GALEN RevisitedGALEN Revisited

Alan RectorBiohealth Informatics Group & NW Institute of BioHealth Informatics

School of Computer Science, University of Manchester

rector@cs.man.ac.uk

www.opengalen.orgwww.co-ode.org

Open GALEN

BioHealthInformaticsGroup

© University of Manchester

© University of Manchester 2

Plan of sessionPlan of session► GALEN Overview

► What and why

► The GALEN development paradigm► Loosely coupled development and intermediate representations

► The GALEN Meta Model► Normalisation because Knowledge is Fractal

► The GALEN Ontology Revisited► Basics in GALEN and OWL

► Upper Ontologies in 20 questions (or less)

► Parts and Wholes -

►Role inclusion and SEP Triples

► Collectives

► Special Problems

► Duals

► Summary and Questions

© University of Manchester 3

Key lessons from GALENKey lessons from GALEN

► Applications are the purpose: What’s it for

► Enumeration does not scale► Use logic for compositional systems

► “Conceptual Lego”

► Logic is hard and must be hidden► Use “intermediate representations” / “close to user forms”

► Training time limit for domain experts is 3 daysw

► Normalise the ontology► Modularity is essential

► Establish patterns► Having agreed conventions and upper ontologies is more important than

which

► Separate language and logic► It is easier to agree on meanings thean words

© University of Manchester 4

Where I come fromWhere I come from

Best Practice

Clinical Terminology

Data Entry

Clinical Record

Clinical research &

Decision Support

Best Practice

Data Entry

Electronic Health

Records

GALEN Ontologie

s &Descripti

onlogics

Healthcare

Mr Ivor BigunMr Ivor BigunDun RoaminDun RoaminAnytownAnytownAny countryAny country4431 3654 902734431 3654 90273

Clinical research

Decision Support &Knowledge Presentation

© University of Manchester 5

By way of User Centred DesignBy way of User Centred DesignKR was a solution, not a goalKR was a solution, not a goal

© University of Manchester 6

Problem space & solution spaceProblem space & solution space

``

Guidelines, Patterns, Tools

Problem space

Solutionspace

© University of Manchester 7

… … and now toand now to► BioOntologies, Anatomy, and Molecular Pathways

► Capturing biologists knowledge

► Reconciling diverse views / Avoiding ontological dogmatism

► Integrating ≥500 sources

► Healthcare record standards: Data models and Terminology► Improving the rigour of “UML” based message standards

► Binding of terminology to data models

► Medical terminologies / ontologies► GALEN, SNOMED, NCI thesaurus

► Forms generation for clinical trials, data entry & entry and decision support.

► PEN&PAD Revisited

► User oriented Ontology Tools - CO-ODE/Protégé-OWL

► Semantic Web Best Practice WG & Healthcare & Life Sciences SIG(& campaigner for OWL 1.1)

© University of Manchester 8

What are my prejudices?What are my prejudices?

►“First do the right thing; then do it right”► and hope that by the time you know what to do someone else

can show you how

► “There is no one way!”► “Society for the Promotion of Secular Ontology”

►“Better” is better than “best”► The best is often the enemy of the good

►Unobtrusive assistance is better than advice► “Shedding light” rather than

“uttering prophecies”

© University of Manchester 9

Who are my users?Who are my users?

► Intermediate users► Clinical terminologies developers

► GO, SNOMED, GALEN, CCAM, FMA, …

► IT staff configuring clinical systems► NHS, Healthcare information systems staff

► Standards developers► BioPAX, HL7, ??ML,…,

► Near to end users► Bioinformaticians

► Trialists and other specialist healthcare informaticians

► End users► Biolomedical scientists

► Clinicians, carers and patients

© University of Manchester 10

Where we started:Where we started:A VisionA Vision► Useful and Usable clinical systems

► Information when and where you need it

►to make better decisions

►“Shedding light”

►“Cuing”

► In your own language

► Aggregated data as a byproduct of clinical

► Built by communities

► …without getting caught in the combinatorial explosion

© University of Manchester 11

Clinergy/ Pen&PAD Clinergy/ Pen&PAD

► Nice product, bad timing.

© University of Manchester 12

FormsForms

© University of Manchester 13

and more formsand more forms

© University of Manchester 14

Generated TextGenerated Text

And And automatic automatic (Read) code (Read) code generationgeneration

© University of Manchester 15

But there are combinatorially But there are combinatorially many possible formsmany possible forms► The PROMIS system was discontinued in 1987 at

70K forms and accelerating► A major influence on our work

►For us KR is a way to avoid combinatorial explosions

► A supplier recently expanded all XML forms for data capture in one clinic to 107

© University of Manchester 16

Fractal tailoring of reusable resources:Fractal tailoring of reusable resources:on the fly: but how to build on the hierarchies?on the fly: but how to build on the hierarchies?

Renin dependent Hypertension at

St Stevens Hospitals for the National

Hypertension Survey

Hypertension Renin Dependent

Hypertension`In St Stevens Hospital

National Hypertension Survey

17

……so assemble forms from logical so assemble forms from logical structures in a comprehensive ontologystructures in a comprehensive ontology

hasSpecificSubprocess (‘SurgicalAccessing’

hasSurgicalOpenClosedness (SurgicalOpenClosedness which

hasAbsoluteState surgicallyOpen))

(‘SurgicalProcess’ which

isMainlyCharacterisedBy (performance which

isEnactmentOf (‘SurgicalFixing’ which

actsSpecificallyOn (PathologicalBodyStructure which <

involves Bone

hasUniqueAssociatedProcess FracturingProcess

hasSpecificLocation (Collum which

isSpecificSolidDivisionOf (Femur which

hasLeftRightSelector leftSelection))>))))

……but it takes months to learn to to do it but it takes months to learn to to do it

© University of Manchester 18

……but logic & formal ontology but logic & formal ontology scare users scare users►Require months to train even to a minimal level

►People make errors► Even experienced people

►Logic inferences can be directly contrary to language maxims

►Make logic (& formal ontology) the “assembly language”► Give users high level languages

►Ideally built with meta-authoring language construction kit

19

So simplify into an intermediate So simplify into an intermediate representation / close to user formrepresentation / close to user form

"Open fixation of a fracture of the neck of the left femur"

MAIN fixing

ACTS_ON fracture

HAS_LOCATION neck of long bone

IS_PART_OF femur

HAS_LATERALITY left

HAS_APPROACH open

20

FRACTURE SURGERY FRACTURE SURGERY

……and generate friendly and generate friendly forms for end usersforms for end users

Structured Data Entry

File Edit Help

TibiaTibia FibulaFibula AnkleAnkle More...More...

RadiusRadius UlnaUlna WristWrist More...More...HumerusHumerus

FemurFemur

LeftLeft RightRight

More...More...Gt Gt TrochTroch

ShaftShaft NeckNeck

FemurFemur

LeftLeft

NeckNeck

ReductionReduction FixationFixation

OpenOpen ClosedClosedOpenOpen

FixationFixation

2 steps to heaven...

