1,720,986 research outputs found
Supporting the distributed execution of clinical guidelines by multiple agents
No full textClinical guidelines (GLs) are widely adopted in order to improve the quality of patient care, and to optimize it. To achieve such goals, their application on a specific patient usually requires the interventions of different agents, with different roles (e.g., physician, nurse), abilities (e.g., specialist in the treatment of alcohol-related problems) and contexts (e.g., many chronic patients may be treated at home). Additionally, the responsibility of the application of a guideline to a patient is usually retained by a physician, but delegation of responsibility (of the whole guideline, or of a part of it) is often used
equired (e.g., delegation to a specialist), as well as the possibility, for a responsible, to select the executor of an action (e.g., a physician may retain the responsibility of an action, but delegate to a nurse its execution). To manage such phenomena, proper support to agent interaction and communication must be provided, providing agents with facilities for (1) treatment continuity (2) contextualization, (3) responsibility assignment and delegation (4) check of agent “appropriateness”. In this paper we extend GLARE, a computerized GL management system, to support such needs. We illustrate our approach by means of a practical case study
Conformance analysis for comorbid patients in Answer Set Programming
No full textThe treatment of comorbid patients is a hot problem in Medical Informatics, since the plain application of multiple Computer-Interpretable Guidelines (CIGs) can lead to interactions that are potentially dangerous for the patients. The specialized literature has mostly focused on the “a priori” or “execution-time” analysis of the interactions between multiple Computer-Interpretable Guidelines (CIGs), and/or CIG “merge”. In this paper, we face a complementary problem, namely, the a posteriori analysis of the treatment of comorbid patients. Given the CIGs, the history of the status of the patient, and the log of the clinical actions executed on her, we try to explain the actions executed on the patient (i.e., the log) in terms of the actions recommended by the CIGs, of their potential interactions, and of the possible ways of managing each such interaction, pointing out (i) deviations from CIG recommendations not explained in terms of interaction management (if any) and (ii) unmanaged interactions (if any). Our approach is based on Answer Set Programming, and, to face realistic problems, devotes specific attention to the temporal dimension
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Temporal reasoning and query answering with preferences and probabilities for medical decision support
No full textKnowledge-based decision support systems have a long tradition within the medical area. In particular, in the last decades, many Computer-Interpretable Guidelines (CIG) systems have been built to provide evidence-based and knowledge-based support to physicians. Since CIGs are, by definition, devoted to the management of specific diseases, the treatment of comorbid patients constitutes a challenging task in the area, involving (i) the detection of the possible interactions between (the effects of) the actions recommended by multiple CIGs (one for each disease of the patient), (ii) the management of such interactions and, finally, (iii) the conciliation of (the recommendations of) different CIGs. This paper focuses on issue (i) above, and specifically, on an innovative approach to support interaction detection along the temporal dimension. Practically, interactions can only occur between effects that intersect in time. Therefore, interaction detection involves the representation of temporal information (temporal constraints), and temporal reasoning (to propagate such constraints). Additionally, query answering facilities are important to support physicians in the investigation of the results of temporal reasoning. Current CIG approaches that face such issues take into account only “crisp” temporal constraints, i.e., they consider all temporal constraints as equally probablepreferred. However, preferences about the temporal constraints between CIGs actions may be available, as well as knowledge about the probabilistic distribution of the effects of CIGs actions in time. Considering such additional pieces of information can provide crucial advantages, in term of the flexibility and informativeness of the support provided by the CIG system to physicians. In this paper, we propose the first homogeneous approach to represent and reason with (propagate) temporal constraints with both preferences and probabilities. We ground our approach on the widely-used Simple Temporal Problem (STP) framework, which supports temporal reasoning on temporal constraints about possible distances between events. We extend (i) the representation formalism to associate preferences andor probabilities to the possible distances, and (ii) the operations to propagate the constraints to combine also preferences and probabilities. We also (iii) provide an experimental evaluation of our approach, and (iv) propose a wide range of query-answering supports, to facilitate physicians in the analysis of the results of temporal reasoning in general, and in the temporal detection of possible interactions in particular. Finally, (v) we also show how such a temporal framework is integrated in GLARE-SSCPM, a CIG system to treat comorbid patients, and show the advantages of our approach considering a running example
Gitelman syndrome, spironolactone and effects on puberty
No full textDGN, ragazza di 17 anni affetta da malattia di Gitelman.
Primogenita di tre sorelle sane, ha manifestato i primi sintomi
all’età di 7 anni con profonda astenia e segno di Chvostek alle
mani durante un episodio di gastroenterite acuta. Alla luce del
riscontro di alcalosi metabolica, ipokaliemia e QT allungato la
bambina veniva ricoverata per gli approfondimenti del caso e nel
sospetto di di tubulopatia renale, si eseguiva indagine genetica
con riscontro di mutazione patogenetica di SLCA3 (esone 18
c.221G>A; c.2237G>A). Si impostava pertanto la terapia con
risparmiatore di potassio (Spironolattone) e supplementazione di
KCl e Mg per os
Successivo follow up regolare presso il nostro servizio di
Nefrologica Pediatrica, senza sostanziali novità cliniche da
segnalare se non un quadro di amenorrea primaria.
