=Paper= {{Paper |id=Vol-1180/CLEF2014wn-eHealth-ShenEt2014 |storemode=property |title=An Investigation of the Effectiveness of Concept-based Approach in Medical Information Retrieval |pdfUrl=https://ceur-ws.org/Vol-1180/CLEF2014wn-eHealth-ShenEt2014.pdf |volume=Vol-1180 |dblpUrl=https://dblp.org/rec/conf/clef/ShenweiNLL14 }} ==An Investigation of the Effectiveness of Concept-based Approach in Medical Information Retrieval== https://ceur-ws.org/Vol-1180/CLEF2014wn-eHealth-ShenEt2014.pdf
                 An Investigation of
    the Effectiveness of Concept-based Approach
          in Medical Information Retrieval
        GRIUM @ CLEF2014eHealthTask 3

            Wei Shen, Jian-Yun Nie, Xiaohua Liu, and Xiaojie Liu

                   C.P. 6128, succursale Centre-ville Montreal,
                           Quebec CANADA H3C 3J7
               {shenwei,nie,xiaohul,xiaojie}@iro.umontreal.ca



      Abstract. In our participation in the CLEF 2014 eHealth task 3a, we in-
      vestigate the effectiveness of concept-based retrieval techniques on med-
      ical IR. Concepts are determined using the existing resources and tools:
      UMLS Metathesaurus and MetaMap. We tested several methods based
      on concepts. Although some of these methods lead to slight improve-
      ments in retrieval effectiveness over a traditional bag-of-words method,
      the impact of the rich domain ressource is lower than we expected. So the
      whole question on whether and how such a resource can help improve
      medical IR effectiveness remains open. In this report, we describe the
      methods tested as well as their results.

      Keywords: concept-based retrieval, query expansion, language model,
      UMLS, MetaMap, Indri


1   INTRODUCTION
Our experiments on CLEF 2014 eHealth Task 3 [1, 2] aim to investigate the
effectiveness of concept-based approaches in Medical IR. Medicine is possibly
the area in which there are the best manually constructed resources for identi-
fying concepts. Metathesaurus [24] is a large thesaurus in medicine, gathering
resources such as MeSH [25], Snomed [26], etc. Tools for identifying and dis-
ambiguating concepts in texts, such as MetaMap [27] have also be developed.
In Metathesaurus a term is linked to a large number of other terms, denoting
his synonyms, lexical variants, abbreviations and hypernyms, hyponyms, etc.
Intuitively, the availability of those resources and tools should result in better
IR effectiveness than the traditional bag-of-words approaches. However, the pre-
vious experimental results have been disappointing. For example, [3] did not
observe any improvement using concepts recognized from texts. [4] exploited
a statistical thesaurus and obtained 2.2% improvement. [5] used MetaMap to
recognize concepts from texts, and used the concepts in query expansion. This
led to an improvement of 4.4% over the bag-of-words approach. A number of
other studies [6–21] have also used different resources and tools. However, the




                                      236
global conclusions are similar: In some cases, slight improvements are obtained,
in other cases, no improvements or even degradations are observed. Overall, the
experimental results using medical resources and tools for IR have been lower
than one expects. The whole question remains: can we really benefit from the
rich resources and tools in the medical area to improve IR effectiveness? Are
they related to the way that the resources and tools are used?
    In our experiments in CLEF 2014, we would like to examine a few more
possible approaches to take advantage of medical concepts. In our experiments,
we use MetaMap to recognize medical concepts from documents and queries.
MetaMap identifies concepts from a text (document or query). From the concept
IDs (CUI - Concept Unified Identifier) identified, we can further identify the
concept word sequence (SUI - String Unified Identifier). Our experiments will
test several ways to exploit either CUI or SUI. In prticular, we will focus on query
expansion using concepts, as query expansion has been shown to be relatively
effective in the previous experiments on medical IR.


