bims-librar Biomed News
on Biomedical librarianship
Issue of 2022–05–29
25 papers selected by
Thomas Krichel, Open Library Society



  1. Stud Health Technol Inform. 2022 May 25. 294 585-586
      Many clinical studies are greatly dependent on an efficient identification of relevant datasets. This selection can be performed in existing health data catalogues, by searching for available metadata. The search process can be optimised through questioning-answering interfaces, to help researchers explore the available data present. However, when searching the distinct catalogues the lack of metadata harmonisation imposes a few bottlenecks. This paper presents a methodology to allow semantic search over several biomedical database catalogues, by extracting the information using a shared domain knowledge. The resulting pipeline allows the converted data to be published as FAIR endpoints, and it provides an end-user interface that accepts natural language questions.
    Keywords:  Clinical Studies; Health Data; Ontology; Semantic Questioning
    DOI:  https://doi.org/10.3233/SHTI220535
  2. Inf Serv Use. 2022 ;42(1): 95-106
      Donald A.B. Lindberg M.D. arrived at the U.S. National Library of Medicine in 1984 and quickly launched the Unified Medical Language System (UMLS) research and development project to help computers understand biomedical meaning and to enable retrieval and integration of information from disparate electronic sources, e.g., patient records, biomedical literature, knowledge bases. This chapter focuses on how Lindberg's thinking, preferred ways of working, and decision-making guided UMLS goals and development and on what made the UMLS markedly "new and different" and ahead of its time.
    Keywords:  Donald A.B. Lindberg M.D.; U.S. National Library of Medicine; Unified Medical Language System
    DOI:  https://doi.org/10.3233/ISU-210138
  3. Eur J Investig Health Psychol Educ. 2022 May 04. 12(5): 458-464
      Nowadays, a multitude of scientific publications on health science are being developed that require correct bibliographic search in order to avoid the use and inclusion of retracted literature in them. The use of these articles could directly affect the consistency of the scientific studies and could affect clinical practice. The aim of the present study was to evaluate the capacity of the main scientific literature search engines, both general (Gooogle Scholar) and scientific (PubMed, EMBASE, SCOPUS, and Web of Science), used in health sciences in order to check their ability to detect and warn users of retracted articles in the searches carried out. The sample of retracted articles was obtained from RetractionWatch. The results showed that although Google Scholar was the search engine with the highest capacity to retrieve selected articles, it was the least effective, compared with scientific search engines, at providing information on the retraction of articles. The use of different scientific search engines to retrieve as many scientific articles as possible, as well as never using only a generic search engine, is highly recommended. This will reduce the possibility of including retracted articles and will avoid affecting the reliability of the scientific studies carried out.
    Keywords:  biomedical publishing; publication ethics; research methodology; retraction of publication; scientific misconduct
    DOI:  https://doi.org/10.3390/ejihpe12050034
  4. Inf Serv Use. 2021 ;41(3-4): 221-229
      In June 1993, the National Library of Medicine (NLM) joined with the National Institutes of Health's (NIH) Office of AIDS Research (OAR), and the National Institute of Allergy and Infectious Diseases (NIAID) to host a conference at a pivotal time in the HIV/AIDS epidemic to understand better the information needs of five major constituency groups: clinical researchers; clinical providers; news media and the public; patients; and the affected community. NLM's director, Donald A.B. Lindberg M.D., and staff sought to identify new program possibilities benefitting from the input of current and potential users of the Library's information services. Conference recommendations led to a key NLM policy change providing cost-free access to all AIDS data, and the establishment of the HIV/AIDS community information outreach program (ACIOP), which enabled new partnerships with local community-based organizations serving the affected community. Uniquely funded and long running, more than 300 ACIOP projects have been supported to-date. These projects have improved awareness and use of national HIV/AIDS information resources; enhanced information seeking skills; developed locally generated information resources; and enhanced the capacity of community-based organizations to use new information and computer technologies providing access to essential information resources and services.