A febbraio 2021, all’età di 14 anni, in presenza di pubarca e
peluria pubica dall’età di 11 anni (Ph 4, A2, B 4-5), in assenza di
menarca, eseguiva prima valutazione Endocrinologica Pediatrica
presso il nostro centro. Veniva sottoposta quindi ad ulteriori
approfondimento diagnostico che mostrava normalità degli
esami ormonali con attivazione in senso puberale e assenza di
anomalie ginecologiche.
Per persistenza di amenorrea, a distanza di 15 mesi, eseguito, su
indicazione Ginecologica MAP test con con didrogesterone, senza
beneficio.
Durante il follow-up clinico si segnala inoltre concomitante
riscontro di calo ponderale di 4 kg in pochi mesi e iniziale
restrizione alimentare e dismorfofobia per cui intraprendeva
percorso di terapia nutrizionale educazionale.
A gennaio 2023, dopo discussione collegiale del caso e colloquio
con i genitori, si decideva di interrompere la terapia con
spironolattone e di intraprendere switch ad amiloride. Poche
settimane dopo lo switch terapeutico, si assisteva alla comparsa
di spotting e poi ciclo mestruale, confermando l’ipotesi di una
possibile interazione tra lo spironolattone e gli ormoni sessuali
La malattia di Gitelman è una tubulopatia ereditaria Nadisperdente associata a ipokaliemia. E’ una patologia a
trasmissione autosomica recessiva, dovuta a mutazioni in
proteine responsabili del riassorbimento di NaCl localizzate nel
tubulo contorto distale e collettore.
Clinicamente è caratterizzata dalla presenza di ipokaliemia,
alcalosi metabolica, ipomagnesemia, ipocalciuria, pressione
arteriosa normale o lievemente ridotta ed elevati livelli ematici di
renina e aldosterone.
La terapia si basa su idratazione e dieta adeguate e sulla
supplementazione di NaCl, K e Mg. Inoltre, può essere indicato
l’uso di farmaci diuretici risparmiatori di potassio, di ACE inibitori
o inibitori del recettore dell’angiotensina.
Numerosi studi riportano un’associazione tra la sindrome di
Gitelman ed un ritardo nello sviluppo puberale (1). Più in
generale, le malattie renali croniche (CKD) possono ritardare
l’avvio o la progressione della pubertà, con conseguenze
sull’accrescimento staturale e sulla funzione riproduttiva in età
adulta (2). Nonostante sia innegabile che anche una scorretta
alimentazione possa contribuire a queste manifestazioni, sempre
più studi confermano un rapporto di causalità diretta degli effetti
biologici della CKD sull’asse ipotalamo-ipofisi-gonadi. Infatti, non
è raro che pazienti affetti da CKD e/o che hanno ricevuto un
trapianto di reni siano affetti da pubertà ritardata ed
ipogonadismo ipergonadotropo(4, 5, 6).
In alcuni studi, anche l’utilizzo di diuretici risparmiatori di
potassio (in particolare spironolattone) è stato correlato ad
ipogonadismo e a ritardo nello sviluppo puberale negli
adolescenti. Infatti, lo spironolattone agisce come antiandrogeno
andando a competere con gli ormoni sessuali per il legame con il
recettore degli androgeni, provocando un aumento della
secrezione di LH e FSH, ma soprattutto un aumento di 17-OHP.
Lo spironolattone mostra quindi sia un’azione di blocco nei
confronti del feedback negativo dell’asse ipotalamo-ipofisigonadi, ma anche un’inibizione enzimatica a livello gonadico e/o
surrenalico (7). Per tali motivi, gli studi sembrano confermare
l’utilità dello spironolattone nel trattamento di acne e irsutismo;
inoltre, poichè lo sviluppo puberale (in particolare nei soggetti di
sesso maschile) è mediato sia da ormoni androgeni che
estrogeni, il blocco dell’azione androgenica sembrerebbe avere
un ruolo anche nel ritardare lo sviluppo puberale in soggetti
affetti da pubertà precoce idiopatica. (8, 9, 10)
In conclusione, lo spironolattone può avere effetti sulla
steroidogenesi sia surrenalica che gonadica, può aumentare i
livelli di gonadotropine in soggetti di età pediatrica e può agire
come antiandrogeno sui tessuti periferici (11).
Per questi motivi, la terapia con spironolattone può essere
associata ad irregolarità mestruali nelle femmine, a ginecomastia
ed impotenza nei maschi e a ritardo nello sviluppo puberale in
entrambi i sessi
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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