Conceptual graph-based knowledge representation for supporting reasoning in African traditional medicine

Although African patients use both conventional or modern and traditional healthcare simultaneously, it has been proven that 80% of people rely on African traditional medicine (ATM). ATM includes medical activities stemming from practices, customs and traditions which were integral to the distinctive African cultures. It is based mainly on the oral transfer of knowledge, with the risk of losing critical knowledge. Moreover, practices differ according to the regions and the availability of medicinal plants. Therefore, it is necessary to compile tacit, disseminated and complex knowledge from various Tradi-Practitioners (TP) in order to determine interesting patterns for treating a given disease. Knowledge engineering methods for traditional medicine are useful to model suitably complex information needs, formalize knowledge of domain experts and highlight the effective practices for their integration to conventional medicine. The work described in this paper presents an approach which addresses two issues. First it aims at proposing a formal representation model of ATM knowledge and practices to facilitate their sharing and reusing. Then, it aims at providing a visual reasoning mechanism for selecting best available procedures and medicinal plants to treat diseases. The approach is based on the use of the Delphi method for capturing knowledge from various experts which necessitate reaching a consensus. Conceptual graph formalism is used to model ATM knowledge with visual reasoning capabilities and processes. The nested conceptual graphs are used to visually express the semantic meaning of Computational Tree Logic (CTL) constructs that are useful for formal specification of temporal properties of ATM domain knowledge. Our approach presents the advantage of mitigating knowledge loss with conceptual development assistance to improve the quality of ATM care (medical diagnosis and therapeutics), but also patient safety (drug monitoring)

Neurodegeneration in tauopathies and synucleinopathies

While increasing life expectancy is a major achievement, the global aging of societies raises a number of medical issues, such as the development of age-related disorders, including neurodegenerative diseases. The three main disease groups constituting the majority of neurodegenerative diseases are tauopathies, alpha-synucleinopathies and diseases due to repetitions of glutamine (including Huntington's disease). In each neurodegenerative disease, the accumulation of one or more aggregated proteins has been identified as the molecular signature of the disease (as seen, for example, in Alzheimer's disease, Parkinson's disease, dementia with Lewy bodies, amyotrophic lateral sclerosis and frontotemporal dementia). The etiology of neurodegenerative diseases is often multifactorial, and the known risk factors include, in addition to genetic polymorphisms and age, some other possible causes, such as certain immune and metabolic conditions, endocrine pathologies, gender, socioeconomic or professional status, oxidative stress or inflammation, vitamin deficiencies and environmental factors (chemical exposure, metals). However, innovative strategies to elaborate suitable diagnostic and therapeutic approaches (aiming to at least delay or possibly even reverse disease progression) require further knowledge of the genetic and adaptive immunological characteristics of neurodegenerative diseases

Adverse drug reactions in some African herbal medicine: literature review and stakeholders' interview

Revue non indexée dans le JCR.International audienceBackground: In view of the large consumption of herbal medicine in Africa countries, it is likely that many adverse drugs reactions go unrecorded with either patients failing to present to health services, or no pharmacovigilance analysis being made, or the analysis not being reported centrally. This problem is of interest especially for those who are working in the general area of adverse drug reactions or stakeholders in the domain of herbal medicine for considering safety issues. Methods: We are particularly interested in the way that the use of very wellknown and highly valued plants is linked to the observation of adverse drug reactions in African countries. We investigated, through a literature review and using the Internet (with a semantic search strategy), some wellknown or popular medicinal plants used in African herbal medicine (AHM). Other information on the properties related to use, and characteristics of medicinal plants was complemented by some interviews with stakeholders. Results: Although substantial progress has been made in elucidating the mechanisms of action of many drugs, the pharmacological actions of many medicinal plants are generally not well understood. The results of a literature review suggest that the reported adverse drug reactions of herbal remedies are often due to a lack of understanding of their preparation and appropriate use. The results of stakeholders' interviews suggest that there is a growing need to provide patients with correct information about the herbal medicines they consume. Conclusion: An important aspect of herbal medicine is the correct, timely, and integrated communication of emerging data on risk as an essential part of pharmacovigilance, which could actually improve the health and safety of patients. This calls for improved collaboration between traditional practitioners and modern healthcare professionals, researchers, and drug regulatory authorities. In addition, there is a need for an adverse drug reaction reporting system to facilitate the collection, monitoring, and evaluation of adverse drug events

Verifying a medical protocol with temporal graphs: The case of a nosocomial disease

Objective: Our contribution focuses on the implementation of a formal verification approach for medical protocols with graphical temporal reasoning paths to facilitate the understanding of verification steps. Materials and methods: Formal medical guideline specifications and background knowledge are represented through conceptual graphs, and reasoning is based on graph homomorphism. These materials explain the underlying principles or rationale that guide the functioning of verifications. Results: An illustration of this proposal is made using a medical protocol defining guidelines for the monitoring and prevention of nosocomial infections. Such infections, which are acquired in the hospital, increasemorbidity andmortality and add noticeably to economic burden. An evaluation of the use of the graphical verification found that this method aids in the improvement of both clinical knowledge and the quality of actions made. Discussion: As conceptual graphs, representations based on diagrams can be translated into computational tree logic. However, diagrams are much more natural and explicitly human, emphasizing a theoretical and practical consistency. Conclusion: The proposed approach allows for the visualmodeling of temporal reasoning and a formalization of knowledge that can assist in the diagnosis and treatment of nosocomial infections and some clinical problems. This is the first time that one emphasizes the temporal situation modeling in conceptual graphs. It will also deliver a formal verification method for clinical guideline analyses

Using conceptual graphs for clinical guidelines representation and knowledge visualization

