bluuebunny/crossref_metadata_2025 huggingface dataset:
A UML Approach to Process Modelling of Clinical Practice Guidelines for Enactment
Authors: Knape T.  , Hederman L.  , Wade V.P.  , Gargan M.  , Harris C.  , Rahman Y.
Published: February 2025

Although clinical practice guidelines (CPGs) have been suggested as a means of encapsulating best practice in evidence-based medical treatment, their usage in clinical environments has been disappointing. Criticisms of guideline representations have been that they are predominantly narrative and are difficult to incorporate into clinical information systems. This paper analyses the use of UML process modelling techniques for guideline representation and proposes the automated generation of executable guidelines using XMI. This hybrid UML XMI approach provides flexible authoring of guideline decision and control structures whilst integrating appropriate data flow. It also uses an open XMI standard interface to allow the use of authoring tools and process control systems from multiple vendors. The paper first surveys CPG modelling formalisms followed by a brief introduction to process modelling in UML. Furthermore, the modelling of CPGs in UML is presented leading to a case study of encoding a diabetes mellitus CPG using UML.
IMGT, the international ImMunoGeneTics information system®, http://imgt.cines.fr: the reference in immunoinformatics
Authors: Lefranc Marie-Paule  , Giudicelli Véronique  , Ginestoux Chantal  , Chaume Denys
Published: February 2025

IMGT, the international ImMunoGeneTics information system® (http://imgt.cines.fr), is a high quality integrated information system specializing in immunoglobulins (IG), T cell receptors (TR), major histocompatibility complex (MHC) and related proteins of the immune system of human and other vertebrates, created in 1989, by the Laboratoire d’ImmunoGénétique Moléculaire (LIGM), at the Université Montpellier II, CNRS, Montpellier, France. IMGT is the global reference in immunogenetics and immunoinformatics and provides a common access to standardized data which include nucleotide and protein sequences, oligonucleotide primers, gene maps, genetic polymorphisms, specificities, 2D and 3D structures. IMGT includes three sequence databases (IMGT/LIGM-DB, IMGT/MHC-DB hosted at EBI, IMGT/PRIMER-DB), one genome database (IMGT/GENE-DB), one 3D structure database (IMGT/3Dstructure-DB), Web resources comprising 8000 HTML pages (“IMGT Marie-Paule page”) and interactive tools for sequence (IMGT/V-QUEST, IMGT/JunctionAnalysis, IMGT/Allele-Align, IMGT/PhyloGene) and genome (IMGT/GeneSearch, IMGT/Gene View, IMGT/Locus View) analysis. IMGT data are expertly annotated according to the rules of the IMGT Scientific chart, based on the IMGT-ONTOLOGY concepts. IMGT tools are particularly useful for the analysis of the IG and TR repertoires in physiological normal and pathological situations. IMGT has important applications in medical research (repertoire analysis in autoimmune diseases, AIDS, leukemias, lymphomas, myelomas), biotechnology related to antibody engineering (phage displays, combinatorial libraries) and therapeutic approaches (graft, immunotherapy). IMGT is freely available at http://imgt.cines.fr.
WASP -a generic web-based, interactive, patient simulation system
Authors: Zary Nabil  , Fors Uno G.H.
Published: February 2025

Computer based patient case simulation systems have during the recent years been introduced in medical education to allow students to `meet" more cases that are educationally optimized and adapted to the actual learning situation. However, three major problems exist with most computer based case simulation systems today: They are expensive to develop, experienced multimedia developers are needed for the development and teachers/clinicians can not develop and adjust cases to fit their own specific educational needs
Nursing care nomenclatures: real implementation in the computerized patient care record
Authors: Lovis Christian  , Butel Jacques  , Arnet Pierre-Antoine  , Sarrey Evelyne  , Geissbuhler Antoine
Published: February 2025

We report our experience in the conception and the use of a detailed nursing care documentation electronic record. This nursing care record is completely nomenclature driven, including the user-interface. International nomenclatures or classifications such as NANDA are used. They have been translated to French and their language adapted to the local practice habits. This nursing CPR is used in nineteen wards in the five campuses of the University Hospitals of Geneva, covering a broad range of nursing care types, such as acute adult and paediatric care, surgery, general internal medicine, geriatrics, in- and outpatient psychiatry and long-term rehabilitation. This paper focuses on the problematic of the use of nomenclatures and classification in a nursing daily practice, particularly the social and behavioural challenges that had to be faced. The rationale behind the use of these nomenclatures is presented We present some of the techniques that have been used to make a nomenclature-driven nursing CPR more attractive for nurses.
Patient demands and the development of EHR systems
Authors: Zurita Laura  , Nøhr Christian
Published: February 2025