2       METHODS
Let us first describe the bag-of-words baseline method to which our methods
will be compared. Then we will describe how concepts are determined and used
in our approaches.

2.1      Baseline
As baseline, we use a traditional approach based on language modeling, with
Dirichlet smoothing[23]. We use Indri as the basic experimental platform for all
the methods. For the baseline method, the score of a document D for a query Q
is determined as follows:
                                             n
                                          1X
                            S(Q, D) =           log P (qi |D)                   (1)
                                          n i=1

where n is the length of query and P (qi |D) is adjusted by Dirichlet smoothing,
                                                      tf
                                                       qi ,C
                                          tfqi ,D + µ |C|
                            P (qi |D) =                                         (2)
                                                 |D| + µ

Here C represent the whole collection and |C| is its size. All the terms are
stemmed using Porter stemmer, and stop words from PubMed are removed.

2.2      Concept-based IR
Concept identification We use UMLS Metathesaurus Release2012AB as our
resource. A concept is defined as a “meaning”1 . Each meaning is given a CUI
    1
        http://www.ncbi.nlm.nih.gov/books/NBK9684/




                                      237
(Concept Unified Identifier). The different synonyms and abbreviations of this
concept is called a Term which is identified by LUI (Lexical Unified Identifer).
Each of their lexical variant will be further subdivided into different String.
SUI (String Unified Identifier) is their ID. For example, concept C0004238 cor-
responds to the meaning atrial fibrillation. While atrial fibrillation
and auricular fibrillation are two synonyms, they are identified by two dif-
ferent LUIs L0004238 and L0004237. These two terms have both their singular
and plural forms, with and without s. So in UMLS concept C0004238 corre-
sponds to 4 different SUIs representing its 4 different expression strings, called
SUIname in Metathesaurus.




              Fig. 1. Concept, Term, String and Atom Identifiers [24]



    MetaMap is a tool that identifies concepts from a text. Among other func-
tionalities, MetaMap can identify the CUI corresponding to the concept string.
It can also find all different string expressions (i.e. SUI names) for this concept.
CUI and SUI names are the two different concept expressions that we used in
our experiments. An example is shown in the figure below.


            Original Expression    CUI   SUIname
                                         atrial fibrillation
            atrial fibrillation C0004238 atrial fibrillations
                                         auricular fibrillation
                                         auricular fibrillations

             Fig. 2. Mapping original expression to CUI and SUIname




                                     238
Retrieval on concept ID space We can view the whole set of concepts IDs
as defining a concept space. Both document and query can then be represented
as a set of CUI that MetaMap has recognized. The ranking score of a document
can be determined by the matching score based on the concept IDs using the
language model.
                                               n
                                            1X
            S(Q, D) = S(QCU I , DCU I ) =         log P (qCU Ii |DCU I )     (3)
                                            n i=1

It is possible that some of the concepts in documents and queries cannot be
correctly identified by MetaMap. In this case, a more reasonable approach is to
combine the concept-based retrieval with the traditional word-based retrieval.
We implement it as follows:

             S(Q|D) = λS(Qorig , Dorig ) + (1 − λ)S(QCU I , DCU I )          (4)


Reformulation with concept SUI name CUI is a very strict expression
of concept. Another alternative expression of a concept is to enumerate all his
SUIname in Metathesaurus. These SUInames are put into the #syn() operator
in Indri[29], who treat all of the expressions listed as synonyms. We further
test different operators #1(), #uwN(), #uwN+1() and #combine() with different
flaxibility for each concept name, where #1() matches the term in parentheses
as an exact phrase. #uwN() and #uwN+1() allows terms to appear in unordered
window of size N and N + 1. #combine() just eliminate all dependence and
group terms as ”bag of words”. This method is denoted by:

                         S(Q|D) = S(Qsuiname , Dorig )                       (5)

Again, the above method can be combined with the word-based approach as
follows:

           S(Q|D) = λS(Qorig , Dorig ) + (1 − λ)S(Qsuiname , Dorig )         (6)


Query expansion with mutual information Term co-occurrence analysis
has been quite successful in traditional IR to determine related terms. Here, we
try to determine related concepts using concept co-occurrences. Two concepts
are considered to be related if they co-occur frequently. The relevance between
two concepts x and y is measured by Point-wise Mutual Information (PMI):

                                           p(x, y)
                              pmi = log                                      (7)
                                          p(x)p(y)

We found that many of the determined concepts are indeed strongly related. For
example, the related concepts to Sepsis are listed in Figure 3. We can see that
they are usually related to the related drugs, diseases and treatments.




                                    239
                                    blood poison      bougardirey hemoglobin mali substance
                      injectable product solesta      abrasive point
                      brem hemoglobin mer sur         factor gamma interferon necrosis tumor
                            cilastatin dose mass      hazebrouck hemoglobin
               glomerulosclerosis intercapillary      blanche grange hemoglobin
concord enterica entericon salmonella ser subsp       immunosuppressant macrolide
                                adrenergic nerve      hemoglobin henri mondor substance
              aeromonadaceae family organism          dibromopropamidine product
                            injection mitomycin       hemoglobin maputo substance
                                        murexide      abnormal blood find urea
                            blood entity fluidity     hemoglobin ibadan k
                                     gene kdm4b       hemoglobin vaasa
                cystic disease medullary uremic       gard hemoglobin ty
                               entire pelvis renal    phosphomannan
                                       crotalarias

                Fig. 3. Top 30 Mutual Information concepts of Sepsis



   In our experiment, the original query is expanded by the top mutual infor-
mation concepts. In addition, the query is further expanded by the suiNames of
the concepts.

  S(Q, D) = λ1 S(Qorig , Dorig ) + λ2 S(Qsuiname , Dorig ) + λ3 S(Qmi , Dorig )              (8)

with
                                   λ1 + λ2 + λ3 = 1                                          (9)


Markov Random Field Model In addition to taking into account synonyms,
we also consider dependencies between words within a concept. Markov Random
Field (MRF) model [22] can be used to account for dependencies between words.
By default, one can assume that there is a dependency between two adjacent
query words. Many experimental results showed that this model works better
than the traditional bag-of-words method. When concepts are identified, it is
possible that we only assume dependencies within a concept, and we believe that
this could be a better approach than the default model. The MRF model contains
three components. The first component is the traditional uni-gram language
model. The second component is an ordered model, in which a concept is required
to appear together and in order. This can be implemented in Indri as follows:

                                                                   tf#1(q1 ,q2 ,...qk ),C
                                      tf#1(q1 ,q2 ,...qk ),D + µ           |C|
           P (qorderedConcept |D) =                                                         (10)
                                                       |D| + µ

where tf#1(q1 ,q2 ,...qk ),D is the frequency of an ordered concept in document, and
k is the length of this concept.




                                        240
   The third component is an unordered model, in which the words within a
concept can appear in any order within a text window.
                                                                  tf#uwk+1(q1 ,q2 ,...qk ),C
                                 tf#uwk+1(q1 ,q2 ,...qk ),D + µ           |C|
    P (qunorderedConcept |D) =                                                                 (11)
                                                       |D| + µ

where tf#uwk+1(q1 ,q2 ,...qk ),D is the frequency of the words in a window of size
k + 12 .
   Based on the above probabilities, we can define S(qorderedConcept , D) and
S(qunorderedConcept , D). The final score is a combination of these three models,

S(Q, D) = λ1 S(Qword , D) + λ2 S(qorderedConcept , D) + λ3 S(qunorderedConcept , D)
                                                                              (12)
where
                               λ1 + λ2 + λ3 = 1                               (13)
The model defined above is compared to the default MRF model, in which any
two adjacent query words are assumed to be dependent (sequential dependence
model).