© University of Manchester 21

global cycle &work at centre

local cycles: work by users

Loosely coupled distributedLoosely coupled distributedontology developmentontology development

From authoring to meta-authoringFrom 80% central/global effort

to 10% central/global effort

User effort cut by 75% compared with manual methodsMostly in reduced committee meetings & arguments

22

……in their own languagein their own language

“open fixation of fracture of collum of left femur”

“open fractuurvan collum femur van linkerfemoraal van bot fixeren”

“Áíïé÷ôüò ÓôåñÝùóç on Ðáèïëïãéêüò ÄïìÞ Óþìáôïò of Ïóôü of Êüëï of Áñéóôåñüò Ìçñéáßï Ïóôü caused by Êüôáãìá”

“ fixation on patologisk struktur of ben of inre kroppsdeldel of lateral position femur caused by fraktur #surgicallyOpen (Adjective)# #leftSelection (Adjective)# #Collum (Noun)#”

© University of Manchester 23

… … but translation betweenbut translation between languages / cultures is tricky languages / cultures is tricky► Language is a poor guide

► Must separate language labels from ‘concept’► A fundamental philosophical debate

►For ontologies of science and medicine, concepts are virtually independent of linguistic labels

►And linguistic labels vary in time and space

© University of Manchester 24

And to real world problemsAnd to real world problemsThe Coding of ChocolateThe Coding of ChocolateAn international conversion guideAn international conversion guide

C-F0811

C-F0816

C-F0817

C-F0819

C-F081A

C-F081B

C-F081C

C-F0058

SNOMED-CT

UbOVv

UbOW2

UbOW3

UbOW4

UbOW5

UbOW6

UbOW7

Ub1pT

CTV3

Bounty barCrème egg

Kit KatMars Bar

Milky WaySmarties

TwixSnicker

Term

?

© University of Manchester 25

Integration instead of mapping Integration instead of mapping multiple big vocabulariesmultiple big vocabularies

© University of Manchester 26

But of course the logic is not all you need

Modules in the GALEN Server

A single point of access for language, classification, code conversion, and indexing - well separated internally

API

Reference Management Multilingual Dictionaries

MultilingualModule

Common Reference Model

ConceptModule

Code Store

Code ConversionModule

ClientApplication

Server

Client

Extrinsics Store

IndexingModule

© University of Manchester 27

Fundamental problem:Fundamental problem:Knowledge is Fractal! Knowledge is Fractal!

► Therefore combinatorially explosive

► Enumeration does not scale!

Normalisation & the Normalisation & the GALEN Metamodel GALEN Metamodel

© University of Manchester 28

The scaling problem: The scaling problem: The combinatorial explosion The combinatorial explosion

Predicted

Actual

► It keeps happening!► “Simple” brute force

solutions do not scale up!

► Conditions x sites x modifiers x activity x context

► Huge number of terms to author

► Software CHAOS

© University of Manchester 29

Combination of things to Combination of things to be done & time to do each be done & time to do each thingthing

Effort per term

Things to build

► Terms and forms needed

► Increases exponentially

► Effort per term or form► Must decrease to

compensate

► To give the effectiveness we want

► Or might accept

What we

would like

What we might accept

© University of Manchester 30

Problems:Problems:

The exploding bicycleThe exploding bicycle(codes for injuries involving cyclists)(codes for injuries involving cyclists)►1972 ICD-9 (E826) 8

►READ-2 (T30..) 81

►READ-3 87

►1999 ICD-10 ……

ICD = International Classification of diseases

© University of Manchester 31

topClassI Certain infectious and parasitic diseasesII NeoplasmsIII Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanismIV Endocrine, nutritional and metabolic diseasesV Mental and behavioural disordersVI Diseases of the nervous systemVII Diseases of the eye and adnexaVIII Diseases of the ear and mastoid processIX Diseases of the circulatory systemsX Diseases of the respiratory systemXI Diseases of the digestive systemXII Diseases of the skin and subcutaneous tissueXIII Diseases of the musculoskeletal system and connective tissueXIV Diseases of the genitourinary systemXV Pregnancy, childbirth and the puerperiumXVI Certain conditions originating in the perinatal periodXVII Congenital malformations, deformations and chromosomal abnormalitiesXVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedXIX Injury, poisoning and certain other consequences of external causesXX External causes of morbidity and mortality

V01-V99 Transport accidentsV01-V09 Pedestrian injured in transport accidentV10-V19 Pedal cyclist injured in transport accident

V10 Pedal cyclist injured in collision with pedestrian or animalV10.0 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident

V10.00 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in sports activityV10.01 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in leisure activityV10.02 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while working for an incomeV10.03 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in other types of workV10.04 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.08 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in other specified activitiesV10.09 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, during unspecified activity

V10.1 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accidentV10.10 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in sports activityV10.11 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in leisure activityV10.12 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while working for an incomeV10.13 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in other types of workV10.14 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.18 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in other specified activitiesV10.19 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, during unspecified activity

V10.2 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accidentV10.20 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV10.21 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV10.22 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while working for an incomeV10.23 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV10.24 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.28 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV10.29 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V10.3 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alightingV10.30 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in sports activityV10.31 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in leisure activityV10.32 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while working for an incomeV10.33 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in other types of workV10.34 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activitiesV10.38 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in other specified activitiesV10.39 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, during unspecified activity

V10.4 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accidentV10.40 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in sports activityV10.41 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in leisure activityV10.42 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while working for an incomeV10.43 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in other types of workV10.44 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.48 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in other specified activitiesV10.49 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, during unspecified activity

V10.5 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accidentV10.50 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in sports activityV10.51 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in leisure activityV10.52 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while working for an incomeV10.53 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in other types of workV10.54 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.58 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in other specified activitiesV10.59 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, during unspecified activity

V10.9 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accidentV10.90 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in sports activityV10.91 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in leisure activityV10.92 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while working for an incomeV10.93 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in other types of workV10.94 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.98 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in other specified activitiesV10.99 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, during unspecified activity

V11 Pedal cyclist injured in collision with other pedal cycleV11.0 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident

V11.00 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in sports activityV11.01 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in leisure activityV11.02 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while working for an incomeV11.03 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in other types of workV11.04 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.08 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in other specified activitiesV11.09 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, during unspecified activity

V11.1 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accidentV11.10 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in sports activityV11.11 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in leisure activityV11.12 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while working for an incomeV11.13 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in other types of workV11.14 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.18 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in other specified activitiesV11.19 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, during unspecified activity

V11.2 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accidentV11.20 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV11.21 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV11.22 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while working for an incomeV11.23 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV11.24 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.28 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV11.29 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V11.3 Pedal cyclist injured in collision with other pedal cycle, while boarding or alightingV11.30 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in sports activityV11.31 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in leisure activityV11.32 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while working for an incomeV11.33 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in other types of workV11.34 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activitiesV11.38 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in other specified activitiesV11.39 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, during unspecified activity

V11.4 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accidentV11.40 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in sports activityV11.41 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in leisure activityV11.42 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while working for an incomeV11.43 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in other types of workV11.44 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.48 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in other specified activitiesV11.49 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, during unspecified activity

V11.5 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accidentV11.50 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in sports activityV11.51 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in leisure activityV11.52 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while working for an incomeV11.53 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in other types of workV11.54 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.58 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in other specified activitiesV11.59 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, during unspecified activity

V11.9 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accidentV11.90 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in sports activityV11.91 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in leisure activityV11.92 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while working for an incomeV11.93 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in other types of workV11.94 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.98 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in other specified activitiesV11.99 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, during unspecified activity

V12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicleV12.0 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident

V12.00 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in sports activityV12.01 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in leisure activityV12.02 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while working for an incomeV12.03 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in other types of workV12.04 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV12.08 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in other specified activitiesV12.09 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, during unspecified activity

V12.1 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accidentV12.10 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in sports activityV12.11 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in leisure activityV12.12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while working for an incomeV12.13 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in other types of workV12.14 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV12.18 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in other specified activitiesV12.19 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, during unspecified activity

V12.2 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accidentV12.20 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV12.21 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV12.22 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while working for an incomeV12.23 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV12.28 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV12.29 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V12.3 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting

V12.30 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in sports activity

V12.31 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in leisure activity

V12.32 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while working for an income

V12.33 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in other types of work

V12.34 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V12.38 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in other specified activities

V12.39 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, during unspecified activity

V12.4 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident

V12.40 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in sports activity

V12.41 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in leisure activity

V12.42 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while working for an income

