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PubMed1994

Natural language processing of medical texts within the HELIOS environment.

A large number of hospital applications are potentially interested in natural language processing since they currently heavily depend on an efficient use of a huge amount of textual information. The need for systems that are able to accept multiple European languages is of paramount interest, as language barriers can be a strong impediment for large-scale communication in Europe, in particular regarding telemedicine. In the context of the AIM project HELIOS, the Natural Language Processing (NLP) component offers a large variety of medical services according to natural language free input. It allows the multilingual analysis of medical texts (currently in English, French and German) and the storage of the meaning of these texts under a deep knowledge representation that can be queried whenever it is needed. In addition, it provides facilities to handle knowledge source embedded into the conceptual typologies and into the dictionaries. This article aims at describing all these functionalities and their integration into the environment of the HELIOS project.

Artificial Intelligence↗
PubMed1993

Modelling for natural language understanding.

Natural Language Understanding (NLU) is a rapidly growing field in medical informatics. Its potential for tomorrow's applications is important. However, it is limited by its ability to ground its components on a solid model of the domain. This opens the way for the emergence of the discipline of medical domain modelling, as part of the vast field of Knowledge Base (KB) engineering. This article aims at describing the current development of a multilingual natural language system, strongly oriented towards the semantics of the domain. Special emphasis is presently given to the task of building a domain model, and to establish direct links with the language platform. The result is a model-driven NLU system. Numerous benefits are expected in the long term.

Artificial Intelligence↗
PubMed1993

Goals for concept representation in the GALEN project.

The GALEN project aims to develop language independent concept representation systems as the foundations for the next generation of multilingual coding systems. Traditional coding schemes have reached the limits of what can be maintained and managed, and a shift to formal compositional systems is now essential. GALEN is developing one such scheme and an associated concept model, together with criteria for their evaluation. It should provide the flexibility required to cope with the diversity amongst medical applications, whilst ensuring the coherence necessary for integration and re-use of terminologies.

Humans↗
PubMed1995

Toward a medical linguistic knowledge base.

This paper presents the design of a Medical Linguistic Knowledge Base (MLKB). This MLKB is intended to be the multilingual recipient for all the declarative knowledge about languages. It includes words, their syntax and their conceptual representation, typology of concepts of the domain, rules for semantic analysis and conceptual schemata. For that purpose, Sowa's conceptual graphs are considered as an adequate knowledge representation. The MLKB will be an enormous body of information, and the difficulty to feed it and to validate it appears immediately. Therefore, it is necessary to start an international initiative to merge efforts from different groups.

Language↗
PubMed1995

The use of text encoding in the development of a terminology and knowledge system associated with the Norwegian version of the ICD-10.

In order to achieve a high quality on the coding work according to the ICD-10 in Norway, we have selected a new method for developing a Norwegian version. The objective is to arrive at a version which will ensure safe and easy coding. Standardization of nomenclature/terminology has been emphasized, leaving the users in no doubt as to what is the preferred terminology. Separate auxiliary applications for the ICD-10 are developed to make search operations more efficient in the coding work. For each code, a selected amount of supplementary information is given, enabling the user to check, on a medical basis, whether or not the selected code is the correct one. The ICD-10 will appear in SGML format, a markup language which, to our knowledge, has not been used for medical classification systems before. This format is well-suited for the development of multilingual classification systems, a fact which WHO should consider when they now start to develop the ICD-11.

Expert Systems↗
PubMed1995

Constructing clinical applications: the GALEN approach.

A common problem for developers of clinical applications is coping with the diversity of medical language. Medical language as it is used all over the world varies widely, while the referents for these words stay essentially the same. Software developers must reconcile this diversity with the practical necessity of producing applications that are usable in a variety of hospitals, while ensuring that information can be shared between applications. Existing approaches center around coding and classification schemes, but these approaches must be supplemented by a range of sophisticated terminological services in order for the language barriers to be overcome. To address this, the GALEN project is developing an application called the Terminology Server to provide such a range of terminological services (e.g., conceptual and multilingual services). The software is built upon a re-usable core model of medical terminology. This paper reports on the development of a clinical application called the SCUI (Structured Clinical User Interface) which draws on these GALEN technologies and illustrates an innovative approach to the construction of future clinical applications. The SCUI was specifically developed and tested in the context of infectious diseases to satisfy the demands made by the medical intensive care unit on the Geneva Hospital's microbiology laboratory.

Clinical Laboratory Information Systems↗
PubMed1995

Ethical issues in neonatal paediatrics--the Singapore perspective.