Patient demands to the development and implementation of electronic health care records (EHR) are rarely considered in professional health informatics societies. This project has investigated the citizens’ opinion in Denmark by means of a newly developed methodology “development space”. A group of citizens form a lay panel and are briefed on the fundamental issues in the development and strategies for EHR. They confront an expert panel with a number of questions and on the basis of the answers they write a report. The results show that the citizens in the lay panel demanded clear answers to strategic, technical and attitudinal questions. They demonstrated an ability to see through relatively complex relations and formulate multifaceted opinions, which can add valuable input to the development and implementation process of EHR in the professional environments.
An Automated Diagnostic System for Tubular Carcinoma of the Breast – An Overview of Approach and Considerations
Authors: Leong F.Joel W-M.  , McGee James O’D.
Published: February 2025

A computer-based automated histopathology recognition system was developed to distinguish benign from malignant lesions. Tubular carcinoma of the breast, which has several reactive and neoplastic mimics, was selected as a model. Archivai stained tumour sections from the United Kingdom National External Quality Assurance Scheme for breast pathology and supplementary material from external pathologists formed the study population. A diagnostic process similar to that employed by the histopathologist was adopted, viz, low-power feature extraction and analysis by cluster/glandular groupings followed by high-power confirmation. To circumvent problems of stain variability, greyscale quantisation of images was achieved through Karhunen-Loeve transformation with results suggesting that histological stains provide information primarily through contrast and not colour. Mean nearest neighbour and variance of cell nuclei distances were found to be 100% effective in distinguishing images which contained diffuse tumour, and no clustering. Gaussian smoothing followed by minimum variance quantisation allowed segmentation of gland clusters. Perona-Malik nonlinear diffusion filter employed prior to intensity thresholding and morphological filtering was 92% (7330/7973) effective in segmenting individual glands. In a set of 62 benign and 52 malignant gland clusters, the features found to discriminate tubular carcinoma from benign conditions included >20% of glands with sharp-angled edge, cluster area >150,000 pixels, ratio total gland area:total cluster area <0.14, >60 glands per cluster and the ratio average malignant gland area:benign gland area <0.5. Suspicions clusters were subjected to high-power feature analysis for nuclear morphology, nucleoli detection and basement membrane assessment. Watershed thresholding achieved nuclear segmentation and nuclear area >1.3x mean benign nuclear area was found to have a malignant likelihood ratio of 14.5. Progressive thresholding was used to detect nucleoli. Basement membrane was accentuated by colour segmentation and demonstrated 0.96 sensitivity, 0.89 specificity and 0.92 positive predictive value for distinguishing malignancy.
Technologies for Haptic Systems in Telemedicine
Authors: Monkman Gareth J.  , Boese Holger  , Ermert Helmut  , Klein Dagmar  , Freimuth Herbert  , Baumann Michael  , Egersdoerfer Stefan  , Bruhns Otto T.  , Meier Alexander  , Raja Kashif
Published: February 2025

The ability to image the elastic properties of tissue is potentially useful in a variety of applications. The field of elastic imaging has grown in response to the Potential use of such information in medical diagnosis. Real time ultrasound elastography represents a recent development in determining strain and elasticity distributions. Nevertheless, commonly used imaging techniques rely on the interpretation of two dimensional visual data displayed on a video screen. In reality however, physicians often prefer tactile exploration making the simultaneous portrayal of both video and haptic information most desirable.
A New Form of Application Service Provider (ASP) in the Development of Data Systems and Data Flow and Management of Data in (Multiple Campus) Health Care Institutions.
Authors: Laurent Christophe R.
Published: February 2025

There is a distinct lag in the way the informatics management is applied, implemented and used in health care institutions in comparison to other industries. Part of this is caused by strict regulations, but there also seems to be a defined trust and attitude problem from the medical corps towards dependency from automatisation. The only way to guarantee overall advance however is to apply technology implementations which enhance the performance capabilities of the medical corps, the way they already have in other fields. We propose a new model for implementing software applications and their communication on the scale of a multi campus health care institution.
BIOTERRORISM: DEVELOPMENT OF LARGE -SCALE MEDICAL READINESS USING MULTIPOINT DISTANCE-BASED SIMULATION TRAINING
Authors: von Lubitz Dag K.J.E.  , Carrasco Benjamin  , Fausone Carol-Ann  , Gabbrielli Francesco  , Kirk John  , Lary Marvis J.  , Levine Howard  , Patrcelli Frederic  , Pletcher Timothy A.  , Richir Simon  , Stevens George  , Wroblewski Gary
Published: February 2025

Accordingly to HIRSA, 35,000 health professionals need to be trained in recognition and acute field treatment of victims of bioterrorism within year 2004 alone The Department of Defense anticipates even larger numbers. Training of very large number of healthcare workers is particularly daunting in the context of “just-in-time” education. The paper presents utilization of simulationbased distance training as a particularly useful tool in rapid development of readiness in a large population of widely distributed medical and lay personnel facing imminent threat of a chem/bioterrorism incident.
A Virtual Reality Based Navigation System for Endovascular Surgery
Authors: Pujol Sonia  , Pecher Matthieu  , Magne Jean-Luc  , Cinquin Philippe
Published: February 2025

