how it can be presented in a useful and actionable manner to address public health questions. A subsidiary aim is to present the methodology used in this research in a way that provides useful guidance to future applications of dental PM. Objectives: Review dental and healthcare PM literature establishing state-of-the-art. Evaluate existing PM methods and their applicability to this research’s dataset. Extend existing PM methods achieving the aims of this research. Apply PM methods to the research dataset addressing public health questions. Document and present this research’s methodology. Apply data-mining, PM, and data-visualisation to provide insights into the variable pathways leading to different outcomes. Identify the data needed for PM of a dental EHR. Identify challenges to PM of dental EHR data. Methods: Extend existing PM methods to facilitate PM research in public health by detailing how data extracts from a dental EHR can be effectively managed, prepared, and used for PM. Use existing dental EHR and PM standards to generate a data reference model for effective PM. Develop a data-quality management framework. Results: Comparing the outputs of PM to established care-pathways showed that the dataset facilitated generation of high-level pathways but was less suitable for detailed guidelines. Used PM to identify the care pathway preceding a dental extraction under general anaesthetic and provided unique insights into this and the effects of policy decisions around school dental screenings. Conclusions: Research showed that PM and data-mining techniques can be applied to dental EHR data leading to fresh insights about dental treatment processes. This emerging technology along with established data mining techniques, should provide valuable insights to policy makers such as principal and chief dental officers to inform care pathways and policy decisions

Simplifying, reading, and machine translating health content: an empirical investigation of usability

Text simplification, through plain language (PL) or controlled language (CL), is adopted to increase readability, comprehension and machine translatability of (health) content. Cochrane is a non-profit organisation where volunteer authors summarise and simplify health-related English texts on the impact of treatments and interventions into plain language summaries (PLS), which are then disseminated online to the lay audience and translated. Cochrane’s simplification approach is non-automated, and involves the manual checking and implementation of different sets of PL guidelines, which can be an unsatisfactory, challenging and time-consuming task. This thesis examined if using the Acrolinx CL checker to automatically and consistently check PLS for readability and translatability issues would increase the usability of Cochrane’s simplification approach and, more precisely: (i) authors’ satisfaction; and (ii) authors’ effectiveness in terms of readability, comprehensibility, and machine translatability into Spanish. Data on satisfaction were collected from twelve Cochrane authors by means of the System Usability Scale and follow-up preference questions. Readability was analysed through the computational tool Coh-Metrix. Evidence on comprehensibility was gathered through ratings and recall protocols produced by lay readers, both native and non-native speakers of English. Machine translatability was assessed in terms of adequacy and fluency with forty-one Cochrane contributors, all native speakers of Spanish. Authors seemed to welcome the introduction of Acrolinx, and the adoption of this CL checker reduced word length, sentence length, and syntactic complexity. No significant impact on comprehensibility and machine translatability was identified. We observed that reading skills and characteristics other than simplified language (e.g. formatting) might influence comprehension. Machine translation quality was relatively high, with mainly style issues. This thesis presented an environment that could boost volunteer authors’ satisfaction and foster their adoption of simple language. We also discussed strategies to increase the accessibility of online health content among lay readers with different skills and language backgrounds

Text complexity and text simplification in the crisis management domain

Due to the fact that emergency situations can lead to substantial losses, both financial and in terms of human lives, it is essential that texts used in a crisis situation be clearly understandable. This thesis is concerned with the study of the complexity of the crisis management sub-language and with methods to produce new, clear texts and to rewrite pre-existing crisis management documents which are too complex to be understood. By doing this, this interdisciplinary study makes several contributions to the crisis management field. First, it contributes to the knowledge of the complexity of the texts used in the domain, by analysing the presence of a set of written language complexity issues derived from the psycholinguistic literature in a novel corpus of crisis management documents. Second, since the text complexity analysis shows that crisis management documents indeed exhibit high numbers of text complexity issues, the thesis adapts to the English language controlled language writing guidelines which, when applied to the crisis management language, reduce its complexity and ambiguity, leading to clear text documents. Third, since low quality of communication can have fatal consequences in emergency situations, the proposed controlled language guidelines and a set of texts which were re-written according to them are evaluated from multiple points of view. In order to achieve that, the thesis both applies existing evaluation approaches and develops new methods which are more appropriate for the task. These are used in two evaluation experiments – evaluation on extrinsic tasks and evaluation of users’ acceptability. The evaluations on extrinsic tasks (evaluating the impact of the controlled language on text complexity, reading comprehension under stress, manual translation, and machine translation tasks) Text Complexity and Text Simplification in the Crisis Management domain 4 show a positive impact of the controlled language on simplified documents and thus ensure the quality of the resource. The evaluation of users’ acceptability contributes additional findings about manual simplification and helps to determine directions for future implementation. The thesis also gives insight into reading comprehension, machine translation, and cross-language adaptability, and provides original contributions to machine translation, controlled languages, and natural language generation evaluation techniques, which make it valuable for several scientific fields, including Linguistics, Psycholinguistics, and a number of different sub-fields of NLP.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A Multimodal Analysis of Two Publications Intended for the Oral, Head and Neck Cancer Patient

