18 research outputs found
Development of temporal logic-based fuzzy decision support system for diagnosis of acute rheumatic fever/rheumatic heart disease
In this paper we describe our research work in developing a Clinical Decision Support System (CDSS) for the diagnosis of Acute Rheumatic Fever (ARF)/Rheumatic Heart Diseases (RHD) in Nepal. This paper expressively emphasizes the three problems which have previously not been addressed, which are: (a) ARF in Nepal has created a lot of confusion in the diagnosis and treatment, due to the lack of standard unique procedures, (b) the adoption of foreign guideline is not effective and does not meet the Nepali environment and lifestyle, (c) using (our proposed method) of hybrid methodologies (knowledge-based, temporal theory and Fuzzy logic) together to design and develop a system to diagnose of ARF case an early stage in the English and Nepali version. The three tier architecture is constructed by integrating the MS Access for backend and C#.net for fronted to deployment of the system
A Conceptual Framework to Predict Mental Health Patients' Zoning Classification.
Zoning classification is a rating mechanism, which uses a three-tier color coding to indicate perceived risk from the patients' conditions. It is a widely adopted manual system used across mental health settings, however it is time consuming and costly. We propose to automate classification, by adopting a hybrid approach, which combines Temporal Abstraction to capture the temporal relationship between symptoms and patients' behaviors, Natural Language Processing to quantify statistical information from patient notes, and Supervised Machine Learning Models to make a final prediction of zoning classification for mental health patients
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A supervised machine learning approach to generate the auto rule for clinical decision support system
This paper illustrates a prototype for a Clinical Decision Support System (CDSS), using Supervised Machine Learning (SML) to derive rules from pre-constructed cases or to automatically generate rules. We propose an integrated architecture invoking two main components - Rule Pattern Matching Process (RPMP) and Auto Rule Generation Process (ARGP). The RPMP searches for and matches rules from a clinically derived reference set, successful discovery resulting in continued processing through the system. If no rule is found, the AGRP is automatically activated. The AGRP has been designed based on the SML approach. A Decision Tree Algorithm has been used and nested If-else statements applied to transform the decision tree algorithm to generate rules. For experimental purposes, we have developed a prototype and implemented a learning algorithm for generating auto rules for the diagnosis of Acute Rheumatic Fever (ARF). Based on results, the prototype can successfully generate the auto rules for ARF diagnosis. The prototype was designed to classify the ARF stages into “Detected”, “Suspected” and “Not detected”, in addition, it has classifiers capable of classifying the severity levels of detected stage into Severe, Moderate or Mild case. We simulated a set of 104 cases of ARF and observed the rules. The prototype successfully generated the new rule and classified it with the appropriate category (stage). In summary, the applied approach performed extremely well and the developed prototype provided reliable rules for ARF diagnosis. This prototype therefore reduces the task of manually creating ARF diagnosis rules. This approach could be applied in other clinical diagnosis processes
Development of decision support system for the diagnosis of arthritis pain for rheumatic fever patients: Based on the fuzzy approach
Developing a Decision Support System (DSS) for Rheumatic Fever (RF) is complex due to the levels of vagueness, complexity and uncertainty management involved, especially when the same arthritis symptoms can indicate multiple diseases. It is this inability to describe observed symptoms precisely that necessitates our approach to developing a Decision Support System (DSS) for diagnosing arthritis pain for RF patients using fuzzy logic. In this paper we describe how fuzzy logic could be applied to the development of a DSS application that could be used for diagnosing arthritis pain (arthritis pain for rheumatic fever patients only) in four different stages, namely: Fairly Mild, Mild, Moderate and Severe. Our approach employs a knowledge-base that was built using WHO guidelines for diagnosing RF, specialist guidelines from Nepal and a Matlab fuzzy tool box as components to the system development. Mixed membership functions (Triangular and Trapezoidal) are applied for fuzzification and Mamdani-type is used for the fuzzy reasoning process. Input and output parameters are defined based on the fuzzy set rules
Rising rural body-mass index is the main driver of the global obesity epidemic in adults
Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe
Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants
Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions
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Temporal logic-based fuzzy decision support system for diagnosis of rheumatic fever and rheumatic heart disease
This is a collaboration project between the Nepal Heart Foundation (NHF) and the University of Greenwich (UoG), United Kingdom (UK). Our mutual aim, agreed at the outset, has been to analyse, design and develop a cost effective Clinical Decision Support System (CDSS) for diagnosis and recognition of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) at an early stage by developing/adopting UK’s and NHF’s treatment practices and procedures that would be appropriate for the Nepalese environment and lifestyle. The Application we developed was designed for use by community health workers and doctors in the rural areas of Nepal where laboratory facilities, expert services and technology are often deficient.