Endovascular surgery provides a minimally invasive solution for the treatment of aortic aneurysms. Fluoroscopic guidance involves X-rays exposure and loss of space information. We have developed a navigation system allowing real-time visualisation of the endovascular tools in a 3D model of the vessels without any radiation exposure. A modified endoprosthesis is equipped with a magnetic sensor tracked by the Aurora™magnetic localizer. The registration step uses 2.5D ultrasonography to replace pre-operative CT data in the Operating Room referential. The Virtual Reality based navigation system shows the location of the endoprosthesis inside a 3D CT model of the aorta. Endovascular procedure benefits from a reduced radiation exposure.
Reaction-Time Measurement and Real-Tune Data Acquisition for Neuroscientific Experiments in Virtual Environments
Authors: Valvoda Jakob T.  , Assenmacher Ingo  , Kuhlen Torsten  , Bischof Christian H.
Published: February 2025

This paper describes an approach to neuroscientific reaction-time experiments and resulting methods for data processing under real-time constraints in virtual environments (VE). Immersive VEs produce huge amounts of data, which has to be processed in real-time to meet the interactivity requirement of VE. Furthermore, data is needed often with a timing resolution and even more crucial with an accuracy in the range of milliseconds. Unfortunately recent operating systems do not in general guarantee timing precision in this range. For these purposes we have researched possibilities for reaction-time measurement and realtime data acquisition. Our system enables neuroscientists to perform reaction-time experiments in platform-independent virtual environments.
A Haptic Surgical Simulator for the Continuous Curvilinear Capsulorhexis Procedure During Cataract Surgery
Authors: Webster Roger  , Sassani Joseph  , Shenk Rodney  , Good Nathan
Published: February 2025

This paper describes a technique for simulating the capsulorhexis procedure during cataract surgery. The continuous curvilinear capsulorhexis technique can be a difficult procedure for beginning ophthalmology surgeons. In the initial phase of tearing the tissue, the tear vector is tangential to the circumference of the tear circle. However, without the proper re-grasping of the flap of torn tissue close to the tear point, the tear vector angle quickly runs downhill possibly causing severe damage to the tissue. Novice surgeons tend to try to complete the capsulorhexis without the time consuming regrasping of the tissue flap. Other factors such as anterior bowing of the lens diaphragm, patient age, and shallow anterior chambers add to the problematic nature of the procedure. Our capsulorhexis simulator models these various tear problems and anomalies to provide a training environment without the dangers of using live patients.
Increasing face validity of a vascular interventional training system
Authors: Winder John  , Zheng Huiru  , Hughes Simon  , Kelly Barry  , Wilson Carol  , Gallagher Anthony
Published: February 2025

Background. Many aspects of medical training take place on real patients in a live environment thus incurring risk. Apart from the obvious risks to patients there is the issue of X-ray exposure to both staff and trainees. Image quality used during interventional procedures is low to ensure minimum X-ray radiation dose. A virtual interventional system may be used to simulate the interventional cardiology training environment therefore reducing overall risk. The purpose of this project was to determine the appropriate image quality settings on a virtual training system to accurately simulate interventional cardiology and increase the face validity of the overall system.
Real-Time Volume Haptic Rendering of Non-linear Viscoelastic Behavior of Soft Tissue through Dynamic Atomic Unit Approach
Authors: Chanda A.  , Kesavadas T.
Published: February 2025

The aim of computer haptics is to enable the user to touch, feel and maneuver virtual objects using a haptic interface. As the user “feels” the virtual object by applying force through the interface, complex calculations have to be done in real-time to generate a feedback force appropriate to the material properties of the object being “touched”. In this paper we propose a method for modeling soft bodies, which incorporate non-linear, viscoelastic, anisotropic behavior that will enable real-time user interaction and still satisfy the high force-feedback frequency requirements. In this paper, we restrict the user interaction with virtual objects to palpation.
Workflow Modeling and Analysis of Computer Guided Prostate Brachytherapy under MR Imaging Control
Authors: Dickhaus Christoph F.  , Burghart Catherina  , Tempany Clare  , D'Amico Anthony  , Haker Steven  , Kikinis Ron  , Woern Heinz
Published: February 2025

We demonstrate that classical Business Process Reengineering (BPR) methods can be successfully applied to Computer Aided Surgery while increasing safety and efficiency of the overall procedure through an integrated Workflow Management System. Computer guided Prostate Brachytherapy, as a sophisticated treatment by an interdisciplinary team, is perfectly suited to apply our method. Detailed suggestions for improvement of the whole procedure could be derived by our modified BPR method.
Male Sexual Dysfunctions: immersive Virtual Reality and multimedia therapy
Authors: Optale Gabriele  , Pastore Massimiliano  , Marin Silvia  , Bordin Diego  , Nasta Alberto  , Pianon Carlo
Published: February 2025