    Keywords:  Donald A.B. Lindberg M.D.; HIV/AIDS community information outreach program; HIV/AIDS information services conference; U.S. National Institutes of Health; U.S. National Library of Medicine; community-based outreach
    DOI:  https://doi.org/10.3233/ISU-210124
  5. Inf Serv Use. 2021 ;41(3-4): 241-254
      Donald A.B. Lindberg, M.D., brought with him when he joined NLM an inquisitive mind, tech savvy, and new ideas. He was an early advocate of both outreach and evaluation innovation at NLM. Dr. Lindberg initiated and supported multiple pilot test and implementation projects to strengthen NLM's health information outreach to healthcare providers, research scientists, health science and hospital librarians, and the general public, including minority and underserved populations. He helped steer NLM's transition to the Internet, and NLM's development of a robust framework for evaluating Internet and Web-based health information dissemination and outreach to its many audiences. Dr. Lindberg's leadership led to numerous landmark accomplishments, including the capacity-building "Measuring the Difference" outreach evaluation Guide, and a multi-dimensional approach to Internet and website evaluation that placed NLM at the forefront of federal agencies using these new and emerging technologies to support their missions.
    Keywords:  Donald A.B. Lindberg M.D.; Internet performance; U.S. National Library of Medicine; customer satisfaction; evaluation; health information dissemination; outreach; usage data; user surveys; web data analytics; websites
    DOI:  https://doi.org/10.3233/ISU-210126
  6. Inf Serv Use. 2021 ;41(3-4): 255-267
      This chapter considers the transformation of U.S. National Library of Medicine's (NLM) national network of libraries into an effective force for spreading awareness of NLM's resources, services, and tools and increasing their use. Several examples of network programs and projects are recounted to illustrate the influence of NLM's longest serving Director, Donald A.B. Lindberg M.D. on the development and evolution of NLM's library network.
    Keywords:  Donald A.B. Lindberg M.D.; National Network of Libraries of Medicine (NN/LM); Outreach; Regional Medical Library; U.S. National Library of Medicine
    DOI:  https://doi.org/10.3233/ISU-210127
  7. Inf Serv Use. 2021 ;41(3-4): 213-220
      The U.S. National Library of Medicine's (NLM) Environmental Health Information Partnership (EnHIP) collaborates with Historically Black Colleges and Universities (HBCUs) and other minority-serving academic institutions to enhance their capacity to reduce health disparities through the access, use, and delivery of environmental health information on their campuses and in their communities. The partnership began in 1991 as the Toxicology Information Outreach Panel (TIOP) pilot project, and through successive iterations it is NLM's longest running outreach activity. EnHIP's continued relevance today as an information outreach and training program testifies to the prescience of NLM director, Donald A.B. Lindberg M.D's initial support for the program. Dr. Lindberg's seeing to its continued success to benefit participating institutions and help achieve the societal goals of environmental justice serve as well to benefit NLM by increasing its visibility, and use of its resources in the classroom, for research, and in community outreach. NLM envisions an expanding role for EnHIP in advancing health equity as the impact of environmental exposure, climate change, and increasing zoonotic diseases disproportionately impact their communities.
    Keywords:  Donald A.B. Lindberg M.D.; Environmental Health Information Partnership; Environmental justice; Health disparities; Historical black colleges and universities; Outreach; U.S. National Library of Medicine
    DOI:  https://doi.org/10.3233/ISU-210123
  8. Inf Serv Use. 2022 ;42(1): 129-136
      This paper gives a flavor of Dr. Donald A.B. Lindberg's view of the expanding role of libraries, his curiosity, and his tolerance for taking educated risks, through the creation and nurturing of National Library of Medicine's Visible Human Project. That project produced the Visible Man and Visible Woman datasets and a suite of tools for presenting and analyzing those and similar datasets. The results are used in teaching anatomy and other medical school courses and in software from the open-source Insight Tool Kit (ITK) that is included in many if not most volume-reconstructing systems. This story is a bit personal. From the beginning we recognized and understood each other since we were both "boys from Brooklyn".