In Singapore, formulating ethical guidelines for people who live in a multiracial, multilingual, multicultural and multi-religious community can be difficult. The "individualised prognostic" strategy in the management of critically ill infants has been followed. Our neonatal paediatricians encounter the following ethical problems: extremely premature babies whose viability is doubtful, babies born with severe congenital malformations, babies born with signs of life in legal or therapeutic termination of pregnancy, the asphyxiated babies or babies with severe or extensive brain damage, and babies who are chronically sick and have no chance of recovery or leaving the hospital. Good ethical decisions require medical facts. The infant's diagnosis and prognosis must be accurate. There should also be detailed information that continuation of any form of medical treatment for the infant is futile, will do more harm than good and is inhumane. Ethical decisions should be made in the best interests of the infant. Dating of the infant's gestational age should be accurate and reliable, and there should also be unanimous definitions such as fetal viability, abortions and lethal malformations. Ethical guidelines and the law must also keep pace with changes in medical practice.

Abortion, Legal↗
PubMed1995

Reference materials and reference measurement systems in laboratory medicine. Harmonization of nomenclature and definitions in reference measurement systems.

Reliability of clinical laboratory results is obtained through quality assurance in both their production and transmission. The former involves a reference measurement system of reference materials and reference measurement procedures with metrological and statistical verification of results. The latter requires that sender and receiver have access to a common terminology. Thus, two data banks are required. A plurilingual systematic vocabulary related to the reference measurement system, giving concepts with terms and definitions concerning measurement standards, reference measurement procedures, internal quality control, external quality assessment, probability and statistics-mainly based on existing authoritative publications. The material should be processed by standard scientific terminological procedure and offered to pertinent organizations and specialists for comment before finalization and authorization. A multilingual collection of systematic names for properties examined by the branches of Laboratory Medicine, such as clinical chemistry, clinical immunology, clinical microbiology, clinical pharmacology, haematology and blood banking, and histochemistry and cytology. The database should function as a reference to consultation and as a link in the transmission of data between local laboratory "dialects". This should be based on the ongoing comprehensive IUPAC/IFCC project for forming names in collaboration with relevant scientific organisations and area specialists. The relational data base including "run-time" software would be accessed by e-mail (gopher or other storage medium).

Chemistry, Clinical↗
PubMed1995

A Terminology Server for medical language and medical information systems.

GALEN is developing a Terminology Server to support the development and integration of clinical systems through a range of key terminological services, built around a language-independent, re-usable, shared system of concepts--the CORE model. The focus is on supporting applications for medical records, clinical user interfaces and clinical information systems, but also includes systems for natural language understanding, clinical decision support, management of coding and classification schemes, and bibliographic retrieval. The Terminology Server integrates three modules: the Concept Module which implements the GRAIL formalism and manages the internal representation of concept entities, the Multilingual Module which manages the mapping of concept entities to natural language, and the Code Conversion Module which manages the mapping of concept entities to and from existing coding and classification schemes. The Terminology Server also provides external referencing to concept entities, coercion between data types, and makes its services available through a uniform applications programming interface. Taken together these services represent a new approach to the development of clinical systems and the sharing of medical knowledge.

Artificial Intelligence↗
PubMed1995

Representing clinical narratives using conceptual graphs.

The analysis of medical narratives and the generation of natural language expressions are strongly dependent on the existence of an adequate representation language. Such a language has to be expressive enough in order to handle the complexity of human reasoning in the domain. Sowa's Conceptual Graphs (CG) are an answer, and this paper presents a multilingual implementation, using French, English and German. Current developments demonstrate the feasibility of an approach to natural Language Understanding where semantic aspects are dominant, in contrast to syntax driven methods. The basic idea is to aggregate blocks of words according to semantic compatibility rules, following a method called Proximity Processing. The CG representation is gradually built, starting from single words in a semantic lexicon, to finally give a complete representation of the sentence under the form of a single CG. The process is dependent on specific rules of the medical domain, and for this reason is largely controlled by the declarative knowledge of the medical Linguistic Knowledge Base.

Artificial Intelligence↗
PubMed1998

The distinction between linguistic and conceptual semantics in medical terminology and its implication for NLP-based knowledge acquisition.

Natural language understanding systems have to exploit various kinds of knowledge in order to represent the meaning behind texts. Getting this knowledge in place is often such a huge enterprise that it is tempting to look for systems that can discover such knowledge automatically. We describe how the distinction between conceptual and linguistic semantics may assist in reaching this objective, provided that distinguishing between them is not done too rigorously. We present several examples to support this view and argue that in a multilingual environment, linguistic ontologies should be designed as interfaces between domain conceptualizations and linguistic knowledge bases.