The study describes a therapeutic approach using psycho-dynamic psychotherapy integrating virtual environment (VE) for resolving impotence or better erectile dysfunction (ED) of presumably psychological or mixed origin and premature ejaculation (PE). The plan for therapy consists of 12 sessions (15 if a sexual partner was involved) over a 25-week period on the ontogenetic development of male sexual identity, and the methods involved the use of a laptop PC, joystick, Virtual Reality (VR) helmet with miniature television screen showing a new specially-designed CD-ROM programs using Virtools with Windows 2000 and an audio CD. This study was composed of 30 patients, 15 (10 suffering from ED and 5 PE) plus 15 control patients (10 ED and 5 PE), that underwent the same therapeutic protocol but used an old VR helmet to interact with the old VE using a PC Pentium 133 16Mb RAM. We also compared this study with another study we carried out on 160 men affected by sexual disorders, underwent the same therapeutic protocol, but treated using a VE created (in Superscape VRT 5.6) using always Windows 2000 with portable tools. Comparing the groups of patients affected by ED and PE, there emerged a significant positive results value without any important differences among the different VE used. However, we had a % increase of undesirable physical reactions during the more realistic 15-minute VR experience using Virtools development kit. Psychotherapy alone normally requires long periods of treatment in order to resolve sexual dysfunctions. Considering the particular way in which full-immersion VR involves the subject who experiences it (he is totally unobserved and in complete privacy), we hypothesise that this methodological approach might speed up the therapeutic psycho-dynamic process, which eludes cognitive defences and directly stimulates the subconscious, and that better results could be obtained in the treatment of these sexual disorders. This method can be used by any psychotherapist and it can be used alone or associated with pharmacotherapy prescribed by the urologist/andrologist as part of a therapeutic alliance.
Mistakes in Medical Ontologies: Where Do They Come From and How Can They Be Detected?
Authors: Ceusters Werner  , Smith Barry  , Kumar Anand  , Dhaen Christoffel
Published: February 2025

We present the details of a methodology for quality assurance in large medical terminologies and describe three algorithms that can help terminology developers and users to identify potential mistakes. The methodology is based in part on linguistic criteria and in part on logical and ontological principles governing sound classifications. We conclude by outlining the results of applying the methodology in the form of a taxonomy different types of errors and potential errors detected in SNOMED-CT®
BIOAVAILABILITY AND BIOEQUIVALENCE TRIALS: STATISTICS & PHARMACOKINETIC PRINCIPLES
Authors: Rajaram Lakshminarayan  , Roy Sandip K.  , Skerjanec Andrej
Published: February 2025

This document has been prepared as a set of workshop material, which will be presented in the International Congress on Medical and Care Compunetics in June 2004 in Den Hague, The Netherlands. The workshop is divided into two parts and deals with the fundamentals of the bioavailability and bioequivalence studies. First part of the workshop deals with the pharmacokinetic principles, and the second part discusses the statistical approaches and the data analysis using the Statistical Analysis Software (SAS).
Vibroacoustic Sound Therapy: Case Studies with Children with Profound and Multiple Learning Difficulties and the Elderly in Long-Term Residential Care
Authors: Ellis Phil
Published: February 2025

This paper describes the development of Vibroacoustic Sound Therapy, an approach which is being developed for use in special schools for children with profound and multiple learning difficulties, and in long-term care homes for the elderly and the elderly mentally infirm. Using non-invasive techniques and music/sound technology, children and the elderly are being empowered and enabled to (re)discover self expression and communication skills. Two case studies drawn from the world of the young disabled, and from the elderly, illustrate the potential for improving quality of life and well-being in these institutional settings.
High Level Security Policies for Health Care Establishments
Authors: Katsikas Sokratis  , Kokolakis Spyros
Published: February 2025

Health Care Establishments (HCE) are today highly dependent upon Information and Communications Technologies (ICT). This increasing reliance upon ICT has stressed the need to foster security in Healthcare Information Systems (HIS). Security policies may have a significant contribution to this effort, but they could become the cause of portability and interoperability problems. Moreover, policies that fail to take into account all the aspects of HIS security, the legal and regulatory requirements, and the existence of several stakeholders may lead to ineffective or inefficient security measures. Policies of a special category, named Generic Security Policies (GSP), should be developed to provide policy-level harmonisation and guidance to policy-makers within HCE. Six such policies are comparatively reviewed herein.
Non-Telephone Healthcare: The Role of 4G and Emerging Mobile Systems for Future m-Health Systems
Authors: Istepanian R.  , Philip N.  , Wang X.H.  , Laxminarayan S.
Published: February 2025

The next generation of “m-health technologies” is a new and evolving topic in the areas of telemedical and telecare systems. These technologies involve the exploitation of mobile telecommunication and multimedia technologies to provide better access to healthcare personnel on the move, by removing the key disadvantage of trailing wires in current systems. These technologies provide equal access to medical information and expert care by overcoming the boundaries of separation that exist today between different users of such medical information. A great benefit to all users will be a more efficient use of resources and far greater location independence. In this paper we will address some notes and future trends in these emerging areas and their applications for m-health systems. Especially we will discuss the role of 4G and emerging mobile systems for future m-health systems. The new technologies can make the remote medical monitoring, consulting, and health care more flexible and convenient. But, there are challenges for successful wireless telemedicine, which are addressed in this paper.
Use of Information Technology to Improve Quality of Healthcare: Kosova's Telemedicine Project and International Virtual e-Hospital as an Example
Authors: Latifi Rifat  , Muja Shaip  , Bekteshi Flamur  , Reinicke Matthias
Published: February 2025