    Keywords:  Donald A.B. Lindberg; Insight Tool Kit; U.S. National Library of Medicine; Visible Human Project
    DOI:  https://doi.org/10.3233/ISU-210145
  9. Inf Serv Use. 2022 ;42(1): 3-10
      This overview summary of the Informatics Section of the book Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine illustrates how the NLM revolutionized the field of biomedical and health informatics during Lindberg's term as NLM Director. Authors present a before-and-after perspective of what changed, how it changed, and the impact of those changes.
    Keywords:  Donald A.B. Lindberg; U.S. National Library of Medicine; biomedical informatics; health informatics
    DOI:  https://doi.org/10.3233/ISU-210133
  10. Inf Serv Use. 2022 ;42(1): 11-19
      As a young pathologist, Donald A.B. Lindberg, M.D., tirelessly sought scientific solutions to clinical and research problems. Directing several clinical laboratories at the University of Missouri in Columbia, Dr. Lindberg developed the world's first computerized laboratory information system, speeding analysis and reporting. He directed his team in building computer systems to help clinicians retrieve medical knowledge, enable patients to find information about personal or family health issues, and provide expert automated assistance to physicians in reaching differential diagnoses outside their specialties. Developing superior functionalities with the limited information technologies of the time, Dr. Lindberg's pioneering work in Columbia foreshadowed his subsequent inspired leadership as Director of the United States National Library of Medicine.
    Keywords:  AI/COAG; AI/RHEUM; Artificial Intelligence; CONSIDER; Computers in Medicine; Donald A.B. Lindberg; Knowledge Based Systems; Laboratory Information Systems; Regional Medical Program; University of Missouri-Columbia
    DOI:  https://doi.org/10.3233/ISU-210140
  11. Inf Serv Use. 2021 ;41(3-4): 203-211
      Under the leadership of NLM Director Donald A.B. Lindberg M.D., the National Library of Medicine (NLM) continued to promote its services to the nation's health care professionals and scientists. With support of the U.S. Congress, it initiated new communications and outreach programs and services directed at the general public that revolutionized their access to information as well. Because effective health communication must be tailored for the audience and the situation, Lindberg supported the development of online health information tools designed to help consumers find free, comprehensive, timely, and trustworthy sources of health information that, ultimately, can improve patient outcomes. New and popular consumer-friendly websites were championed by Lindberg, including MedlinePlus, and ClincialTrials.gov, and he formed unique partnerships with national physician organizations to educate their patients about reliable sources of health information from the NLM. A new era of timely and trusted online health information for the general public began in 2006 under Lindberg's tenure culminating in the development, publication and distribution of NIH's first consumer magazine, NIH MedlinePlus, featuring the research and findings of the NIH. In his effort to improve patient outcomes, Dr. Lindberg revolutionized the Library's outreach capabilities and successfully expanded its mission to serve not only health professionals and scientists, but also consumers nationwide.
    Keywords:  Donald A.B. Lindberg M.D.; U.S. National Library of Medicine; consumer health; outreach
    DOI:  https://doi.org/10.3233/ISU-210122
  12. Inf Serv Use. 2021 ;41(3-4): 315-323
      Personal reflections on Donald A.B. Lindberg M.D. are offered by four Native American leaders who were instrumental in the successful development of the National Library of Medicine's (NLM) Native Voices Exhibition: Stories of Health and Wellness from American Indians, Alaska Natives and Native Hawaiians. A uniquely collaborative effort, the exhibition features nearly 100 videographed interviews conducted by Dr. Lindberg with Native elders, healers, leaders, and people. He is credited with the incorporation of indigenous peoples' healing knowledge in a personal and relational way, making for a wonderful journey together that was a very large chapter in his life and that of the authors.
    Keywords:  Alaska Native; American Indian; Donald A.B. Lindberg M.D.; Indigenous people; Native Hawaiian; Native Voices Exhibition; Native healing; U.S. National Library of Medicine
    DOI:  https://doi.org/10.3233/ISU-210131
  13. Inf Serv Use. 2022 ;42(1): 29-38
      The Integrated Academic/Advanced Information Systems (IAIMS) program began in 1983 and was based on a study by the Association of American Medical Colleges (AAMC). Donald A.B. Lindberg M.D. was a member of the AAMC Advisory Committee. The U.S. National Library of Medicine (NLM) grants for IAIMS were initiated in 1984 the same year Dr. Lindberg became Director of the NLM. This chapter presents an overview of IAIMS and its progression through three stages with Dr. Lindberg's leadership.