V12.43 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in other types of work

V12.44 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.48 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in other specified activities

V12.49 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, during unspecified activity

V12.5 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident

V12.50 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in sports activity

V12.51 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in leisure activity

V12.52 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while working for an income

V12.53 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in other types of work

V12.54 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.58 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in other specified activities

V12.59 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, during unspecified activity

V12.9 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident

V12.90 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V12.91 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V12.92 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V12.93 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V12.94 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.98 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V12.99 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V13 Pedal cyclist injured in collision with car, pick-up truck or van

V13.0 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident

V13.00 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in sports activity

V13.01 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in leisure activity

V13.02 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while working for an income

V13.03 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in other types of work

V13.04 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.08 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in other specified activities

V13.09 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, during unspecified activity

V13.1 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident

V13.10 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in sports activity

V13.11 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in leisure activity

V13.12 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while working for an income

V13.13 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in other types of work

V13.14 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.18 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in other specified activities

V13.19 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, during unspecified activity

V13.2 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident

V13.20 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V13.21 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V13.22 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while working for an income

V13.23 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V13.24 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.28 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V13.29 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V13.3 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting

V13.30 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in sports activity

V13.31 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in leisure activity

V13.32 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while working for an income

V13.33 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in other types of work

V13.34 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V13.38 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in other specified activities

V13.39 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, during unspecified activity

V13.4 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident

V13.40 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in sports activity

V13.41 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in leisure activity

V13.42 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while working for an income

V13.43 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in other types of work

V13.44 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.48 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in other specified activities

V13.49 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, during unspecified activity

V13.5 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident

V13.50 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in sports activity

V13.51 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in leisure activity

V13.52 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while working for an income

V13.53 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in other types of work

V13.54 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.58 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in other specified activities

V13.59 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, during unspecified activity

V13.9 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident

V13.90 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V13.91 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V13.92 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while working for an income

V13.93 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V13.94 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.98 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V13.99 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, during unspecified activity

V14 Pedal cyclist injured in collision with heavy transport vehicle or bus

V14.0 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident

V14.00 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in sports activity

V14.01 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in leisure activity

V14.02 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while working for an income

V14.03 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in other types of work

V14.04 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.08 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in other specified activities

V14.09 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, during unspecified activity

V14.1 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident

V14.10 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in sports activity

V14.11 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in leisure activity

V14.12 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while working for an income

V14.13 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in other types of work

V14.14 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.18 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic, while engaged in other specified activities accident

V14.19 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic, during unspecified activity accident

V14.2 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident

V14.20 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V14.21 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V14.22 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while working for an income

V14.23 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V14.24 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.28 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V14.29 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V14.3 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting

V14.30 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in sports activity

V14.31 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in leisure activity

V14.32 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while working for an income

V14.33 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in other types of work

V14.34 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V14.38 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in other specified activities

V14.39 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, during unspecified activity

V14.4 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident

V14.40 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in sports activity

V14.41 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in leisure activity

V14.42 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while working for an income

V14.43 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in other types of work

V14.44 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.48 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in other specified activities

V14.49 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, during unspecified activity

V14.5 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident

V14.50 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in sports activity

V14.51 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in leisure activity

V14.52 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while working for an income

V14.53 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in other types of work

V14.54 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.58 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in other specified activities

V14.59 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, during unspecified activity

V14.9 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident

V14.90 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V14.91 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V14.92 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while working for an income

V14.93 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V14.94 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.98 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V14.99 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, during unspecified activity

V15 Pedal cyclist injured in collision with railway train or railway vehicle

V15.0 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident

V15.00 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in sports activity

V15.01 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in leisure activity

V15.02 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while working for an income

V15.03 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in other types of work

V15.04 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.08 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in other specified activities

V15.09 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, during unspecified activity

V15.1 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident

V15.10 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in sports activity

V15.11 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in leisure activity

V15.12 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while working for an income

V15.13 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in other types of work

V15.14 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.18 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in other specified activities

V15.19 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, during unspecified activity

V15.2 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident

V15.20 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V15.21 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V15.22 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while working for an income

V15.23 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V15.24 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.28 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V15.29 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V15.3 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting

V15.30 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in sports activity

V15.31 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in leisure activity

V15.32 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while working for an income, while working for an income

V15.33 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in other types of work

V15.34 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V15.38 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in other specified activities

V15.39 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, during unspecified activity

V15.4 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident

V15.40 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in sports activity

V15.41 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in leisure activity

V15.42 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while working for an income

V15.43 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in other types of work

V15.44 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.48 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in other specified activities

V15.49 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, during unspecified activity

V15.5 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident

V15.50 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in sports activity

V15.51 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in leisure activity

V15.52 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while working for an income

V15.53 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in other types of work

V15.54 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.58 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in other specified activities

V15.59 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, during unspecified activity

V15.9 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident

V15.90 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V15.91 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V15.92 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V15.93 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V15.94 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.98 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V15.99 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V16 Pedal cyclist injured in collision with other nonmotor vehicle

V16.0 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident

V16.00 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in sports activity

V16.01 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in leisure activity

V16.02 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while working for an income

V16.03 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in other types of work

V16.04 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.08 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in other specified activities

V16.09 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, during unspecified activity

V16.1 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident

V16.10 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in sports activity

V16.11 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in leisure activity

V16.12 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while working for an income

V16.13 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in other types of work

V16.14 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.18 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in other specified activities

V16.19 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, during unspecified activity

V16.2 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident

V16.20 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V16.21 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V16.22 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while working for an income

V16.23 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V16.24 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.28 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V16.29 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V16.3 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting

V16.30 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in sports activity

V16.31 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in leisure activity

V16.32 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while working for an income

V16.33 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in other types of work

V16.34 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V16.38 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in other specified activities

V16.39 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, during unspecified activity

V16.4 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident

V16.40 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in sports activity

V16.41 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in leisure activity

V16.42 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while working for an income

V16.43 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in other types of work

V16.44 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.48 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in other specified activities

V16.49 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, during unspecified activity

V16.5 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident

V16.50 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in sports activity

V16.51 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in leisure activity

V16.52 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while working for an income

V16.53 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in other types of work

V16.54 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.58 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in other specified activities

V16.59 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, during unspecified activity

V16.9 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident

V16.90 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V16.91 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V16.92 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V16.93 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V16.94 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.98 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V16.99 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V17 Pedal cyclist injured in collision with fixed or stationary object

V17.0 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident

V17.00 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in sports activity

V17.01 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in leisure activity

V17.02 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while working for an income

V17.03 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in other types of work

V17.04 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.08 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in other specified activities

V17.09 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, during unspecified activity

V17.1 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident

V17.10 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in sports activity

V17.11 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in leisure activity

V17.12 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while working for an income

V17.13 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in other types of work

V17.14 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.18 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in other specified activities

V17.19 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, during unspecified activity

V17.2 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident

V17.20 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V17.21 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V17.22 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while working for an income

V17.23 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V17.24 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.28 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V17.29 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V17.3 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting

V17.30 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in sports activity

V17.31 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in leisure activity

V17.32 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while working for an income

V17.33 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in other types of work

V17.34 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V17.38 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in other specified activities

V17.39 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, during unspecified activity

V17.4 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident

V17.40 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in sports activity

V17.41 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in leisure activity

V17.42 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while working for an income

V17.43 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in other types of work

V17.44 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.48 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in other specified activities

V17.49 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, during unspecified activity

V17.5 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident

V17.50 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in sports activity

V17.51 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in leisure activity

V17.52 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while working for an income

V17.53 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in other types of work

V17.54 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.58 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in other specified activities