3     EXPERIMENT
The data set for task 3 consists of a set of documents in the mdeical domain,
provided by the Khresmoi project. Each document contains #Uid,#date,#url
and #content fields. We convert the collection into TREC style. In the content
part, we eliminate all commend, css and JavaScript part and all HTML tags.
Only the remaining textual contents are indexed. Each query contains ,
<desc>, <discharge_summary>. We use the short title queries.
The following 12 methods (runs) are tested:
 1. baseline (Submitted as GRIUM_EN_Run1)
 2. SUIname query, groupped by #1() oprator.
 3. SUIname query expansion, groupped by #1() oprator.
 4. SUIname query expansion, groupped by #uwN() oprator.
 5. SUIname query expansion, groupped by #uwN+1() oprator.(Submitted as
    GRIUM_EN_Run5)
 6. SUIname query expansion, groupped by #combine() oprator.
 7. manual SUIname query expansion, groupped by #combine() oprator. Con-
    cepts are identified manually.
 8. Pure CUI query retrieved in CUI document
 9. CUI query expansion, document also contain <original> and <cui> two
    fields.(Submitted as GRIUM_EN_Run7)
10. Top mutual information and SUI name query expansion.
    (Submitted as GRIUM_EN_Run6 )
    2
      We only use k+1 as the window size in our experiments, although other sizes could
also be used




                                         241
11. Markov Random Field baseline with bigram and biterm.
12. Markov Random Field with concept dependence.
Only 4 of them (those with the run IDs) have been submitted.



4       RESULT
The experimental results are summarized in Fig. 4.3



                                                                        Result
Submit Run ID       Method                                      MAP     P@10 R-prec
Run1     Run 1      Baseline                                0.3945 0.7180 0.4201
         Run a      #1(SUIname) query                       0.2717 0.5680 0.3042
         Run b      #1(SUIname) query expansion             0.3916 0.6900 0.4217
         Run c      #uwN(SUIname) query expansion           0.4055 0.7500 0.4279
Run5     Run 5      #uwN+1(SUIname) query expansion         0.4069 0.7420 0.4283
         Run e      #combine(SUIname) query expansion       0.4112 0.7140 0.4286
         Run f      #combine(manual SUIname) query expan- 0.4185 0.7540 0.4306
                    sion
         Run g      CUI query                               0.2276 0.4920 0.2692
Run7     Run 7      CUI expansion                           0.3495 0.6540 0.3862
Run6     Run 6      #uwN+1(SUIname) expansion + Mutual- 0.4007 0.7120 0.4156
                    Info expansion
         Run h      Markov random field baseline            0.3999 0.7320 0.4175
         Run i      Markov random field with concept depen- 0.3965 0.7260 0.4195
                    dence

          Fig. 4. Result of 12 runs evaluated by clef2014t3.qrels.test.binary.



    First of all, we observe that the method using only strict concept space is
less effective than the traditional word-based method. Run g, which use CUI
query leads to a degradation of 42.3% compared to the baseline. If we simply
compare the “bag-of-words” and “bag-of-concepts” methods, bag-of-words ap-
proach is certainly more flexible as a retrieve framework.
The result is far from what was expected. That means concept mapping pro-
cedure is still the bottleneck of the concept-based approach. Unfortunately, the
mapping process is much more complicated than it seems. The definision of con-
cept itself is not clear. An important hypothesis of “concept” is that “a meaning
” should correspend only to one concept. But in fact, in UMLS a meaning can
    3
     In order to keep the result comparable with other runs, we change the lambda of
GRIUM EN Run5 from 5/6 to 1/10. The submitted result was 0.4016 for MAP, 0.7540
for P10.