    Keywords:  Association of American Medical Colleges (AAMC); IAIMS; National Library of Medicine (NLM); integrated information; integrated resources; medical libraries
    DOI:  https://doi.org/10.3233/ISU-210134
  14. Inf Serv Use. 2022 ;42(1): 39-45
      Through his visionary leadership as Director of the U.S. National Library of Medicine (NLM), Donald A. B. Lindberg M.D. influenced future generations of informatics professionals and the field of biomedical informatics itself. This chapter describes Dr. Lindberg's role in sponsoring and shaping the NLM's Institutional T15 training programs.
    Keywords:  Donald A.B. Lindberg; U.S. National Library of Medicine; biomedical informatics training
    DOI:  https://doi.org/10.3233/ISU-210135
  15. Inf Serv Use. 2021 ;41(3-4): 281-292
      In 1997, Donald A.B. Lindberg M.D., Director, U.S. National Library of Medicine (NLM) agreed to address the request of African malaria researchers for full access to the Internet and medical journals as part of the U.S. National Institutes of Health's (NIH) contribution to the Multilateral Initiative on Malaria (MIM). This challenge matched my interests and previous experience in Africa. I joined NLM in 1997 to help establish the MIM Communications Network (MIMCom) in partnership with several NIH components and more than 30 other partners in Africa, the U.S., the United Kingdom (U.K.), and Europe. After a successful launch of MIMCom, NLM worked with African partners to create a series of innovative programs with scientists, librarians, journal editors, and medical students to build capacity on the continent and enhance global access to research in Africa.
    Keywords:  National Library of Medicine (U.S.); Sub-Saharan Africa; global health; information technology; malaria
    DOI:  https://doi.org/10.3233/ISU-210129
  16. Inf Serv Use. 2022 ;42(1): 107-115
      The highest priority new initiative resulting from the 1985-86 National Library of Medicine Long Range Planning exercise initiated by NLM Director Dr. Donald A.B. Lindberg was the creation of new information resources and services related to molecular biology and genetics, termed "biotechnology information". Beginning with existing NLM resources and research projects associated with molecular data, and with Lindberg's enthusiastic support, the institution launched a Congressionally-mandated Center that has become an essential part of 21st century biomedical science.
    Keywords:  Donald A.B. Lindberg; Genomics; Human Genome Project; National Center for Biotechnology Information; U.S. National Library of Medicine
    DOI:  https://doi.org/10.3233/ISU-210139
  17. Inf Serv Use. 2021 ;41(3-4): 193-201
      Friends and colleagues of Donald A.B. Lindberg M.D. came together to give tribute to his extraordinary contributions during his tenure (1984-2015) as Director of the U.S. National Library of Medicine (NLM). Dr. Lindberg died in 2019. The book, Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine. includes four sections. The ten edited chapters in section three (the Outreach section) are briefly summarized in this overview. As Associate Director for Health Information Programs Development, Elliot R. Siegel Ph.D. coordinated NLM's outreach programming under Dr. Lindberg's leadership from its inception in 1989 to his own retirement in 2010. Dr. Lindberg's legacy at NLM is one of new possibilities imagined, significant changes made in the mission and ethos of a venerable institution, and numerous successes achieved in a variety of settings and contexts. Like so much else Dr. Lindberg accomplished, these Outreach programs that profoundly changed the character of NLM would likely not have occurred without him. He made a difference.