V17.59 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, during unspecified activity

V17.9 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident

V17.90 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V17.91 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V17.92 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while working for an income

V17.93 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V17.94 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.98 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V17.99 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, during unspecified activity

V18 Pedal cyclist injured in noncollision transport accident

V18.0 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident

V18.00 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in sports activity

V18.01 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in leisure activity

V18.02 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while working for an income

V18.03 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in other types of work

V18.04 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.08 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in other specified activities

V18.09 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, during unspecified activity

V18.1 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident

V18.10 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in sports activity

V18.11 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in leisure activity

V18.12 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while working for an income

V18.13 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in other types of work

V18.14 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.18 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in other specified activities

V18.19 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, during unspecified activity

V18.2 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident

V18.20 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V18.21 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V18.22 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while working for an income

V18.23 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V18.24 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.28 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V18.29 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V18.3 Pedal cyclist injured in noncollision transport accident, while boarding or alighting

V18.30 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in sports activity

V18.31 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in leisure activity

V18.32 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while working for an income

V18.33 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in other types of work

V18.34 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V18.38 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in other specified activities

V18.39 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, during unspecified activity

V18.4 Pedal cyclist injured in noncollision transport accident, driver, traffic accident

V18.40 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in sports activity

V18.41 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in leisure activity

V18.42 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while working for an income

V18.43 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in other types of work

V18.44 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.48 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in other specified activities

V18.49 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, during unspecified activity, during unspecified activity

V18.5 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident

V18.50 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in sports activity

V18.51 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in leisure activity

V18.52 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while working for an income, while working for an income

V18.53 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in other types of work

V18.54 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.58 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in other specified activities

V18.59 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, during unspecified activity, during unspecified activity

V18.9 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident

V18.90 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V18.91 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V18.92 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while working for an income, while working for an income

V18.93 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V18.94 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.98 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V18.99 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, during unspecified activity, during unspecified activity

V19 Pedal cyclist injured in other and unspecified transport accidents

V19.0 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.00 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.01 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.02 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.03 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.04 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.08 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.09 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.1 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.10 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.11 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.12 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.13 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.14 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.18 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.19 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.2 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.20 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.21 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.22 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.23 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.24 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.28 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.29 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.3 Pedal cyclist [any] injured in unspecified nontraffic accident

V19.30 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in sports activity

V19.31 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in leisure activity

V19.32 Pedal cyclist [any] injured in unspecified nontraffic accident, while working for an income

V19.33 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in other types of work

V19.34 Pedal cyclist [any] injured in unspecified nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.38 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in other specified activities

V19.39 Pedal cyclist [any] injured in unspecified nontraffic accident, during unspecified activity

V19.4 Driver injured in collision with other and unspecified motor vehicles in traffic accident

V19.40 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.41 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.42 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.43 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.44 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.48 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.49 Driver injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.5 Passenger injured in collision with other and unspecified motor vehicles in traffic accident

V19.50 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.51 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.52 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.53 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.54 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.58 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.59 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.6 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident

V19.60 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.61 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.62 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.63 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.64 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.68 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.69 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.8 Pedal cyclist [any] injured in other specified transport accidents

V19.80 Pedal cyclist [any] injured in other specified transport accidents, while engaged in sports activity

V19.81 Pedal cyclist [any] injured in other specified transport accidents, while engaged in leisure activity

V19.82 Pedal cyclist [any] injured in other specified transport accidents, while working for an income

V19.83 Pedal cyclist [any] injured in other specified transport accidents, while engaged in other types of work

V19.84 Pedal cyclist [any] injured in other specified transport accidents, while resting, sleeping, eating or engaging in other vital activities

V19.88 Pedal cyclist [any] injured in other specified transport accidents, while engaged in other specified activities

V19.89 Pedal cyclist [any] injured in other specified transport accidents, during unspecified activity

V19.9 Pedal cyclist [any] injured in unspecified traffic accident

V19.90 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in sports activity

V19.91 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in leisure activity

V19.92 Pedal cyclist [any] injured in unspecified traffic accident, while working for an income

V19.93 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in other types of work

V19.94 Pedal cyclist [any] injured in unspecified traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.98 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in other specified activities

V19.99 Pedal cyclist [any] injured in unspecified traffic accident, during unspecified activity

1999 ICD10: 587 codes1999 ICD10: 587 codes

•V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income

•W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity

•X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

•V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income

•W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity

•X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

© University of Manchester 32

Building large Terminologies Building large Terminologies Logic for “Conceptual Lego”Logic for “Conceptual Lego”

hand

extremity

body

acute

chronic

abnormalnormal

ischaemicdeletion

bacteriumpolymorphism

cell

protein

gene

infection

inflammation

Lung

expression

virusmucus

polysacharide

© University of Manchester 33

Logic as the clips for Logic as the clips for “Conceptual Lego”“Conceptual Lego”

“SNPolymorphism of CFTRGene causing Defect in MembraneTransport of Chloride Ion causing Increase in Viscosity of Mucus in CysticFibrosis…”

“Hand which isanatomically normal”

© University of Manchester 34

Build complex Build complex representations representations from modularisedfrom modularisedprimitivesprimitives

GenesSpecies

Protein

Function

Disease

Protein coded bygene in humans

Function ofProtein coded bygene in humans

Disease caused by abnormality inFunction ofProtein coded bygene in humans

Gene in humans

© University of Manchester 35

Normalising (untangling) Normalising (untangling) OntologiesOntologies

StructureFunction

Part-wholeStructure Function

Part-w

hole

© University of Manchester 36

Normalisation of ontologiesNormalisation of ontologies

► Building combinatorially explosive polyhierarchies from simple trees

© University of Manchester 37

Example: Animals & PlantsExample: Animals & Plants

► Dog

► Cat

► Cow

► Person

► Tree

► Grass

► Herbivore

► Male

► Female

► Dangerous

► Pet

► Domestic Animal

► Farm animal

► Draft animal

► Food animal

► Fish

► Carp

► Goldfish

► Carnivore

► Plant

► Animal

► Fur

► Child

► Parent

► Mother

► Father

© University of Manchester 38

Organise the conceptsOrganise the conceptsExample: Animals & PlantsExample: Animals & Plants

► Dog

► Cat

► Cow

► Person

► Tree

► Grass

► Herbivore

► Male

► Female

► Healthy

► Pet

► Domestic Animal

► Farm animal

► Draft animal

► Food animal

► Fish

► Carp

► Goldfish

► Carnivore

► Plant

► Animal

► Fur

► Child

► Parent

► Mother

► Father

© University of Manchester 39

Extend the conceptsExtend the concepts“Laddering”“Laddering”

► Take a group of things and ask what they have in common

► Then what other ‘siblings’ there might be

► e.g.

► Plant, Animal Living Thing

► Might add Bacteria and Fungi but not now

► Cat, Dog, Cow, Person Mammal

► Others might be Goat, Sheep, Horse, Rabbit,…

► Cow, Goat, Sheep, Horse Hoofed animal (“Ungulate”)

► What others are there? Do they divide amongst themselves?