                                        242
be represented by a single accurate concept or be broken down into smaller con-
cepts. For example, in query 36, for meaning open pelvic fracture, we can have
4 choices:

 1. {Open fracture of pelvis}
 2. {Fractures, Open} and {Pelvis}
 3. {Open} and {Fracture of pelvis}
 4. {Open} and {Fracture} and {Pelvis}

    This is not simply an ambiguity, but also a granularity problem. None of
them should be judged as definitly wrong, but their retrieval performance is
different. In Fig.5, we show the concepts identified using different strategies:


 Mapping       Mapped concept expression                               MAP(in
 strategy                                                              Run e)
 Original     Convalescence after an open pelvic fracture and a right
 query        superior rami fracture
 MetaMap      [Convalescence] [Fractures, Open] [Pelvis] [Open] [Frac- 0.4958
              ture of pelvis] [Right superior] [Branch of plant] [Frac-
              ture]
 Broad manual [Convalescence] [Fractures, Open] [Pelvis] [Right supe- 0.3820
              rior] [Fracture of public rami]
 Middle man- [Convalescence] [Open fracture of pelvis] [Right superior] 0.3445
 ual          [Fracture of public rami]
 Narrow man- [Convalescence] [Open fracture of pelvis, multiple public 0.3078
 ual          rami - unstable]

Fig. 5. Performance of different mapping strategies. Implemented by method e: #com-
bine(SUIname) expansion.


the concepts identified by MetaMap, the broad concepts, narrow concepts and
those in the middle level identified manually from Metathesaurus, as well as the
corresponding MAP score. As we can see, the strategy that group many words
into a very specific concept (Narrow manual) does not produce the best result.
On the contrary, the other strategies that break long concepts into parts work
significantly better. Still, the concepts that we recognize from a text have a
large impact on the final retrieval result. This brings some new challenges for
mapping task. [28] reported that MetaMap reached 84% in precision and 70%
in recall. However, this evaluation is not done for the purpose of IR. For the 50
test queries, MetaMap identified 88 concepts. A rough evaluation indicates that
only 66% of them, i.e.58 concepts seem reasonable for IR. We believe that even
these concepts may not form the best way to do retrieval.
    Knowing that mapping is not always acurate, some compromise solutions
have to be used. Our tests show that at least two such strategies can help to
reduce the impact of wrong mapping.
First, the most simple way is to also consider the original query. The concept




                                     243
      Run     Method                               MAP     Compared Compared
      name                                                 with     with Run
                                                           baseline g:    CUI
                                                                    query
      Run 1 Baseline                     0.3945
      Run g CUI query                    0.2276 -42.3%
      Run a #1(SUIname) query            0.2717 -31.1%                +19.4%
      Run b #1(SUIname) expansion        0.3916 -0.7%                 +72.1%
      Run e #combine(SUIname) expansion  0.4112 +4.2%                 +80.7%
      Run f #combine(manual SUIname) ex- 0.4185 +6.1%                 +83.9%
            pansion

      Fig. 6. The benefits of query expansion strategie and retrieval flexibility


based synonyms are only treated as a complement to the original query. In our
test, Run b, #1(SUIname) expansion brought an improvement of 57.2% over a
pure #1(SUIname) query. At Run c, 5, e, f, the combination query brought an
improvement.
Second, instead of strict CUI Id, we use SUIname as the expression of concept. As
we can see in the result, Run a produced 19.4% less mistake than Run g. In addi-
tion, taking into account the fact that concepts IDs can share many words.Using
SUIname can further help us retrieving documents on related concepts. That is
why, with #combine() operator, Run e achieved the best performance over all
11 automatic runs. Our two MRF runs (Run h and Run i ) showed in another
way that naive concept-based dependence does not bring any improvement.




Fig. 7. Query expansion Vs. Pure CUI, SUIname query and baseline at MAP. The
three straight lines represent respectively pure CUI, SUIname query and baseline. The
four curves show their different combination result.




                                       244
    Fig.7 shows the impact of using different values for lambda.
At last, our naive mutual information expansion did not bring any additional
information as expected.


