In previous work, we proposed an approach called the Structural Difference Method (SDM) to correlating the anatomy of Homo sapiens with selected species, using the Foundational Model of Anatomy (FMA) ...as a framework and graph matching as a method, for determining similarities and differences between species. In this paper, we present the design of a comparative anatomy information system that utilizes the SDM and allows users to issue queries to determine the similarities and differences between two species. Our system will serve as a pilot project for cross-species anatomical information collection, storage, and retrieval. The underlying data structure of a mapping, and the syntax and semantics of the system's query language, are presented.
Paget's disease of bone (PDB) is a common disorder characterized by focal abnormalities of bone remodeling. We previously identified variants at the CSF1, OPTN and TNFRSF11A loci as risk factors for ...PDB by genome-wide association study. Here we extended this study, identified three new loci and confirmed their association with PDB in 2,215 affected individuals (cases) and 4,370 controls from seven independent populations. The new associations were with rs5742915 within PML on 15q24 (odds ratio (OR) = 1.34, P = 1.6 × 10−14), rs10498635 within RIN3 on 14q32 (OR = 1.44, P = 2.55 × 10−11) and rs4294134 within NUP205 on 7q33 (OR = 1.45, P = 8.45 × 10−10). Our data also confirmed the association of TM7SF4 (rs2458413, OR = 1.40, P = 7.38 × 10−17) with PDB. These seven loci explained ∼13% of the familial risk of PDB. These studies provide new insights into the genetic architecture and pathophysiology of PDB.
Clinical trial protocol documents play an important role in clinical research. However, clinical protocol writing remains a complex and relatively un-studied process. Protocols are often written by ...teams of people, yet little prior research has captured the problems or analyzed the collaboration support needs of protocol writers. Here we present the results of an initial ethnographic study into the clinical trial protocol writing processes at a representative cooperative clinical trial group funded by National Cancer Institute (NCI). We analyzed the collaborative nature of the writing process, identified common problems, derived information and communication support needs of collaborative clinical protocol writers, and provided recommendations to streamline the process. We believe that this paper contributes useful implications for the design of future collaborative clinical protocol writing tools.
Reuse, CORBA, and knowledge-based systems GENNARI, JOHN H.; CHENG, HEYNING; ALTMAN, RUSS B. ...
International journal of human-computer studies,
10/1998, Letnik:
49, Številka:
4
Journal Article
Recenzirano
By applying recent advances in the standards for distributed computing, we have developed an architecture for a CORBA implementation of a library of platform-independent, sharable problem-solving ...methods and knowledge bases. The aim of this library is to allow developers to reuse these components across different tasks and domains. Reuse should be cost-effective; therefore, the library will include standard problem-solving methods whose semantics are well understood and are described with a language for stating the requirements and capabilities of a component. In addition, when a developer needs toadapta component to a new task, the adaptation costs should be minimal. Thus, we advocate the use of separate mediating components that isolate these adaptations from the original component. We demonstrate our approach with an example: an implementation of a problem-solving method, a knowledge-base server, and mediating components that adapt the method to different knowledge bases and tasks.
We present our experience of using prototype scenarios to actively involve users in the design of a collaborative clinical trial protocol authoring system. This method enables us to do usability ...testing and elicit prompt user feedback at the early phase of de-sign. We conclude that it is an effective approach to the design of complex medical information systems.
While it has been established that electronic order entry systems can prevent transcription errors and check orders for severe drug allergies and interactions, continuous monitoring of the ...effectiveness of order checks is important. The goal of this study is to examine the rate at which high severity order checks generated in the electronic medical record at VA Puget Sound are overridden by clinicians. We compare our results to those of a previous study that found high override rates for Critical Drug Inter-action and Allergy-Drug Interaction order check categories. We are interested in determining whether system changes addressing these high rates have been successful in reducing the overall override rate in these categories. Because the method used previously to extract orders is no longer available, the first step in our study was to develop a new procedure to gather order entry data. This procedure is the subject of our report.