► Wild, Domestic Demoestication

► What other states – “Feral” (domestic returned to wild)

© University of Manchester 40

Choose some main axesChoose some main axes

►Add abstractions where needed► e.g. “Living thing”

► identify relations► e.g. “eats”, “owns”, “parent of”

► Identify definable things► e.g. “child”, “parent”, “Mother”, “Father”

►Things where you can say clearly what it means

►Try to define a dog precisely – very difficult

►A “natural kind”

► make names explicit

© University of Manchester 41

Choose some main axesChoose some main axesAdd abstractions where needed; identify relations; Add abstractions where needed; identify relations; Identify definable things, make names explicitIdentify definable things, make names explicit

► Living Thing► Animal

► Mammal

► Cat

► Dog

► Cow

► Person

► Fish

► Carp

► Goldfish

► Plant

► Tree

► Grass

► Fruit

► Modifiers► domestic

► pet

► Farmed

► Draft

► Food

► Wild

► Health► healthy

► sick

► Sex► Male

► Female

► Age► Adult

► Child

Definable Carinvore Herbivore Child Parent Mother Father Food Animal Draft Animal

Relations eats owns parent-of …

© University of Manchester 42

Self_standing_entitiesSelf_standing_entities

►Things that can exist on there own nouns►People, animals, houses, actions, processes, …

►Roughly nouns

►Modifiers►Things that modify (“inhere”) in other things

►Roughly adjectives and adverbs

© University of Manchester 43

Reorganise everything but “definable” things into Reorganise everything but “definable” things into pure trees – these will be the pure trees – these will be the “primitives”“primitives”

► Self_standing► Living Thing

► Animal

►Mammal

► Cat

► Dog

► Cow

► Person

► Pig

►Fish

► Carp Goldfish

► Plant

►Tree

►Grass

►Fruit

► Modifiers► Domestication

► Domestic

► Wild

► Use► Draft

► Food

► pet

► Risk

► Dangerous

► Safe

► Sex

► Male

► Female

► Age

► Adult

► Child

Definables Carnivore Herbivore Child Parent Mother Father Food Animal Draft Animal

Relations eats owns parent-of …

© University of Manchester 44

If anything needs clarifying, If anything needs clarifying, add a text commentadd a text comment

► Self_standing► Living Thing

► Animal

► Mammal

► Cat

► Dog

► Cow

► Person

► Pig

► Fish

► Carp Goldfish

► Plant

► Tree

► Grass

► Fruit

– The abstract ancestor concept including all living things – restrict to plants and animals for now”

© University of Manchester 45

Identify the domain and range Identify the domain and range constraints for constraints for propertiesproperties

► Animal eats Living_thing

► eats domain: Animal; range: Living_thing

► Person owns Living_thing except person

► owns domain: Person range: Living_thing & not Person

► Living_thing parent_of Living_thing

► parent_of: domain: Animal range: Animal

© University of Manchester 46

If anything is used in a special way,If anything is used in a special way,add a text commentadd a text comment

► Animal eats Living_thing

► eats domain: Animal; range: Living_thing

— ignore difference betweenparts of living thingsand living thingsalso derived from livingthings

© University of Manchester 47

For For definable thingsdefinable things► Paraphrase and formalise the definitions in terms of the primitives, relations and

other definables.

► Note any assumptions to be represented elsewhere.

► Add as comments when implementing

► “A ‘Parent’ is an animal that is the parent of some other animal” (Ignore plants for now)

► Parent = Animal and parent_of some Animal

► “A ‘Herbivore’ is an animal that eats only plants”(NB All animals eat some living thing)

► Herbivore= Animal and eats only Plant

► “An ‘omnivore’ is an animal that eats both plants and animals”► Omnivore=

Animal and eats some Animal and eats some Plant

© University of Manchester 48

Paraphrases and CommentsParaphrases and Comments► Write down the paraphrases and put them in the comment space.

► We can show you how to make the comment space bigger to make it easier.

► Without a paraphrase, we cannot tell if we disagree on ► What you meant to represent

► How you represented it

► Without a paraphrase we will mark down by at least half and give no partial credit

► We will try to understand what you are doing, but we cannot read your minds.

© University of Manchester 49

Which properties can be filled inWhich properties can be filled inat the class level now?at the class level now?

►What can we say about all members of a class?

►eats

►All cows eat some plants

►All cats eat some animals

►All pigs eat some animals & eat some plants

© University of Manchester 50

Fill in the detailsFill in the details(can use property matrix wizard)(can use property matrix wizard)

© University of Manchester 51

Check with classifierCheck with classifier

►Cows should be Herbivores►Are they? why not?

►What have we said?

►Cows are animals and, amongst other things, eat some grass and eat some leafy_plants

►What do we need to say:Closure axiom

►Cows are animals and, amongst other things,eat some plants and eat only plants

►(See “Vegetarian Pizzas” in OWL tutorial)

© University of Manchester 52

Closure AxiomClosure Axiom

► Cows are animals and, amongst other things,eat some plants and eat only plants

ClosureAxiom

© University of Manchester 53

Open vs Closed World Open vs Closed World reasoningreasoning► Open world reasoning

► Negation as contradiction

► Anything might be true unless it can be proven false

► Reasoning about any world consistent with this one

► Closed world reasoning► Negation as failure

► Anything that cannot be found is false

► Reasoning about this world

► Ontologies are not databases

© University of Manchester 54

Tables are easier to manage Tables are easier to manage than DAGs / than DAGs / PolyhierarchiesPolyhierarchies

…and get the benefit of inference:Grass and Leafy_plants are both kinds of Plant

© University of Manchester 55

Remember to add any Remember to add any closure axiomsclosure axioms

ClosureAxiom

Then let the reasoner do the work

© University of Manchester 56

Normalisation:Normalisation:From Trees to DAGsFrom Trees to DAGs

Before classification A tree

After classification A DAG

Directed Acyclic Graph

© University of Manchester 57

Untangling and EnrichmentUntangling and EnrichmentUsing a classifier to make life easierUsing a classifier to make life easier

Substance- Protein- - ProteinHormone- - - Insulin- Steroid- - SteroidHormone- - - Cortisol- Hormone- -ProteinHormone- - - Insulin- - SteroidHormone- - - Cortisol- Catalyst- - Enzyme- - - ATPase

- PhsioloicRole- - HormoneRole- - CatalystRole

- Substance- - Protein- - - Insulin- - - ATPase- Steroid- - Cortisol

Hormone ≡ Substance & playsRole-someValuesFrom HormoneRole

ProteinHormone ≡ Protein & playsRole someValuesFrom HormoneRole

SteroidHomone ≡ Steroid & playsRole someValuesFrom HormoneRole

Catalyst ≡ Substance & playsRole someValuesFrom CatalystRole

Enzyme ≡ Protein & playsRole someValuesFrom CatalystRole

Insulin playsRole someValuesFrom HormoneRole

Cortisol playsRole someValuesFrom HormoneRole

ATPase playsRole someValuesFrom CatalystRole

Substance- Protein- - ProteinHormone- - - Insulin- - Enzyme- - - ATPase- Steroid- - SteroidHomone^- - - Cortisol-Hormone- - ProteinHormone^- - - Insulin^- - SteroidHormone^- - - Cortisol^- Catalyst- - Enzyme^- - - ATPase^

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Modularised into structure and Modularised into structure and function ontologies function ontologies (all primitive)(all primitive)

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Unified ontology after Unified ontology after classificationclassification

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Consider the steps to make a Consider the steps to make a changechange► What do we have to do to organise hormones as

metabolic hormones and sex hormones and stress hormones and add in testosterone?