The research undertaken investigated three problems that previously had not been addressed in the Artificial Intelligence (AI) community. These are: 1) ARF in Nepal has created a lot of confusion in diagnosis and treatment, due to the lack of standard procedures; 2) the adoption of foreign guidelines is often not effective and does not suit the Nepali environment and lifestyle and 3) the value of combining (our proposed) Hybrid Approach (Knowledge-based System (KBS), Temporal Theory (TT) and Fuzzy Logic (FL)) to design and develop an application to diagnose ARF cases at an early stage in English and Nepali.
This research presents, validates and evaluates a proposed Hybrid Approach to diagnose ARF at three different stages: 1) Detected; 2) Suspected and 3) Not-detected and also to identify the severity level of detected ARF in the forms of Severe Case, Moderate Case or Mild Case. The Hybrid Approach is a combination of the KBS/Boolean Rule Model, Temporal Model and Fuzzy Model. The KBS/Boolean Rule Model has four components for design and implementation of KBS. These are: identifying the ARF stage in a case; Rule Pattern Matching; New Rule Formation and Rule Selection Mechanism. The Temporal Model has four components namely: Descriptive Explanation of ARF symptoms; Temporal Lookup-Table/Rules and Temporal Reasoning which produce a Temporal Template for demonstrating the relationship between the signs and ARF. The Fuzzification, Fuzzy Inferences and Defuzzification components are applied to design and implement a Fuzzy Model. The research undertaken divided the overall ARF diagnosis problem, in effect its requirements, into several sub-problems and each model of the Hybrid Approach addressed particular sub-problems for example, Identify the stage of the ARF component of the KBS/Boolean Rule Model used to solve the question of identifying the stage of ARF based on the symptoms presented. Each problem was therefore handled using a particular model’s components. This significantly helped to improve maintainability, reliability and the overall quality of our final ARF Diagnosis Application.
The developed ARF Diagnosis Application was experimentally tested and evaluated by NHF’s experts and users through applying NHF’s data sets consisting of 676 real patients’ records. The ARF Diagnosis Application was found to match 99% of the cases derived from NHF’s datasets. The overall ARF diagnostics performance and accuracy was 99.36%. Therefore, the experiments and evaluations of our ARF Diagnosis Application proved that it was logically and technically feasible to employ the Hybrid Approach for developing a new and practical ARF Diagnosis Application. The Application was ultimately developed and succeeded in embracing NHF’s requirements and guidelines thereby matching the Nepalese setting and making it suitable for use in Nepal having fully by met the exigencies of the Nepalese environment and lifestyle. Application of a new ARF diagnosis system (ours) proved that the Hybrid Approach, applied methods of diagnosis of ARF, medication and treatment plan, including help and supporting information which were identified and defined, were shown to be appropriate to support effectively community health workers and doctors who actively care for ARF and RHD cases in rural Nepal
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Fuzzy membership function and input/output parameter for diagnosis of rheumatic fever
This paper describes a suitable fuzzy membership function and input/output parameter for diagnosis of Rheumatic Fever (RF) in Nepal. The current case in Nepal is that computerized health informatics systems and appropriate data sets of RF are not available. Also, some signs and symptoms of RF do not reflect the measurement numerical values. These signs and symptoms will expresses in linguistic variables based on the doctor’s belief. Therefore, it is quite hard to determine the membership functions and input/output parameter. We purposed manual adjustable methods to determine the input/output parameters and membership function based on the predefine set of fuzzy rules. We tested different membership functions and changed the output parameter values until the suitable result is not achieved. We applied this method to diagnoses of arthritis pain and evaluated a system in Matlab Fuzzy toolbox. In this paper, we focus on the evaluation the different membership functions with different input/output parameters and present the results
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Temporal logic–based fuzzy decision support system for rheumatic fever and rheumatic heart diseases in Nepal
Decision Support Systems (DSSs) have been used in many fields as a tool to support decision making at different levels in an organisation. However, use of DSSs in medical diagnosis is always hampered by levels of uncertainty in that observed symptoms cannot be precisely described. It is this inability to describe observed symptoms precisely that necessitates our approach to develop a DSS for diagnosing Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) using Fuzzy and Temporal logic. Developing a decision support system for RF/RHD is complex due to the level of vagueness, complexity and uncertainty management involved, especially when the same symptoms can indicate multiple diseases. In this paper we describe how fuzzy logic could be applied to the development of a DSS that could be used for diagnosing arthritis pain (diagnosis of arthritis pain for rheumatic fever patient only), in four different stages namely Fairly Mild, Mild, Moderate and Severe. Our diagnostic tool allows doctors to log in symptoms describing arthritis pain using numerical values that are estimates of the severity of the pain a patient feels. These values are used as input parameters to the fuzzy logic tool box, which invokes rules in the knowledge to determine a value of severity for the arthritis pain. This fuzzy logic uses rules in the knowledge-based to determine whether the symptoms logged describe arthritis as being fairly mild, mild, moderate or severe. Our approach employs a knowledge base that was built using WHO guidelines for diagnosing RF, Nepal country guidelines and a Matlab fuzzy tool box as components to the system