5    CONCLUSION

This year in task 3, we tested several different ways of integrating concept knowl-
edge. Our results showed that the “bag-of-concepts” is less effective than “bag-
of-words” approach. We further discuss about two effecive ways of reducing
the impact of incorrect concept mapping. Original query is indispensable, and
SUIname is a more flexiable way of using a concept. The mapping performance
is still the bottleneck of the concept-based approach. This is a question that we
will examine in our future research.


References

1. Liadh Kelly, Lorraine Goeuriot, Hanna Suominen, Tobias Schrek, Gondy Leroy,
   Danielle L. Mowery, Sumithra Velupillai, Wendy W. Chapman, David Martinez,
   Guido Zuccon and Joao Palottim. Overview of the ShARe/CLEF eHealth Evalu-
   ation Lab 2014. Proceedings of CLEF 2014. Lecture Notes in Computer Science
   (LNCS). Springer. (2014)
2. Lorraine Goeuriot, Liadh Kelly, Wei Li, Joao Palotti, Pavel Pecina, Guido Zuccon,
   Allan Hanbury, Gareth Jones and Henning Mueller. ShARe/CLEF eHealth Evalu-
   ation Lab 2014, Task 3: User-centred health information retrieval. Proceedings of
   CLEF 2014. (2014)
3. Hersh, William R.; David D. Hickam; and T. J. Leone. Words, concepts, or both:
   Optimal indexing units for automated information retrieval. Mark E. Frisse (ed.)
   Proceedings of the 16th Annual Symposium on Computer Applications in Medical
   Care, 644-648 (1992)
4. Srinivasan P. Query expansion and MEDLINE. Information Processing and Man-
   agement, 32(4): 431-443 (1996)
5. Aronson, A. R., & Rindflesch, T. C. Query expansion using the UMLS Metathe-
   saurus. In Proceedings of the AMIA Annual Fall Symposium. American Medical
   Informatics Association, p. 485 (1997)
6. BOUDIN, Florian, NIE, Jian-Yun, et DAWES, Martin. Clinical information re-
   trieval using document and PICO structure. In : Human Language Technologies:
   The 2010 Annual Conference of the North American Chapter of the Association for
   Computational Linguistics. Association for Computational Linguistics, p. 822-830
   (2010)
7. ZHOU, Wei, YU, Clement, SMALHEISER, Neil, et al. Knowledge-intensive concep-
   tual retrieval and passage extraction of biomedical literature. In : Proceedings of the
   30th annual international ACM SIGIR conference on Research and development in
   information retrieval. ACM. p. 655-662. (2007)
8. Zhu, Dongqing, et al. ”Using discharge summaries to improve information retrieval
   in clinical domain.” Proceedings of the ShARe/-CLEF eHealth Evaluation Lab
   (2013)