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A Few of the changes the A Few of the changes the hard wayhard way

Substance- Protein- - ProteinHormone- - - Insulin- Steroid- - SteroidHormone- - - Cortisol- Hormone- - Sex Hormone- - - ProteinSexHrmn - ProteinHormone- - - ProteinMetabolicHrmn- - - - Insulin- - - ProteinSexHormone - - SteroidHormone- - - Cortisol- Catalyst- - Enzyme- - - ATPase

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The easy way - and only create the ones I The easy way - and only create the ones I needneed

- PhsioloicRole- - HormoneRole- - - SexHR- - - MetabolicHR- - - StressHR- - CatalystRole- -

-Substance- - Protein- - - Insulin- - - ATPase- Steroid- - Cortisol- - Testosterone

SexHR ≡ Substance & playsRole-someValuesFrom SexHR

MetabolicHrmn ≡ Substance & playsRole someValuesFrom MetabolicHR

Testosterone playsRole someValuesFrom SexHR

Cortisol playsRole someValuesFrom StressHr

Substance- Protein- - ProteinHormone- - - Insulin- - Enzyme- - - ATPase- Steroid- - SteroidHomone^- - - Cortisol-Hormone- - ProteinHormone^- - - Insulin^- - SteroidHormone^- - SexHR- - - Testosterone- - StressHormone- - - Cortisol^- - MetabolicHrmn- Catalyst- - Enzyme^- - - ATPase^

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Changes to Structure Changes to Structure

& Roles & Roles

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Update the overall structureUpdate the overall structure

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stress roles are metabolic roles:stress roles are metabolic roles:One change One change

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Another ExampleAnother Example

Diameter Large_diameter Large_increasing_diameter Large_decreasing_diameter Small_diameter Small_increasing_diameter Small_decreasing_diameter

From

to add regular/irregular we get

Diameter Large_diameter Large_increasing_diameter Large_increasing_regular_diameter Large_increasing_irregular_diameter Large decreasing_diameter Large_decreasing_regular_diameter Large_decreasing_irregular_diameter Small_diameter Small_increasing_diameter Small_increasing_regular_diameter Small_increasing_irregular_diameter Small_decreasing_diameter Small_decreasing_regular_diameter Small_decreasing_irregular_diameter

© University of Manchester 67

Instead ofInstead of

Level Large Small

Regularity Regular Irregular

Trend Increasing Decreasing

Which would you rather Which would you rather maintain?maintain?

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Ontology normalisation:Ontology normalisation:Enforced modularityEnforced modularity► All primitives form disjoint trees

► All polyhierarchies formed by inference from definitions► No arbitrary subclass axioms

► Therefore► All concepts have most specific primitive ancestor

► No disjunctions in domain and range constraints

► Consequences► Changes occur in exactly one place

► Defeasible inheritance can be constrained so that each property inherited only along one taxonomy

► The same property cannot apply from two different sources that unless one subsumes the other

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Normalisation: Criterion 1Normalisation: Criterion 1The skeleton should consist The skeleton should consist of disjoint treesof disjoint trees

► Every primitive concept should have exactly one primitive parent

► All multiple hierarchies the result of inference by reasoner

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Normalisation Criterion 2:Normalisation Criterion 2:No hidden changes of meaning No hidden changes of meaning

►Each branch should be homogeneous and logical(“Aristotelian”)

► Hierarchical principle should be subsumption

►Otherwise we are “lying to the logic”

► The criteria for differentiation should follow consistent principles in each branch eg. structure XOR function XOR cause

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A Non-homogeneous taxonomyA Non-homogeneous taxonomy“On those remote pages it is written that animals are

divided into:

a. those that belong to the Emperor b. embalmed ones c. those that are trained d. suckling pigse. mermaids f. fabulous ones g. stray dogs h. those that are included in this classificationi. those that tremble as if they were mad j. innumerable ones k. those drawn with a very fine camel's hair brush l. others m. those that have just broken a flower vase n. those that resemble flies from a distance"

From The Celestial Emporium of Benevolent Knowledge, Borges

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Normalisation Criterion 3Normalisation Criterion 3Distinguish “Self-standing” and Distinguish “Self-standing” and “Refining” Concepts“Refining” Concepts

►Self-standing concepts►Roughly Welty & Guarino’s “sortals”

►person, idea, plant, committee, belief,…

►Refining concepts – depend on self-standing concepts

►mild|moderate|severe, hot|cold, left|right,…

► Roughly Welty & Guarino’s non-sortals

► Closely related to Smith’s “fiat partitions”

► Usefully thought of as Value Types by engineers

►For us an engineering distinction…

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Normalisation Criterion 3aNormalisation Criterion 3aSelf-standing primitives should be Self-standing primitives should be globallyglobally disjoint & open disjoint & open

►Primitives are atomic ► If primitives overlap, the overlap conceals implicit information

►A list of self-standing primitives can never be guaranteed complete► How many kinds of person? of plant? of committee? of belief?

► Can’t infer: Parent & ¬sub1 &…& ¬subn-1 subn

►Heuristic: ► Diagnosis by exclusion about self-standing concepts should NOT

be part of ‘standard’ ontological reasoning

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Normalisation Criterion 3bNormalisation Criterion 3bRefining primitives should be Refining primitives should be locallylocally disjoint & closeddisjoint & closed

► Value classes must be disjoint

► but can be hierarchical

►e.g. “very hot”, “moderately severe”

► Each list can be guaranteed to be complete

► Can infer Parent & ¬sub1 &…& ¬subn-1 subn

► Value types themselves need not be disjoint► “being hot” is not disjoint from “being severe”

►Allowing Valuetypes to overlap is a useful trick, e.g.

►restriction has_state someValuesFrom (severe and hot)

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Normalisation Criterion 4Normalisation Criterion 4AxiomsAxioms

► No axiom should denormalise the ontology

No axiom should imply that a primitive is part of more than one branch of primitive skeleton

► If all primitives are disjoint, any such axioms will make that primitive unsatisfiable

►A partial test for normalisation:

►Create random conjunctions of primitives which do not subsume each other.

►If any are satisfiable, the ontology is not normalised

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Consequences 1Consequences 1

►All self-standing primitives are disjoint

►All multiple classification is inferred

►For any two primitive self-standing classes, either one subsumes the other or they are disjoint

►Every self standing concept is part of exactly one primitive branch of the skeleton

►Every self-standing concept has exactly one most specific primitive ancestor

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Consequences 2Consequences 2

► Primitives introduced by a conjunction of one class and a boolean combination of zero or more restrictions

► Tree subclass-of Plant and restriction isMadeOf someValuesFrom Wood

► Resort subclass-of Accommodation restriction isIntendedFor someValueFrom Holidays

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Consequences 3Consequences 3►Use of axioms limited (outside of skeleton

construction)The following are a safe but not exhaustive guide:

►The right side of subclass axioms limited to restrictions

►Both sides of disjointness axioms limited to restrictions

►No equivalence axioms with disjoint primitives on the two sides

►Equivalence only within branches of the skeleton

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A real example: A real example: Build a simple treeeBuild a simple treee

easy to maintaineasy to maintain

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Let the classifier organise it Let the classifier organise it

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If you want more abstractions,If you want more abstractions,just add new definitionsjust add new definitions(re-use existing data)(re-use existing data)

“Diseases linked to abnormal proteins”

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And let the classifier work againAnd let the classifier work again

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And again – even for a quite And again – even for a quite different category different category

“Diseases linked genes described in the mouse”

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Summary: Why Normalise? Summary: Why Normalise? Why use a Classifier?Why use a Classifier?

► To compose concepts► Allow conceptual lego

► To manage polyhierarchies ► Adding abstractions (“axes”) as needed

► Normalisation

► Untangling

► labelling of “kinds of is-a”

► To avoid combinatorial explosions► Keep bicycles from exploding

► To manage context► Cross species, Cross disciplines, Cross studies

► To check consistency and help users find errors

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The GALEN Schemata RevisitedThe GALEN Schemata Revisited

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Cooperation on the Information resources

Cooperation on the Domain Content Ontologies that are to enable…

Upper Ontology: What’s it for?Upper Ontology: What’s it for?

Cooperation on the Top Domain Ontology that is to enable ….

