Defining Quality-Measurable Medical Alerts From Incomplete Data Through Fuzzy Linguistic Variables and Modifiers

MEDICAL alerts are a powerful tool for preventing the occurrence of undesirable health problems. Unfortunately,
nowadays, alert detection systems suffer from several drawbacks: they take into account only a few number of
parameters normally provided by physical devices, they use simple range based algorithms that do not provide
quality indicators and are not flexible, and they do not treat lacking information properly. Therefore, we think a new
approach is necessary in order to address such limitations. The system that we propose aims to cover the whole
lifecycle of medical alerts, which includes detecting (creating), displaying, and archiving them, but only the
detection module is presented in this paper. The main features of our system are the following: medical alerts are
defined through fuzzy linguistic variables; semantic relationships between variables are expressed by a graph; alerts
are associated with applicability levels (ALs), indicating their conformity to the patients, and with trust levels (TL),
indicating their reliability; lack of information is handled transparently; and alerts are double-filtered before being
shown to users.[1][2].

Our medical alert detection method takes as input a set of linguistic variables representing the patient and the environment. Since
this kind of information is usually not stored in a linguistic format in medical records and meteorological Web sources, we must
transform the original crisp variables (e.g., age = 15) into linguistic ones (e.g., age = young) before using them. This process is
called fuzzification. Membership functions [5] traditionally used to perform this task do not take into account other variables. We
think this is a serious drawback because a variable, whatever information it carries, is not an isolated entity depending only on
itself. In this context, we call modifier a variable that is combined to another in order to express the influence it has on the
second. For example, we say that age is a modifier of weight or that weight is modified by age. t the modifiers of a variable do
not have the same relative importance. The weight, for example, is clearly more influenced by age than by gender, as its LL and
MD can completely change if the patient is 5 or 30 years old, but may remain almost unchanged if it is a man or a woman. For
this reason, we associate an importance level— very important (vi), important (i), or fairly important (fi)—with each one of our
modifiers in order to state how strong is its impact on the variable it modifies. Graphs are made in order to depict the
dependencies between the variables. A fuzzy set whose membership function changes according to specific categories belonging
to other sets. For example, as shown in Fig. 2, we can create three different fuzzy sets (i.e., define three membership functions)
for the LL small, each one of them specialized in a category of age: teenager, adult, and elderly. Each edge in the graph is then
modeled by means of specialized fuzzy sets involving the modifier and the variable in such a way that the fuzzy sets of the first
are specialized to the ones of the second. The modifier humidity. It is a fuzzifiable variable, but there is no category in which we
can specialize its three fuzzy sets (dry, normal, and humid) because it is the first node of its path. The solution is what we call
canonical fuzzy sets (in opposition to specialized ones): sets whose membership function does not depend on any category and
uses the crisp values of the variable directly. Nonnumeric variables like gender are not fuzzifiable at all. They are always leaf
nodes in the graph, and their MDs are set to 1.0 by definition. Now that we know how edges and nodes are modeled, we will
show how to use the graph to fuzzify a variable. The goal of the fuzzification process is to transform a crisp value into one or
more tuples of the form LL, MD, and TL indicating the fuzzy sets to which it belongs, the respective MDs, and the reliability of
these MD. The fuzzification of age, for example, will take its crisp value, say, 65 years, and output the tuple elderly, 0.8, and 0.9,
which indicates that the person belongs to the set of elderly people with an MD of 0.8, and that this MD is 90% reliable, as
indicated by the TL of 0.9. of the alerts they receive. Each time the algorithm finds a missing variable, it tries to find out its LL
and MD by approximation through a historical database storing information about fuzzifications in which the values of all
variables of the path were known. Then, to predict the missing value, it isolates the database entries corresponding to the same
path and compares the values of the remaining variables. In our system, medical alerts are constructed from two simple building
blocks: variables and the logical operator AND. More formally, an alert is defined as follows: alert =(variable-1 AO value-1)
AND ... AND (variable-n AO value-n) where AO stands for arithmetic operator and value-i is an LL. Three operators are
provided: “=” (equals), “≥” (greater than), and “≤” (less than). The operator “≥” takes into account all LLs equal or greater than
elderly (elderly and very elderly) and fat (fat and very fat). [1][3]

We have developed a system for detecting medical alerts based on patient and environmental data. Alerts are defined by expert
users through fuzzy linguistic variables and are associated with two quality indicators used for filtering. Relationships between
variables are modeled by a graph used during their fuzzification. Our system transparently deals with missing information, and is
very modular as variables can be separately created from the alerts using them. Future work includes further research in order to
model other kinds of relationships between variables. For example, only one modifier is applied to a variable at a time but, in
some situations, the simultaneous application of two or more (combined with each other in some way) must be necessary. [1]
[1]. https://ieeexplore.ieee.org/document/4814671/

[2]. https://www.researchgate.net/publication/220521640_Defining_quality-
measurable_medical_alerts_from_incomplete_data_through_fuzzy_linguistic_variables_and_modifiers

[3]. http://cinc.org/archives/2005/pdf/0151.pdf