This paper describes how we applied the PROTÉGÉ-II architecture to build a knowledge-based system that configures elevators. The elevator-configuration task was solved originally with a system that ...employed the propose-and-revise problem-solving method (VT). A variant of this task, here named the Sisyphus-2 problem, is used by the knowledge-acquisition community for comparative studies. PROTÉGÉ-II is a knowledge-engineering environment that focuses on the use of reusable ontologies and problem-solving methods to generate task-specific knowledge-acquisition tools and executable problem solvers. The main goal of this paper is to describe in detail how we used PROTÉGÉ-II to model the elevator-configuration task. This description provides a starting point for comparison with other frameworks that use abstract problem-solving methods.
Beginning with the textual description of the elevator-configuration task, we analysed the domain knowledge with respect to PROTÉGÉ-II’s main goal: to build domain-specific knowledge-acquisition tools. We used PROTÉGÉ-II’s suite of tools to construct a knowledge-based system, called ELVIS, that includes a reusable domain ontology, a knowledge-acquisition tool, and a propose-and-revise problem-solving method that is optimized to solve the elevator-configuration task. We entered domain-specific knowledge about elevator configuration into the knowledge base with the help of a task-specific knowledge-acquisition tool that PROTÉGÉ-II generated from the ontologies. After we constructed mapping relations to connect the knowledge base with the method’s code, the final executable problem solver solved the test case provided with the Sisyphus-2 material. We have found that the development of ELVIS has afforded a valuable test case for evaluating PROTÉGÉ-II’s suite of system-building tools. Only projects based on reasonably large problems, such as the Sisyphus-2 task, will allow us to improve the design of PROTÉGÉ-II and its ability to produce reusable components.
We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.
From November 2009 to September ...2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.
Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P < .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.
In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.
Summary of the EXPLANT-TAVR International Registry. Among 196 patients across 42 centers who underwent surgical explantation for ranscatheter aortic valve replacement (TAVR) device failure, 14.3% who underwent aortic root replacement were compared with the remaining 85.7% who underwent aortic valve replacement (AVR). Concomitant root replacement during TAVR explant was not associated with worse outcomes compared with AVR alone, although this group had fewer comorbidities, with more elective cases. Further understanding of the procedural aspects on the decision for AVR versus root replacement will be important. IQR, Interquartile range; HR, ▪▪▪. Display omitted
Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the ...outcomes of patients undergoing THV explant for IE.
All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD).
A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score 2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029 compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16).
In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.
The contribution of genetic polymorphisms to bone mineral density (BMD) and fracture risk in women is a controversial topic. We evaluated the effect of the XbaI and PvuII polymorphisms of the ...estrogen receptor α to BMD and fracture risk in a meta‐analysis, including published data and additional information from investigators. Five thousand eight hundred thirty‐four women from 30 study groups were analyzed with fixed and random effects models. The PvuII polymorphism was not associated with BMD at any skeletal site examined and 95% CIs exclude effects over 0.015 g/cm2 for both the femoral neck and the lumbar spine. Conversely, XX homozygotes (women carrying two copies of the gene variant without an XbaI restriction site) consistently had higher BMD than other subjects. The magnitude of the effect was similar in the femoral neck and lumbar spine (0.014 g/cm2 95% CI, 0.003–0.025 and 0.015 g/cm2 95% CI, 0.000–0.030, respectively; no between‐study heterogeneity for either). Total body BMD was also significantly higher in XX homozygotes (by 0.039 g/cm2 and 0.029 g/cm2 compared with Xx and xx, respectively). Available data on fractures suggested a protective effect for XX (odds ratio OR, 0.66 95% CI, 0.47–0.93 among 1591 women), but not PP (OR, 0.93 95% CI, 0.72–1.18 among 2229 women). In summary, we have found that XX homozygotes may have higher BMD and also a decreased risk of fractures when compared with carriers of the x allele, whereas the PvuII polymorphism is not associated with either BMD or fracture risk.
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