The Upper Ontology is to enable…

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The GALEN Upper OntologyThe GALEN Upper Ontology► A lightweight ‘ontology’ for practical software engineering –

► Software informed by philosophy, but still software with a specific task► Representing what healthcare and scientific agents at a given place and time report that they have heard, seen,

thought, and done

► Serves for a large ontology of biomedical concepts► Anatomy► Physiology► Diseases► Drugs and their uses► Surgical procedures

► Originally Represented in GRAIL – a non-standard DL with► Existential restrictions► Role hierarchy► Propagates via axioms: R1 o R2 R1

► Restricted General Inclusion Axioms (absorbable)► “Sanctioning” instead of universal restrictions

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How best to reconstruct the GALENHow best to reconstruct the GALENUpper Ontology in OWL?Upper Ontology in OWL?

►With the new expressivity of OWL

►Without propagates_via axioms

►Preserving the principles of “normalisation”► Decomposition of primitives into disjoint trees

► Any information should require changing in only one place

►Taking into account other work and harmonisation► The Digital Anatomist FMA & Harmonisation with Mouse

Developmental and Adult Anatomy in SOFG

► Welty, Guarino’ & Gangemis OntoClean & DOLCE

► Barry Smith’s work on Basic Formal Ontology

►Identifying issues that transcend formalism

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PrinciplesPrinciples► An Implemented Ontology in OWL/DLs

► Must be implemented and support a large ontology

► Must allow definition of top level domain ontology► The goal is to help domain experts reate their starting points and patterns

► Just enough► No distinction without a difference!

► Properties are as important as Classes/Entities/Concepts

► If an upper level category does not act as a domain or range constraint or have some other engineering effect, why represent it?

► Exclude things that will be dealt with by other means or given

► “Concrete domains”

► Time and place

► Designed to record what an observer has recorded at a given place and time

► Non_physical – e.g. agency

► Causation – except in sense of “aetiology”

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Principles 2Principles 2

►Minimal commitment► Don’t make a choice if you don’t have to

►Understandable► Experts an make distinctions repeatably/reliably

►Able to infer classification top domain concepts► ‘Twenty questions’ – to neighbourhood

►Upper ontology primarily composed of ‘open dichotomies’► Open to defer arguments such as whether Collectives of

Physical things are physical

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Specific requirementsSpecific requirements

► Anatomy, Physiology, Disease, Pathology (Procedures)

► Part-whole relations and the relation of diseases to anatomy

► Differences in granularity

► Differences in view between specialties – FMA & Mouse & GALEN

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The GALEN Upper OntologyThe GALEN Upper Ontology

DomainCategory

ModifierConcept

Phenomenon

Feature

Collection

Selector

GeneralisedProcess

GeneralisedStructure

GeneralisedSubstance State

Modality

Role

Unit

GeneralLevelOfSpecification

Status

Aspect

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Relation of original to Relation of original to ReconstructionReconstruction

DomainCategory

ModifierConcept

Phenomenon

Feature

Collection

Selector

GeneralisedProcess

GeneralisedStructure

GeneralisedSubstance State

Modality

Role

Unit

GeneralLevelOfSpecification

Status

Aspect

individuali

Meta

self standing

Refining

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Basic distinctionsBasic distinctions

► Self-standing vs Refining► Roughly the same as ‘Independent’ / ‘sortals’ in DOLCE &

BFO

► Property: is_refined_by

► Self_standing_entity is_refined_by Refining_entity

►Establishes the domain & range of a top property distinction

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Within Self StandingWithin Self Standing

► Continuant vs Occurrent / Structure vs Process► Self_standing_entity participate_in Occurrent

► Discrete vs Mass► Discrete_entity is_constituted_of Mass_entity

► Physical vs Non_physical► Non_physical is_manifested_by Physical

► Only physical an be material

► Material defines non_material (things define holes)

► Biological – Non-biological

► Complex – all collections, relations, groups, etc.► No opposite – all arguments deferred

► Includes GALEN Collections and Modalities

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Basic DistinctionsBasic Distinctions

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Unclassified StrutureUnclassified Struture

© University of Manchester 98

Classified StructureClassified Structure

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Detail of Biological ObjectDetail of Biological Object& Mass/Discrete distinction& Mass/Discrete distinction

Continuants -Mass vs Discrete always distinguished

Occurrents -Mass vs Discrete distinguished case by case

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““Twenty questions”Twenty questions”Example: What is an Organelle?Example: What is an Organelle?

►Is it Continuant or Occurrent? Continuant► Does it happen or do things happen to it?

►Is it physical? yes

►Is it Discrete or mass? Discrete► (Can you count it?)

►If physical & discrete, Is it material or non-material (thing or hole)? Material

►Is it Biological? yes

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Special questions for BiologySpecial questions for Biology

► Is it part of something? yes► if so, definite number or not? yes

► Groups of Organels are part of Cytoplasm`

► Is it pathological? no

► Therefore, it is a “Cell_part” (a subclass of Biological_object)

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Before ClassificationBefore ClassificationClassified simply Biologica_entity

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After ClassificationAfter ClassificationClassified under Cell_part

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Before ClassificationBefore Classification

After ClassificationAfter Classification

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GALEN & Partonomy (& beyond)GALEN & Partonomy (& beyond)

► Fundamental principle: Locus and Partonomy► Disorders/procedures of parts are disorders of the whole

►except when they are not

► An injury to the finger is an injury to the handAn disorder of the heart valve is a heart diseaseRepeair of a coronary artery is a heart operation

►But removal of a lobe of the lung is NOT removal of the lung

►Need a escape mechanism

► Weak principles► Components vs subdivisions

►Subdivisions are similar to the whole

►Components are not

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GALEN & PartonomyGALEN & Partonomy

►Need to distinguish► Location, ‘Locus’, Physical location

► Parthood

►Structural

►Subdivisions vs distinct parts

►Functional

►Constituent

►Membership

► Containment

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Beyond GALEN: Multiple viewsBeyond GALEN: Multiple views

► Need for views to reconcile clinical and anatomical view

► GALEN / SNOMED etc

► Digital Anatomist Foundational Model of Anatomy (FMA)

► The “Heart” and the “Pericardium” (covering of the heart)

► Clinical view: A disorder of the pericardium is a disorder of the heart

►Therefore the pericardium is part of the heart

► Anatomist view:

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Generic MereologyGeneric MereologyParts & Wholes, containment,Parts & Wholes, containment,connection and adjacency –connection and adjacency –► Standard lexical semantic versions motivated by history

Many philosophical versions motivated by topology► This version motivated primarily by anatomy and engineering

► Classic knowledge representation work is► Odell, J. J. (1994). "Six different kinds of composition." Journal of

Object Oriented Programming 5(8): 10-15.

► A short readable summary

► Not complete nor completely up to date

► Winston, M., R. Chaffin, et al. (1987). "A taxonomy of part-whole relations." Cognitive Science 11: 417-444.

► Mereology – the study of parts and wholes► A quick glance at Google…

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Five families of relationsFive families of relations

► Partonomic► Parts and wholes

► The lid is part of the box

► Constitution

► The box is made of cardboard

► Membership?

► The box is part of the shipment

► Nonpartonomic► Containment

► The gift is contained in the box

► Connection/branching/Adjacency

► The box is connected to the container by a strap

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Some testsSome tests

► True kinds of part-of are transitive and A fault to the part is a fault in the whole

► The finger nail is part of the finger is part of the hand is part of the upper extremity is part of the body

► Injury to the fingernail is injury to the body

► The tail-light is part of the electrical system is part of the car► A fault in the tail light is a fault in the car

► Membership is not transitive► The foot of the goose is part of the goose but not part of the flock of geese

► Damage to the foot of the goose is not damage ot the flock of geese

► Containment is transitive but things contained are not necessarily parts► A fault (e.g. souring) to the milk contained in the bottle is not damage to the bottle

► Some kinds of part-whole relation are questionably transitive► Is the cell that is part of the finger a part of the body?