    Keywords:  Donald A.B. Lindberg M.D.; Outreach; U.S. National Library of Medicine
    DOI:  https://doi.org/10.3233/ISU-210121
  18. Inf Serv Use. 2022 ;42(1): 21-27
      Among the many contributions of Donald A.B. Lindberg was his work on behalf of a variety or professional organizations in the field of biomedical and health informatics. These began during his early days at the University of Missouri and continued throughout his 30 years at the National Library of Medicine. This chapter summarizes that work, which occurred both through his personal efforts and through the impact of the NLM under his leadership. Examples include his role in the development of organizations themselves (e.g., the International Medical Informatics Association, the American College of Medical Informatics, and the American Medical Informatics Association) and also his contributions to the professional scientific meetings that have advanced the field (e.g., the Symposium on Computer Applications in Medical Care, MEDINFO, and the AMIA Annual Symposium).
    Keywords:  American Medical Informatics Association; Donald A.B. Lindberg; International Medical Informatics Association; U.S. National Library of Medicine; medical informatics
    DOI:  https://doi.org/10.3233/ISU-210141
  19. Inf Serv Use. 2022 ;42(1): 71-80
      Precision medicine offers the potential to improve health through deeper understandings of the lifestyle, biological, and environmental influences on health. Under Dr. Donald A. B. Lindberg's leadership, the U.S. National Library of Medicine (NLM) has developed the central reference resources for biomedical research and molecular laboratory medicine that enable precision medicine. The hosting and curation of biomedical knowledge repositories and data by NLM enable quality information reachable for providers and researchers throughout the world. NLM has been supporting the innovation of electronic health record systems to implement computability and secondary use for biomedical research, producing the scale of linked health and molecular datasets necessary for precision medicine discovery.
    Keywords:  Donald A.B. Lindberg; National Library of Medicine; electronic health records; genomics; precision medicine
    DOI:  https://doi.org/10.3233/ISU-210144
  20. Inf Serv Use. 2022 ;42(1): 81-94
      When Donald A.B. Lindberg M.D. became Director in 1984, the U.S. National Library of Medicine (NLM) was a leader in the development and use of information standards for published literature but had no involvement with standards for clinical data. When Dr. Lindberg retired in 2015, NLM was the Central Coordinating Body for Clinical Terminology Standards within the U.S. Department of Health and Human Services, a major funder of ongoing maintenance and free dissemination of clinical terminology standards required for use in U.S. electronic health records (EHRs), and the provider of many services and tools to support the use of terminology standards in health care, public health, and research. This chapter describes key factors in the transformation of NLM into a significant player in the establishment of U.S. terminology standards for electronic health records.
    Keywords:  Donald A.B. Lindberg M.D.; RxNorm; U.S. National Library of Medicine; electronic health records; health information exchange; logical observation identifiers names codes; systematized nomenclature of medicine
    DOI:  https://doi.org/10.3233/ISU-210142
  21. Cureus. 2022 Apr;14(4): e24287
      Introduction Branchial cleft cysts are the second most common congenital neck mass and can cause significant anxiety for patients and families despite their benign nature. Education through online patient education materials (PEMs) is critical for informing patients and reducing stress. We aimed to determine the content, quality, and readability of online PEMs related to branchial cleft cysts. Methods The search engine Google was used to collect the first 100 website results for the query "branchial cleft cyst." PEMs were included and assessed for content, quality via the DISCERN tool, and readability via Flesch Reading Ease Score (FRES), Flesch-Kincaid Reading Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Results Twenty-six websites containing PEMs related to branchial cleft cysts were assessed. Most websites were from universities or medical centers and did not contain any media. The mean DISCERN score was 49.3 (SD: 11.1, Median: 52.5), the mean FRES score was 51.9 (SD: 12.1, Median: 54.0), the mean FKGL score was 10.35 (SD: 2.52, Median: 9.95), the mean GFOG score was 13.32 (SD: 2.52, Median: 13.00), and the mean SMOG score was 10.25 (SD: 1.83, Median: 9.95). DISCERN was not significantly correlated with FRES, FKGL, GFOG, or SMOG. Conclusion Online PEMs related to branchial cleft cysts are consistently written above the National Institutes of Health (NIH) recommended sixth-grade reading level and are often of unsatisfactory overall quality. Writers of online PEMs for branchial cleft cysts should consider the readability and quality of their materials to improve patient education and reduce anxiety.