The idea to create the Telemedicine Project of Kosova and the International Virtual e-Hospital Network of Kosova, was presented at G8-Meeting, in Berlin May 4-5, 2000, by the senior author (RL) then Assistant Professor of Surgery at Virginia Commonwealth University, in Richmond, Virginia during the presentation, the “The anatomy of war and destruction of Kosova: The alumni view on reconstruction of heath in Kosova”. Following wide spread acceptance by many countries and institutions around the world of the idea of creating a virtual e-hospital in Kosova” became a reality. To ensure the creation of a telemedicine center and realization of the project in Kosova, the Telemedicine Association of Kosova was created in Prishtina, September 30, 2000. On February 2, 2001 a Memorandum of Understanding (MOU) for the implementation of TPK was signed between all stakeholders in health in Kosova.
Telework for Persons with Disabilities in the EU and the USA: What Can We Learn from Each Other?
Authors: Schopp Laura H.
Published: February 2025

Persons with disabilities represent a growing population in both the European Union (EU) and the United States (USA). The ability to work is a key component in achieving independence and full inclusion in society, and employability is increasingly seen as an important outcome variable for studies in health and disability. However, persons with disabilities face considerable challenges in returning to work due to barriers related to transportation, job changes after disability, lack of support services in the workplace, and related barriers. Telework, or work from a distance, may help to mitigate these obstacles, while expanding the range of work options available for persons with disabilities. The EU has made substantial policy progress to support telework, but persons with disabilities have had only limited long-term success in telework initiatives due to lack of work support services. The USA has generally strong support services but lacks telework policy infrastructure. The EU and the USA can benefit from collaborative work to enhance their complementary strengths.
Evidence-Based Retrieval in E-Health
Authors: Patrick Timothy B.  , Demiris George  , Folk Lillian C.
Published: February 2025

In this chapter we address the issue of standards for information retrieval to support decision making in e-health. Specifically, we consider the issue of evidence-based retrieval in the e-health domains of the consumer, healthcare practitioner, healthcare researcher, and genomics researcher. We present the results of a preliminary study to assess the current state of evidence-based retrieval in e-health. Within this study, we reviewed articles in e-health and telemedicine to determine the extent to which authors provide details of the information retrieval strategies used, as well as evidence of the effectiveness of those strategies. We also examined the extent to which the associated journals require authors of reviews to explicitly provide details of information retrieval strategies that they used, as well as reporting any evidence for the effectiveness of those strategies.
User acceptance of Clinical Information Systems: A methodological approach to identify the key dimensions allowing a reliable evaluation framework
Authors: Despont-Gros Christelle  , Fabry Paul  , Muller Henning  , Geissbuhler Antoine  , Lovis Christian
Published: February 2025

The introduction of Computerized Information Systems (CIS) in clinical settings encountered difficulties. These difficulties highlight the lack of understanding of factors and mechanisms influencing user acceptance. The existing tools and research obtained contradictory results that point out the existence of neglected aspects, such as impacts of CIS, in computer science developments in complex settings.
Computer-based drug ordering: evaluation of interaction with a decision-support system
Authors: Horsky Jan  , Kaufman David R.  , Patel Vimla L.
Published: February 2025

Provider order entry systems (POE) often incorporate active decision- support component for drug dosing. The efficacy of automated alerts that suggest dose amounts to the clinician in real time depends in part on how well they are timed to fit into the decision process and on their representational structure. We have conducted a cognitive evaluation of an interaction with a POE system that offered active decision support for heparin dosing with the goal of characterizing its effectiveness and opportunities for error. Two researchers completed a cognitive walkthrough of an ordering task based on a clinical scenario. In addition, seven clinicians were asked to enter a set of orders in an experiment using the same scenario. The analysis revealed that users without a solid conceptual knowledge of the ordering system followed patterns of inefficient interactive behavior resulting in delays and some errors. Physicians often did not take full advantage of automatic dose computation provided by a decision support component and used it largely as reference. The calculated dose was not perceptually salient in the generated alert and required users to engage in meaning interpretation of the displayed information. Better visual presentation of the alert message would likely result in faster and less cognitively demanding interaction.
Managing the Tensions Between National Standardization vs. Regional Localization of Clinical Content and Templates
Authors: Mattison John E.  , Dolin Robert H.  , Laberge Diane
Published: February 2025

The deployment of sophisticated software tools and electronic health records offers many new opportunities and challenges to support care delivery. One of the key opportunities is to enhance the quality of care with evidence-based medicine (EBM). One of the key challenges is to embed EBM in tools that directly facilitate the process of documentation and care delivery.
Reasons for Physician Non-Adherence to Electronic Drug Alerts
Authors: Taylor Laurel  , Tamblyn Robyn
Published: February 2025