The intrinsic complexity of the medical domain requires the building of some tools to assist the clinician and improve the patient’s health care. Clinical practice guidelines and protocols (CGPs) are documents with the aim of guiding decisions and criteria in specific areas of healthcare and they have been represented using several languages, but these are difficult to understand without a formal background. This paper uses conceptual graph formalism to represent CGPs. The originality here is the use of a graph-based approach in which reasoning is based on graph-theory operations to support sound logical reasoning in a visual manner. It allows users to have a maximal understanding and control over each step of the knowledge reasoning process in the CGPs exploitation. The application example concentrates on a protocol for the management of adult patients with hyperosmolar hyperglycemic state in the Intensive Care Unit

Olfactory dysfunction during the senescence and in the two main neurodegenerative diseases

L’importance du sens olfactif chez l’Homme est largement sous-estimée, comparée à d’autres mammifères. Le système olfactif chez l’humain est complexe et fait intervenir deux composantes principales : l’une périphérique (nerfs et épithélium olfactif) et l’autre centrale (bulbe olfactif et d’autres structures cérébrales impliqués dans l’émotion et la cognition). Avec l’amélioration de l’espérance de vie surtout dans les pays développés, il a été objectivé une diminution de la fonction olfactive avec la sénescence. Une dysfonction olfactive plus marquée a été objectivée dans certaines maladies neurodégénératives notamment la maladie d’Alzheimer et la maladie de Parkinson. Cette relation entre dysfonction olfactive et maladies neurodégénératives a contribué également à relancer l’intérêt et la recherche sur l’olfaction et les troubles olfactifs chez l’humain.The importance of the Human’s sense of smell is largely underestimated compared to other mammals. The olfactory system in humans is complex and involves two main components: a peripheral one (olfactory nerve and epithelium) and the central one (olfactory bulb and other brain structures involved in emotion and cognition). With improving of life expectancy, especially in developed countries, a declining of olfactory function with aging was objectified. A greater olfactory dysfunction was described in number of neurodegenerative diseases including Alzheimer’s and Parkinson’s disease. This relationship between olfactory dysfunction and neurodegenerative diseases has also helped to revive interest and research on olfaction and olfactory disorders in humans

Knowledge-based modelling applied to synucleinopathies

The adoption of telemedicine technologies has enabled collaborative programs involving a variety of links among distributed medical structures and health officials and professionals. The use for telemedicine for transmission of medical data and the possibility for several distant physicians to share their knowledge on given medical cases provides clear benefits, but also raises several unsolved conceptual and technical challenges. The seamless exchange and access of medical information between medical structures, health professionals, and patients is a prerequisite for the harmonious development of this new medical practice. This paper proposes a new approach of semantic interoperability for enabling mutual understanding of terminologies and concepts used. The proposed semantic interoperability approach is based on conceptual graph to support collaborative activities by describing how different health specialists can apply appropriate strategies to eliminate differential medical diagnosis. Intelligent analysis strategies are used to narrow down and pinpoint medical disorders. The model proposed is fully verified by a case study in the context of elderly patients and specifically dealing with synucleinopathies, a group of neurodegenerative diseases that include Parkinson's disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF) and multiple system atrophy (MSA)

Argumentation graphs with constraint-based reasoning for collaborative expertise

Collaborative processes are very important in telemedicine domain since they allow for making right decisions in complex situations with multidisciplinary staff. When modelling these collaborative processes, some inconsistencies can appear. In semantic modelling conceptual graphs), these inconsistencies are verified using constraints. In this work, collaborative processes are represented using an argumentation system modelled in a conceptual graph formalism where inconsistencies could be particular bad attack relation between arguments. To overcome these inconsistencies, two solutions are proposed. The first one is to weight the arguments evolving in the argumentation system on the basis of the competencies of the health professionals and the credibility of the sources justifying their advice (arguments), and the second one is to model some law concepts as constraints in order to check their compliance of the collaborative process

Telemedicine using mobile telecommunication: towards syntactic interoperability in teleexpertise

Telemedicine allows collaborative activities between health professionals for the deployment of medical procedures carried out remotely by means of device using information and communication technologies. This article focuses on the Teleexpertise that allows collaboration between medical professionals in order to share knowledge and expert advices used as explanation elements for decision support. We propose a conceptual model integrating the FIPA (Foundation for Intelligent Physical Agents) Contract Net Protocol which permits to collect medical professionals’ answers for a request for teleexpertise in an efficient manner. Our model satisfies four requirements (coverage, QoS (Quality of Service) guarantees and prioritisation, mobility and roaming, service usability) on the configuration and operation of the underlying network and the services. Therefore, we provide an operational assistance by improvement of the networks quality of service via interoperable web services. Finally, we hope to bring a tangible contribution on the implementation of this suggested conceptualization that will allow to generate relevant and action-oriented finding

Combining conceptual graphs and argumentation for aiding in the teleexpertise

Current medical information systems are too complex to be meaningfully exploited. Hence there is a need to develop new strategies for maximising the exploitation of medical data to the benefit of medical professionals. It is against this backdrop that we want to propose a tangible contribution by providing a tool which combines conceptual graphs and Dung׳s argumentation system in order to assist medical professionals in their decision making process. The proposed tool allows medical professionals to easily manipulate and visualise queries and answers for making decisions during the practice of teleexpertise. The knowledge modelling is made using an open application programming interface (API) called CoGui, which offers the means for building structured knowledge bases with the dedicated functionalities of graph-based reasoning via retrieved data from different institutions (hospitals, national security centre, and nursing homes). The tool that we have described in this study supports a formal traceable structure of the reasoning with acceptable arguments to elucidate some ethical problems that occur very often in the telemedicine domain