    Keywords:  branchial cleft cyst; branchial cyst; patient education material; quality of health information; readability
    DOI:  https://doi.org/10.7759/cureus.24287
  22. Stud Health Technol Inform. 2022 May 25. 294 876-877
      We present an analysis of supplementary materials of PubMed Central (PMC) articles and show their importance in indexing and searching biomedical literature, in particular for the emerging genomic medicine field. On a subset of articles from PubMed Central, we use text mining methods to extract MeSH terms from abstracts, full texts, and text-based supplementary materials. We find that the recall of MeSH annotations increases by about 5.9 percentage points (+20% on relative percentage) when considering supplementary materials compared to using only abstracts. We further compare the supplementary material annotations with full-text annotations and we find out that the recall of MeSH terms increases by 1.5 percentage point (+3% on relative percentage). Additionally, we analyze genetic variant mentions in abstracts and full-texts and compare them with mentions found in supplementary text-based files. We find that the majority (about 99%) of variants are found in text-based supplementary files. In conclusion, we suggest that supplementary data should receive more attention from the information retrieval community, in particular in life and health sciences.
    Keywords:  Semantic annotation; Supplementary materials; Text mining
    DOI:  https://doi.org/10.3233/SHTI220614
  23. Health Inf Manag. 2022 May 25. 18333583221090579
       BACKGROUND: People are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality.
    OBJECTIVE: To summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis.
    METHOD: Systematic appraisal of website content. Searches for "knee osteoarthritis" and "knee arthritis" were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability.
    RESULTS: Thirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0-14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16-56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21-74), and Flesch-Kincaid grade level was 8 (range = 5-11).
    CONCLUSION: Few websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability.
    IMPLICATIONS: Careful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs.
    Keywords:  data quality; e-health; health information management; healthcare; public health
    DOI:  https://doi.org/10.1177/18333583221090579
  24. Inf Serv Use. 2022 ;42(1): 61-70
      The U.S. National Library of Medicine's (NLM) funding for biomedical informatics research in the 1980s and 1990s focused on clinical decision support systems, which were also the focus of research for Donald A.B. Lindberg M.D. prior to becoming NLM's director. The portfolio of projects expanded over the years. At NLM, Dr. Lindberg supported various large infrastructure programs that enabled biomedical informatics research, as well as investigator-initiated research projects that increasingly included biotechnology/bioinformatics and health services research. The authors review NLM's sponsorship of research during Dr. Lindberg's tenure as its Director. NLM's funding significantly increased in the 2000's and beyond. Authors report an analysis of R01 topics from 1985-2016 using data from NIH RePORTER. Dr. Lindberg's legacy for biomedical informatics research is reflected by the research NLM supported under his leadership. The number of R01s remained steady over the years, but the funds provided within awards increased over time. A significant amount of NLM funds listed in RePORTER went into various types of infrastructure projects that laid a solid foundation for biomedical informatics research over multiple decades.
    Keywords:  Donald A. B. Lindberg; U.S. National Library of Medicine; biomedical informatics; informatics research funding
    DOI:  https://doi.org/10.3233/ISU-210137
  25. Inf Serv Use. 2022 ;42(1): 47-59
      The US National Library of Medicine's Biomedical Informatics Short Course ran from 1992 to 2017, most of that time at the Marine Biological Laboratory in Woods Hole, Massachusetts. Its intention was to provide physicians, medical librarians and others engaged in health care with a basic understanding of the major topics in informatics so that they could return to their home institutions as "change agents". Over the years, the course provided week-long, intense, morning-to-night experiences for some 1,350 students, consisting of lectures and hands-on project development, taught by many luminaries in the field, not the least of which was Donald A.B. Lindberg M.D., who spoke on topics ranging from bioinformatics to national policy.
    Keywords:  Donald A.B. Lindberg M.D.; Marine Biological Laboratory; US National Library of Medicine; biomedical informatics training
    DOI:  https://doi.org/10.3233/ISU-210136