Context Many adverse drug errors may be prevented through electronic order entry systems that provide decision support to physicians by screening prescriptions for dosing errors, drugdisease, drug-allergy and drug-drug interactions. The adherence to such decision aids is varied and the reasonsfor this variance not well understood.
Constructing and Validating a Consumer Health Portal Rating Index
Authors: Bomba David  , Land Tim
Published: February 2025

Web-based consumer health information portals are on the increase. With such a large number of health related sites available, design and information quality are key concerns. This article provides an evaluation framework based on the work of Slack (2001) and the HONcode guidelines. Research shows that greater transparency is needed with regard to how rating instruments are constructed and validated. The consumer health portal index developed in this research has been tested for face and content validity through a series of focus groups following Sullivan ‘s 5 step process.
A Mediated Health Search Portal for Trusted Medical Content
Authors: Kanter Andrew S.  , Maldonado Jose  , Varshney Anuj  , Naeymi-Rad Frank
Published: February 2025

The Internet has become an important source of medical information for both patients and providers. However, it is increasingly difficult to properly access and evaluate the information obtained on the Internet. Search engines are frequently used to find information but suffer either from lack of specificity, or cumbersome requirements for use. Mediated search services have been suggested as a possible alternative. This paper describes one such mediated medical information search service called IMO Health Search.
Computer Interviewing in a Primary Care Office: The Patients are Ready
Authors: Smith Paul D.  , Grasmick Michael
Published: February 2025

Computer patient interviewing has been used since 1968 and must be acceptable to a majority of patients for wide spread use to occur. Computer interviewing is still not used widely in the United States. Potential barriers have not been identified in the literature. Methods: 150 of 164 (91.5%) eligible patients at a family medicine ambulatory practice were enrolled in a study to evaluate computer interview of cough and sore throat complaints. Subjects were given the choice to have the interview in the waiting or examination room. Telephone interviews were conducted 2-4 weeks later with 143/150 patients (95.3%). Results: 102/150 (68%) of subjects chose the waiting room and 48/ 150 (32%) chose the examination room for the computer interview. 127/143 (88.8%) were willing to use the computer interview for evaluation of cough or sore throat again in the future. 116/143 (81.1%) were willing to use the computer interview for other medical complaints in the future. Conclusions: Patients are willing to use computer interviewing and some interviews may be conducted in the waiting room.
Toward Improved Guideline Quality: Using the COGS Statement with GEM
Authors: Shiffman Richard N.  , Michel Georges
Published: February 2025

The Conference on Guideline Standardization (COGS) was convened to create a standardized documentation checklist for clinical practice guidelines in an effort to promote guideline quality and facilitate implementation. The statement was created by a multidisciplinary panel using a rigorous consensus development methodology. The Guideline Elements Model (GEM) provides a standardized approach to representing guideline documents using XML. In this work, we demonstrate the sufficiency of GEM for describing COGS components. Using the mapping between COGS and GEM elements we built an XSLT application to examine a guideline’s adherence (or non-adherence) to the COGS checklist. Once a guideline has been marked up according to the GEM hierarchy, its knowledge content can be reused in multiple ways.
Learning Boolean Queries for Article Quality Filtering
Authors: Aphinyanaphongs Yin  , Aliferis Constantin
Published: February 2025

Prior research has shown that Support Vector Machine models have the ability to identify high quality content-specific articles in the domain of internal medicine. These models, though powerful, cannot be used in Boolean search engines nor can the content of the models be verified via human inspection. In this paper, we use decision trees combined with several feature selection methods to generate Boolean query filters for the same domain and task. The resulting trees are generated automatically and exhibit high performance. The trees are understandable, manageable, and able to be validated by humans. The subsequent Boolean queries are sensible and can be readily used as filters by Boolean search engines.
A Comparison of Semantic Categories of the ISO Reference Terminology Models for Nursing and the MedLEE Natural Language Processing System
Authors: Bakken Suzanne  , Hyun Sookyung  , Friedman Carol  , Johnson Stephen
Published: February 2025

Natural language processing (NLP) systems have demonstrated utility in parsing narrative texts for purposes such as surveillance and decision support. However, there has been little work related to NLP of nursing narratives. The purpose of this study was to compare the semantic categories of a NLP system (Medical Language Extraction and Encoding [MedLEE) system) with the semantic domains, categories, and attributes of the International Standards Organization(ISO) reference terminology models for nursing diagnoses and nursing actions. All but two MedLEE diagnosis and procedure-related semantic categories mapped to ISO models. In some instances, we found exact correspondence between the semantic structures of MedLEE and the ISO models. In other situations (e.g. aspects of site or location), the ISO model was not as granular as MedLEE. For clinical procedure and non-invasive examination, two ISO nursing action model components (action and target) were required to represent the MedLEE semantic category. The ISO model requires additional specification of selected semantic categories for the abstract semantic domains in order to achieve the objective of using NLP to parse and encode data from nursing narratives. Our analysis also suggests areas for extension of MedLEE.
Medical Data Abstractionism: Fitting an EMR to Radically Evolving Medical Information Systems
Authors: Steiner David J.  , Coyle Joseph F.  , Rocha Beatriz H. S. C.  , Haug Peter  , Huff Stanley M.
Published: February 2025

