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The Arden Syntax for Medical Logic Systems is a standard for clinical knowledge representation, maintained by the Health Level Seven (HL7) organization and approved by the American National Standards Institute (ANSI). It offers a wide range of syntactical constructs (various forms of numer-ical, logical, temporal operators, conditions, …), each of...
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Citations
... To convert MLMs into an executable format, Arden Syntax compilers described in the literature usually either transform code into intermediate all-purpose programming languages such as Java [8][9][10] or C++ [11], or into specific virtual machine code [12]. The construction of such a compiler by means of a parser generator presupposes a computable language description in the form of a grammar, usually provided in Backus-Naur form. ...
Objective:
The Arden Syntax for Medical Logic Systems is a standard for encoding and sharing medical knowledge in the form of Medical Logic Modules. To improve accessibility for clinicians, the originators of the standard deliberately designed Arden Syntax expressions to resemble natural language, and parentheses around operands are not generally required. For certain patterns of nested expressions, however, the use of parentheses is mandatory, otherwise they are not accepted by an Arden Syntax environment. In this study, we refer to such patterns as anomalies. The purpose of this paper is to investigate the extent and the circumstances of such anomalies, and to outline a solution based on an alternative grammar encoding approach.
Methods:
To analyze the distribution of anomalies in nested expressions, we developed two custom-made complementary utilities. The first utility, termed parser, checks a single expression pattern against the specification-compliant grammar for syntactic correctness. The second utility, termed composer, automatically creates an extensive amount of expression patterns by permuting and nesting operators without the use of parentheses, and stores these together with the expected syntactic correctness. By means of these utilities we conducted a comprehensive analysis of anomalies by comparing the expected correctness with the actual correctness. Any detected anomalies are stored into a set of files, grouped by the respective top-level operator, for a subsequent analysis.
Results:
The composer utility nested 165 unary, binary, or ternary operators of Arden Syntax version 2.8 to a depth of two, resulting in a set of 76,533 expression patterns, of which 18,978 (24.8%) have been identified as anomalies. An automated assessment of their practical relevance for medical knowledge encoding is infeasible. Manual screening of selected samples indicated that only a small proportion of the detected anomalies would be relevant. The cause of the anomalies lies in the encoding of the grammar. A change of the basic encoding approach with some additional customizations eliminates the anomalies. A working expression parser is included in the supplementary material.
Conclusion:
Arden Syntax expressions are affected by anomalies. Since only a small proportion of them have practical relevance and they cannot cause false calculations or clinical decisions, their practical impact is likely limited. However, they may be potential points of confusion for knowledge engineers. An alternative expression grammar, based on a different encoding approach, would not only eliminate the anomalies, but could considerably facilitate both maintenance and further development of the standard.
... We can define the four fuzzy sets of BMI linguistic variables like: The first three fuzzy sets were defined by Fehre et al. (2010) and upon them, we described the fourth one, see Figure 12. ...
Obesity is associated with various diseases, particularly cardiovascular diseases, diabetes type 2, obstructive sleep apnea, certain types of cancer, osteoarthritis, and asthma. The knowledge of the obesity related cancer (ORC) domain is highly required to be represented in a structured and formalized shape. In this paper, we develop an ontology to represent ORC domain knowledge with its diseases, symptoms, diagnosis, and treatments. The proposed ontology is based on the Web Ontology Language (OWL 2) integrated with the fuzzy logic. The fuzzy developed ontology handles the overlapping concepts, ingesting more concepts, and copes with the linguistic domain variables, which were not possible using the regular ontologies. It allows the users to query the fuzzy Dl reasoner for element and answer them with the fuzzy ontology. By developing the fuzzy ORC ontology, it is expected to be a good practice for the ontologists and knowledge engineers.
... We can define the four fuzzy sets of BMI linguistic variables like: The first three fuzzy sets were defined by Fehre et al. (2010) and upon them, we described the fourth one, see Figure 12. ...
Obesity is associated with various diseases, particularly
cardiovascular diseases, diabetes type 2, obstructive sleep apnea, certain types
of cancer, osteoarthritis, and asthma. The knowledge of the obesity related
cancer (ORC) domain is highly required to be represented in a structured and
formalised shape. In this paper, we develop an ontology to represent ORC
domain knowledge with its diseases, symptoms, diagnosis, and treatments.
The proposed ontology is based on the Web Ontology Language (OWL 2)
integrated with the fuzzy logic. The fuzzy developed ontology handles the
overlapping concepts, ingesting more concepts, and copes with the linguistic
domain variables, which were not possible using the regular ontologies. It
allows the users to query the fuzzy Dl reasoner for element and answer them
with the fuzzy ontology. By developing the fuzzy ORC ontology, it is expected
to be a good practice for the ontologists and knowledge engineers.
... The Arden Syntax server was used to provide system/language independent access to the rule engine [11]. For projects that relied on fuzzy logic, we used the enhanced Fuzzy Arden Syntax IDE and Fuzzy Arden Syntax rule engine [12,13]. All of these software products were implemented in Java. ...
Arden Syntax is a widely recognized standard for representing clinical and scientific knowledge in an executable format. It has a history that reaches back until 1989 and is currently maintained by the Health Level 7 (HL7) organization. We created a production-ready development environment, compiler, rule engine and application server for Arden Syntax. Over the course of several years, we have applied this Arden - Syntax - based CDS system in a wide variety of clinical problem domains, such as hepatitis serology interpretation, monitoring of nosocomial infections or the prediction of metastatic events in melanoma patients. We found the Arden Syntax standard to be very suitable for the practical implementation of CDS systems. Among the advantages of Arden Syntax are its status as an actively developed HL7 standard, the readability of the syntax, and various syntactic features such as flexible list handling. A major challenge we encountered was the technical integration of our CDS systems in existing, heterogeneous health information systems. To address this issue, we are currently working on incorporating the HL7 standard GELLO, which provides a standardized interface and query language for accessing data in health information systems. We hope that these planned extensions of the Arden Syntax might eventually help in realizing the vision of a global, interoperable and shared library of clinical decision support knowledge.