Artificial Intelligence↗
PubMed1998

Modeling concepts in medicine for medical language understanding.

Over the past two decades, the construction of models for medical concept representation and for understanding of the deep meaning of medical narrative texts have been challenging areas of medical informatics research. This review highlights how these two inter-related domains have evolved, emphasizing aspects of medical modeling as a tool for medical language understanding. A representation schema, which balances partially but accurately with complete but complex representations of domain-specific knowledge, must be developed to facilitate language understanding. Representative examples are drawn from two major independent efforts undertaken by the authors: the elaboration and the subsequent adjustment of the RECIT multilingual analyzer to include a robust medical concept model, and the recasting of a frame-based interlingua system, originally developed to map equivalent concepts between controlled clinical vocabularies, to invoke a similar concept model.

Artificial Intelligence↗
PubMed1998

G7: a framework for international cooperation in medical informatics.

The world's major economic powers, the G7, have initiated a collaborative International research and demonstration program to exploit the benefits of information and communications technology for society. The Global Healthcare Applications Project (GHAP) is investigating a variety of informatics applications in disease specific domains, telemedicine, and multilingual textual and image database systems. This paper summarizes the nine GHAP sub-projects undertaken to date, with emphasis on those in which the U.S. is a participant. The growing use of smart card technology, especially in Europe, is adding new impetus for similar medical and health experiments in the U.S. A pilot project now underway in several Western states is described.

Computer Communication Networks↗
PubMed2004

Bilingual oral language proficiency in children with cochlear implants.

OBJECTIVE: To document oral language proficiency in a group of prelingually deaf bilingual children with a cochlear implant. DESIGN: Using a repeated-measures paradigm, oral language skills in the first and second language were evaluated at 2 yearly intervals after implantation. Language data were compared with normative data from children with normal hearing. SUBJECTS: Twelve deaf children between the ages of 20 months and 15 years who had received a cochlear implant before the age of 3 years. OUTCOME MEASURE: First-language skills were assessed using 1 of 2 standardized tests, either the Oral and Written Language Scales or the Reynell Developmental Language Scales, depending on the child's age. Second-language proficiency was assessed using the Student Oral Language Observation Matrix. RESULTS: Average standard scores in the first language fell solidly within the average range of normal-hearing peers. Second-language skills showed steady improvement from year 1 to year 2, along a continuum that reflected the amount and intensity of exposure of the child to the second language and the length of experience with the implant. CONCLUSION: A cochlear implant can make oral proficiency in more than 1 language possible for prelingually deaf children.

Adolescent↗
PubMed2002

Paper or screen, mother tongue or English: which is better? A randomized trial.

CONTEXT: To compare family physicians' ability to retain information when reading a review article on paper vs on screen, and in their mother tongue vs in English. METHODS: Randomized trial of 114 Scandinavian family physicians who read a review article in October or November 2000 from the Journal of Trauma for 10 minutes either on paper and in English, on screen and in English, on paper in their mother tongue, or on screen in their mother tongue. To assess comprehension, they immediately completed a questionnaire with 6 open questions about 13 key facts from the review article. Sum score was on a scale from 0 (no correct answers) to 13 points (all questions answered correctly). RESULTS: There was no significant difference between readers of paper vs screen versions, with a median (interquartile range [IQR]) of 4 (2-6) vs 4 (2-5), respectively (P =.97). Physicians who read in their mother tongue scored significantly higher than those who read in English, with a median (IQR) of 4 (3-6) vs 3 (2-4) (P =.01). CONCLUSION: The medium (paper vs screen) did not influence the ability of family physicians to retain medical information. They best retained medical information when reading in their mother tongue.

Adult↗
PubMed1999

Prenatal experience and neonatal responsiveness to vocal expressions of emotion.

Newborn differentiation of emotion and the relevance of prenatal experience in influencing responsiveness to emotion was tested by examining newborn responses to the presentation of a range of vocal expressions. Differential responding was observed, as indicated by an increase in eye opening behavior in response to the presentation of happy speech patterns. More importantly, differential responding was observed only when the infants listened to emotional speech as spoken by speakers of their maternal language. No evidence of discrimination was found in the groups of infants listening to the same vocal expressions in a novel language. The results suggest that as a consequence of prenatal exposure to the distinctive prosodic maternal speech patterns that specify different emotions and to the temporally related stimuli created by distinctive maternal physiological concomitants of emotion, the fetus learns to differentiate those emotional speech patterns typical of the infant's maternal language.

Arousal↗