Growing and maintaining a simple and flexible EMR (Electronic Medical Record) becomes a complicated task in light of diverse and distributed legacy data representation, advancing technologies, changes in medical practice and procedure, and changes in data regulation. Utilizing several abstraction mechanisms can simplify application development and maintenance, and provide flexibility for data evolution and migration. Newer applications built on these abstractions can be the beneficiary of slower obsolescence and lower maintenance costs.
Requirements of tools and techniques to support the entry of structured nursing data
Authors: Hardiker Nicholas R.  , Bakken Suzanne
Published: February 2025

The benefits of structured data are widely accepted within the nursing informatics community. However, despite the existence of structured data in the form of well-established nursing terminologies, computer-based nursing record systems are yet to achieve widespread adoption and few of the potential benefits have yet to be realized. In this paper we argue the need for tools and techniques to support the entry of structured nursing data into computer-based systems. In the absence of a generally accepted solution, we build on preliminary work carried out at the 2002 Nursing Terminology Summit and analyze the results of other studies in order to identify a preliminary set of requirements or desiderata for such tools and techniques. These requirements are centered on: how structured data is presented to users for selection; how to mediate between a variety of conceptual structures -terminologies, information models, user interface models and models of the clinical process; and how to reduce the considerable modeling burden through re-use of modeling constructs. Further applied research is needed with the ultimate goal of developing a general solution that will benefit nurses, other professionals and ultimately their patients.
Generic Computer-based Questionnaires: an Extension to OpenSDE
Authors: van Ginnekena Astrid M.  , de Wildes Marcel  , Blokt C.
Published: February 2025

Development of computer-based questionnaires (CQs) has been an ongoing challenge since the 1960s. The added value of such CQs for data collection and the acceptance by patients have been well documented. Many questionnaire projects, however, were temporary due to dedicated software, limited funding, and lack of integration with medical information systems. Also, the use of a fixed dedicated database makes integration cumbersome, as change in content requires change to the data model. Since much of the functional requirements of CQs is not dependent on content, the challenge is to both separate functionality and database structure from content. Following these principles, we extended OpenSDE, a generic application for structured data entry, with a tool to construct and run CQs as an alternative way of data input.
Specifications and implementation of a new exchange format to support computerized consensus in pathology
Authors: Zapletal Eric  , Le Bozec Christel  , Degoulet Patrice  , Guinebretière Jean-Marc  , Jaulent Marie-Christine
Published: February 2025

In the pathology domain, consensus sessions around multi-headed microscopes enhance reproducibility and can reduce inter-and intra-observer variability. Computerized tools and Web technology could facilitate the organization of consensus sessions and assist pathologists to agree on features that are relevant to diagnosis. In the context of the IDEM project, whose aim is to achieve a computerized platform to allow pathologists to derive consensual diagnostic during Internet-based collaborative sessions, we propose a new extension of the existing TELESLIDE format. This new extended format enables the storage and the exchange of multi-experts descriptions that will be processed by the IDEM consensus engine to produce consensual descriptions. We describe this new format and its implementation in the IDEM teleconsensus platform.
Predicting the Impact of a New Information System on Workflow Using a Discrete Event Simulation
Authors: Bartos Christa E.  , Nigam Milena K.  , Fridsma Douglas B.  , Gadd Cynthia S.
Published: February 2025

Computer simulation of an information system prior to its implementation can predict time and workflow changes in a hospital department, while offering a common ground of communication across various levels in the organization. Often, the simulation can predict unexpected effects of changes to the work environment and allow experimentation with alternative scenarios at minimal cost to the department or the organization. In this paper we describe a discrete-event simulation experiment that predicted an unexpected increase in routine specimen processing time with the introduction of an information system in the HLA tissue typing lab at a major transplant center. The computer simulation enabled the reallocation of existing staff prior to the system implementation.
Mining OMIM$^{\trade}$ for Insight into Complex Diseases
Authors: Cantor Michael N.  , Lussier Yves A.
Published: February 2025

Understanding clinical phenotypes through their corresponding genotypes is one of the principal goals of genetic research. Though achieving'this goal is relatively simple with single gene syndromes, more complex diseases often consist of varied clinical phenotypes that may be the result of interactions among multiple genetic loci. Microarray technology has brought the phenotype -genotype relationship to the molecular level, using differently behaving cancers, for example, as the basis for comparing patterns of gene expression. With this feasibility study, we attempted to use similar methods of analysis at the clinical level, in order to evaluate our hypothesis that the clustering of clinical phenotypes would provide information that would be useful in elucidating their underlying genotypes. Because of its breadth of content and detailed descriptions, we used OMIM as our source materialfor phenotypic and genetic information. After processing the source material, we then performed self-organizing map and hierarchical clustering analysis on representative diseases by phenotypic category. Through predetermined queries over this analysis, we made two findings of potential clinical significance, one concerning diabetes and another concerning progressive neurologic diseases. Our methods provide a formal approach to analyzing phenotypes among diverse diseases, and may help indicate fruitful areas for further research into their underlying genetic causes.
Microarray Data Mining Using Gene Ontology
Authors: Li Songhui  , Becich Michael J.  , Gilbertson John
Published: February 2025