                                        245
9. ZUCCON, G., KOOPMAN, B., et NGUYEN, A. Retrieval of health advice on the
   web: AEHRC at ShARe/CLEF eHealth evaluation lab task 3. In : Proceedings
   of CLEF Workshop on Cross-Language Evaluation of Methods, Applications, and
   Resources for eHealth Document Analysis. (2013)
10. Choi, Sungbin, and Jinwook Choi. ”SNUMedinfo at CLEFeHealth2013 task 3.”
   Proceedings of the ShARe/CLEF eHealth Evaluation Lab (2013)
11. Bedrick, Steven, and G. Sheikhshabbafghi. ”Lucene, metamap, and language mod-
   eling: OHSU at CLEF eHealth 2013 .” Proceedings of the ShARe/CLEF eHealth
   Evaluation Lab (2013)
12. CALLEJAS, P., MIGUEL, A., WANG, Yue, et al. Exploiting Domain Thesaurus
   for Medical Record Retrieval. DELAWARE UNIV NEWARK, (2012)
13. OZTURKMENOGLU, Okan et ALPKOCAK, Adil. DEMIR at TREC Medical:
   Power of Term Phrases in Medical Text Retrieval. In : TREC. (2011)
14. QI, Yanjun et LAQUERRE, Pierre-Franois. Retrieving Medical Records with sen-
   named: NEC Labs America at TREC 2012 Medical Records Track.(2012)
15. KOOPMAN, Bevan, BRUZA, Peter, SITBON, Laurianne, et al. AEHRC & QUT
   at TREC 2011 Medical Track: a concept-based information retrieval approach. In :
   Proceedings of 20th Text REtrieval Conference (TREC 2011). National Institute of
   Standards and Technology (NIST), p. 1-7 (2011)
16. KOOPMAN, Bevan, ZUCCON, Guido, NGUYEN, Anthony, et al. Exploiting
   SNOMED CT concepts and relationships for clinical information retrieval: Aus-
   tralian e-Health Research Centre and Queensland University of Technology at the
   TREC 2012 Medical Track. (2012)
17. KING, Benjamin, WANG, Lijun, PROVALOV, Ivan, et al. Cengage Learning at
   TREC 2011 Medical Track. In : TREC. (2011)
18. FUJITA, Sumio. Revisiting Again Document Length Hypotheses TREC 2004 Ge-
   nomics Track Experiments at Patolis. In : TREC. (2004)
19. DARWISH, Kareem et MADKOUR, Amgad. The GUC Goes to TREC 2004: Using
   Whole or Partial Documents for Retrieval and Classification in the Genomics Track.
   In : TREC. (2004)
20. KRAAIJ, Wessel, RAAIJMAKERS, Stephan, WEEBER, Marc, et al. MeSH Based
   Feedback, Concept Recognition and Stacked Classification for Curation Tasks. In :
   TREC. (2004)
21. LI, Jiao, ZHANG, Xian, ZHANG, Min, et al. THUIR at TREC 2004: Genomics
   Track. In : TREC. (2004)
22. ARONSON, Alan R. et RINDFLESCH, Thomas C. Query expansion using the
   UMLS Metathesaurus. In : Proceedings of the AMIA Annual Fall Symposium.
   American Medical Informatics Association, p. 485. (1997)
23. ChengXiang Zhai: Statistical Language Models for Information Retrieval. Synthesis
   Lectures on Human Language Technologies, Morgan & Claypool Publishers (2008)
24. BODENREIDER, Olivier. The unified medical language system (UMLS): inte-
   grating biomedical terminology. Nucleic acids research, vol. 32, no suppl 1, p. D267-
   D270. (2004)
25. LIPSCOMB, Carolyn E. Medical subject headings (MeSH). Bulletin of the Medical
   Library Association, vol. 88, no 3, p. 265 (2000)
26. SPACKMAN, Kent A., CAMPBELL, Keith E., C, R. A., et al. SNOMED RT:
   a reference terminology for health care. In : Proceedings of the AMIA annual fall
   symposium. American Medical Informatics Association. p. 640. (1997)
27. ARONSON, Alan R. Effective mapping of biomedical text to the UMLS Metathe-
   saurus: the MetaMap program. In : Proceedings of the AMIA Symposium. American
   Medical Informatics Association, p. 17. (2001)




                                       246
28. PRATT, Wanda et YETISGEN-YILDIZ, Meliha. A study of biomedical concept
   identification: MetaMap vs. people. In : AMIA Annual Symposium Proceedings.
   American Medical Informatics Association. p. 529. (2003)
29. STROHMAN, Trevor, METZLER, Donald, TURTLE, Howard, et al. Indri: A lan-
   guage model-based search engine for complex queries. In : Proceedings of the Inter-
   national Conference on Intelligent Analysis. p. 2.6. (2005)
30. MILLER, George A. WordNet: a lexical database for English. Communications of
   the ACM, vol. 38, no 11, p. 39-41. (1995)




                                      247

</pre>