Indiana University-Purdue University Indianapolis (IUPUI

Handbook of Easy Languages in Europe

The Handbook of Easy Languages in Europe describes what Easy Language is and how it is used in European countries. It demonstrates the great diversity of actors, instruments and outcomes related to Easy Language throughout Europe. All people, despite their limitations, have an equal right to information, inclusion, and social participation. This results in requirements for understandable language. The notion of Easy Language refers to modified forms of standard languages that aim to facilitate reading and language comprehension. This handbook describes the historical background, the principles and the practices of Easy Language in 21 European countries. Its topics include terminological definitions, legal status, stakeholders, target groups, guidelines, practical outcomes, education, research, and a reflection on future perspectives related to Easy Language in each country. Written in an academic yet interesting and understandable style, this Handbook of Easy Languages in Europe aims to find a wide audience

Current Challenges in the Application of Algorithms in Multi-institutional Clinical Settings

The Coronavirus disease pandemic has highlighted the importance of artificial intelligence in multi-institutional clinical settings. Particularly in situations where the healthcare system is overloaded, and a lot of data is generated, artificial intelligence has great potential to provide automated solutions and to unlock the untapped potential of acquired data. This includes the areas of care, logistics, and diagnosis. For example, automated decision support applications could tremendously help physicians in their daily clinical routine. Especially in radiology and oncology, the exponential growth of imaging data, triggered by a rising number of patients, leads to a permanent overload of the healthcare system, making the use of artificial intelligence inevitable. However, the efficient and advantageous application of artificial intelligence in multi-institutional clinical settings faces several challenges, such as accountability and regulation hurdles, implementation challenges, and fairness considerations. This work focuses on the implementation challenges, which include the following questions: How to ensure well-curated and standardized data, how do algorithms from other domains perform on multi-institutional medical datasets, and how to train more robust and generalizable models? Also, questions of how to interpret results and whether there exist correlations between the performance of the models and the characteristics of the underlying data are part of the work. Therefore, besides presenting a technical solution for manual data annotation and tagging for medical images, a real-world federated learning implementation for image segmentation is introduced. Experiments on a multi-institutional prostate magnetic resonance imaging dataset showcase that models trained by federated learning can achieve similar performance to training on pooled data. Furthermore, Natural Language Processing algorithms with the tasks of semantic textual similarity, text classification, and text summarization are applied to multi-institutional, structured and free-text, oncology reports. The results show that performance gains are achieved by customizing state-of-the-art algorithms to the peculiarities of the medical datasets, such as the occurrence of medications, numbers, or dates. In addition, performance influences are observed depending on the characteristics of the data, such as lexical complexity. The generated results, human baselines, and retrospective human evaluations demonstrate that artificial intelligence algorithms have great potential for use in clinical settings. However, due to the difficulty of processing domain-specific data, there still exists a performance gap between the algorithms and the medical experts. In the future, it is therefore essential to improve the interoperability and standardization of data, as well as to continue working on algorithms to perform well on medical, possibly, domain-shifted data from multiple clinical centers

Language in genetics research informed consent: The language gap and unrecognized miscommunication

Informed choice is fundamentally a process of communication, reliant entirely on the tools of language. However, the meanings and understandings of words change with time, setting, and context, threatening the basis of consent. We conducted a qualitative content analysis of Canadian genetics research documents, exploring the impacts of language on informed consent. Numerous language usages were noted as potential barriers to informed consent, including language that was vague, variable, and unusually defined. Unique combinations of words were observed to generate novel concepts without clear meanings and definitions were absent or unclear. However, the ambiguity of the language was concealed by words that were simple and familiar. We conclude that a gap in communication may exist when discussing genetics, health, and disease, in that the same words, when used by different individuals, can have different meanings, and thus individuals may not fully understand each other despite using the same words