DNA microarray technology allows scientists to study the expression of thousands of genes - potentially entire genomes - simultaneously. However the large number of genes, variety of statistical methods employed and the complexity of biologic systems complicate analysis of microarray results. We have developed a web based environment that simplifies the presentation of microarray results by combining microarray results processed for statistical significance with probe set annotation by Genbank, NCBI RefSeqs, GeneCards and the Gene Ontology. This allows rapid examination and classification of microarray experiments – annotated by NCIBI tools - by Statistical Significance and Gene Oncology Classes. By providing a simple, easily understood interface to large microarray data sets, this tool has been particularly usefulfor small research groups focused on a small number of related genes and for researchers who want to ask simple questions without the overhead of complex data management and analysis.
The Roots of Trust: Cognition Beyond Rational
Authors: Kennedy William G.
Published: February 2025

Trust is not simply the result of rational cognition but relies on rational and “beyond rational” cognition. The concept of trust is discussed in terms of its biological, Maslow, and cognitive roots. The cognitive roots rely on the Dual Process Theory, i.e. that there are two types of cognition sometimes called rational and non-rational. Therefore, the roots of trust need a cognitive architecture that implements the Dual Process Theory and involves cognition both rational and beyond rational.
First Order Logic Concepts in Fluid Construction Grammar
Authors: Sierra-Santibáñez Josefina
Published: February 2025

This paper proposes a formal definition of Fluid Construction Grammar (FCG) in terms of First Order Logic concepts, including its core inference operations unify and merge. Our aim is not only to clarify basic notions in FCG but also to provide a logical foundation for provably sound and efficient implementations.
On the Detection and Analysis of VAT Carousel Crime
Authors: Jedrzejek Czeslaw  , Bak Jaroslaw  , Falkowski Maciej  , Cybulka Jolanta  , Nowak Maciej
Published: February 2025

The paper presents a simple environment to analyze a sufficient amount of data concerning trading transactions in order to reveal the crime schemes. We assumed that the output of the analysis should be presented in a user-friendly graphical form – the Palantir Technologies tool was used as the system's back-end. The front-end is constituted by the knowledge base expert rules used to reveal a carousel fraud scheme and roles of companies implicated in this crime. We utilize the Jess rule engine to do reasoning.
A Meshless EFG-Based Algorithm for 3D Deformable Modeling of Soft Tissue in Real-Time
Authors: Abdi Elahe  , Farahmand Farzam  , Durali Mohammad
Published: February 2025

The meshless element-free Galerkin method was generalized and an algorithm was developed for 3D dynamic modeling of deformable bodies in real time. The efficacy of the algorithm was investigated in a 3D linear viscoelastic model of human spleen subjected to a time-varying compressive force exerted by a surgical grasper. The model remained stable in spite of the considerably large deformations occurred. There was a good agreement between the results and those of an equivalent finite element model. The computational cost, however, was much lower, enabling the proposed algorithm to be effectively used in real-time applications.
Tele-Orthopaedics: United States Army European Regional Medical Command
Authors: Morgan Jeffrey  , Walker Shaka  , Melaas David  , Crane Maria  , Bacahui Jacob  , Boedeker Ben H.
Published: February 2025

Telemedicine is the provision of medical care over long distances by way of videoconferencing and other communication technologies. Staff at Vilseck U.S. Army Clinic set up a 3-month pilot real-time tele-orthopaedic clinic to determine if it was feasible to extend Orthopaedic specialty care over long distances. A full time physician assistant was located at the patient site and an orthopaedic surgeon was located at the Landstuhl or Heidelberg site. Patients were initially evaluated by the PA. Complex consults were reviewed by the PA and Orthopaedic surgeon via telephone or VTC. Patients meeting possible indications for surgery were then scheduled for a VTC consult with a surgeon.
Perception of Stiffness in Laparoscopy – the Fulcrum Effect
Authors: Nisky Ilana  , Huang Felix  , Milstein Amit  , Pugh Carla M.  , Mussa-Ivaldi Ferdinando A.  , Karniel Amir
Published: February 2025

We explored how the perception of stiffness can be distorted in Minimally Invasive Surgery. We combined a mechanical simulator with a haptic device, and implemented linear springs at the tip of the simulated laparoscopic device. To explore the influence of mechanical advantage on perception, we set different values of the ratio between internal and external length of the tool. We found that a nonsymmetrical ratio causes bias in the perceived stiffness when novice tangential probing is compared to radial probing. In contrast, haptic experts did not show similar perceptual bias.