► Is damage to the cell that is part of the finger damage to the body?

► Not necessarily, since the cells in my body die and regrow constantly

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Structural partsStructural parts

► The leg is a component of of the table► Discrete

► connected,

► clear boundary,

► specifically named

► may be differently constituted

► Can have metal legs on a wooden table or vice versa

► The left side is a subdivision of the table► ‘Side’, ‘Lobe’, ‘segment’, ‘region’,…

► Arbitrary, similarly constituted,

► components typically fall into one or another subdivision;

► defined in relation to something else;

► sensible to talk about what fraction it is: half the table, a third of the table, etc.

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Part Whole relations in OWLPart Whole relations in OWL

►OWL has no special constructs►But provides the building blocks

►Transitive relations►Finger is_part_of Hand

Hand is_part_of Arm Arm is_part_of Body

►

► Finger is_part_of Body

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Simple versionSimple version

►One property is_part_of►transitive

►finger is_part_of some HandHand is_part_of some ArmArm is_part_of some Body

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Get a simple listGet a simple list

► Probe_part_of_body = Domain_category AND is_part_of some Body

► Logically correct► But may not be what we

want to see

►The finger is not a kind of Hand

►It is a part of the hand

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First simple refinementFirst simple refinementdirect partsdirect parts► Add a non-transitive subrelation

► is_part_of : transitive is_part_of_directly : non-transitive

► This means► All direct parts are parts, but not vice versa.

►If the finger is directly part of the hand, THENthe finger is part of the hand.

118 © University of Manchester

Implementation PatternImplementation PatternTransitive properties with non-transitive Transitive properties with non-transitive “direct” subproperties“direct” subproperties

► Transitive properties should have non-transitive children► isPartOf : transitive

isPartOfDirectly : non-transitive

► Split which is used in partial descriptions and complete definitions► Necessary conditions use non-transitive version

► Definitions use transitive version

► Benefits► Allows more restrictions in domain/range constraints and cardinality

► Allows the hierarchy along that axis to be traced one step at a time

► Allow a good approximation of pure trees

► Make the nontransitive subproperty functional

► Transitive properties can (almost) never be functional(by definition, a transitive property has more than one value in any non-trivial system)

► Constraints on transitive properties easily lead to unsatisfiability

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Injuries, Faults, Diseases, Injuries, Faults, Diseases, Etc.Etc.

►A hand is not a kind of a body► … but an injury to a hand is a kind of injury to

a body

►A motor is not a kind of automobile► … but a fault in the motor is a kind of fault in

the automobile

►And people often expect to see partonomy hierarchies

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Role inclusion axioms Role inclusion axioms “Transitive across”“Transitive across”► GALEN: “specialised_by” / “refined along”

► r1 o r2 r1

► has_locus o is_part_of has_locus

► Now coming in OWL 1.1

► Note requires a subrelation for whole► has_locus

has_locus_specifically

► Removal & has_locus_specifically SOME (Lobe & is_part_of SOME Lung)

► DOES NOT IMPLYRemoval & has_locus SOME Lung

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Alternative in OWLAlternative in OWL& perhaps preferable in this case& perhaps preferable in this case: “Adapted SEP Triples”: “Adapted SEP Triples”

► Body (‘as a whole’)► Body

► The Body’s parts► is_part_of some Body

► The Body and it’s parts► Body OR is_part_of some body

► Repeat for all parts► Use ‘Clone class’ or

► NB: ‘JOT’ Python plugin is good for this

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Adapted SEP triples: Adapted SEP triples: UML like viewUML like view

Forearm

ArmPart ofArm

Hand

Arm OR part part of armhas_locus

someInjury to Arm(or part of arm)

Injury to Hand has_locussome

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Adapted SEP triples:Adapted SEP triples:Venn style viewVenn style view

Arm or parts of Arm

Arm

Parts of Arm

HandForeArm

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Resulting classification:Resulting classification:Ugly to look at, but correctUgly to look at, but correct

© University of Manchester 125

Using part-whole relations: Using part-whole relations: Defining injuries or faultsDefining injuries or faults

► Injury_to_Hand = Injury has_locus some Hand_or_part_of_hand

► Injury_to_Arm = Injury has_locus some Arm_or_part_of_Arm

► Injury_to_Body = Injury has_locus some Body_or_part_of_Body

► The expectedhierarchy frompoint of view ofanatomy

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In DL or OWL must use the In DL or OWL must use the Property HierarchyProperty Hierarchy

© University of Manchester 127

Sufficient to support multiple Sufficient to support multiple “views” “views” Clinician’s view:

Pericardium is part of heart &Pericardiitis isa kind of HeartDisease

Anatomist’s view:Pericardium is a distinct organ thatdevelops separatelyfrom Heart

Both views:The Brain is located in the skul but notpart of the skull

Formally:The Brain is contained in the Cavity defined by the Cranium which is a structural part of the skull.

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Adapted SEP TriplesAdapted SEP Triples11

► The disease of the part is a disease of the whole

►Almost always, but we also want to talk about diseases of the whole only

11Schultz & HahnSchultz & Hahn

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Adapted SEP Triples Adapted SEP Triples Disease of the wholeDisease of the whole

► “Removal of the ‘kidney as a whole’” • Removal actsOn some Kidney

► “Removal of a ‘some part of the kidney’”• Removal actsOn some

(Kidney or is_clinical_part_of Kidney)

► “Pathology of a Kidney”• Pathology has_locus some

(Kidney or is_clinical_part_of Kidney)

© University of Manchester 130

Adapted SEP Triples Adapted SEP Triples Complex Condition of the wholeComplex Condition of the whole

► Cardiac_failure is a disorder of the “heart as a whole”

Class: Cardiac_failure DEFINITIONCardiac_pumping has_outcome some (Circulation_of_blood AND ( has_level_quality some (Activity_Level AND has_status some inadequate_status AND has_normality_status some pathological)))INHERITShas_actor Heart “as a whole”

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What’s a Disease?What’s a Disease?

► A pathological process, object, or quality?

► A “Clinical Situation”

► A collection of a root pathology and its consequences

► A “Syndrome”

► If so, then for classification need policies about when to use syndromes and when not

► Therefore best to make Every disease a syndrome even if of only one condition

► AVOID this mess

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DualsDuals► Many processes and their outcomes come in pairs

►“The erosion (process) of the soil took place over many years”

►“The erosion (physical thing) extended over many hectares”

► For software engineering reasons, we do not want to define them independently

• Should the process or object be primary?– Erosion_object = Physical_continuant &

is_specific_outcome_of some Erosion_occurrent– Erosion_process = Physical_occurrent &

has_specific_outcome some Erosion_continuant

• Should it be a complex?– Erosion = Nexus &

has_occurrent some Erosion_occurrent has_continuant some Erosion_continuant

© University of Manchester 133

Engineering IssuesEngineering Issues

► Must be consistent within the ontology or classification fails

► An occurrent cannot be a kind of continuant or visa versa

► For a ‘nexus’, the site must be declared for the nexus as a whole

► If for each individually, cannot express the constraint that they must be the same

► GALEN chose to make occurrents primary(with exceptions for a few complete subontologies)

► Or is it a continuant pattern that ought to common

► Would this be different from a ‘nexus’ in engineering terms?

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GranularityGranularityCollective vs IndividualCollective vs Individual► Collectives (‘multiples’) of discrete entities at one level of

granularity form mass entities at the next

► e.g. multiple of grains of sand is constituent of a beach multiple of red cells are a portion of blood multiple of water molecules are a portion of water multiple of bone cells are a portion of bone tissue is a constituent of long bones

► The concern is with the collective as a whole not its ‘grains’

► Loss or gain of grains does not affect identity of multiple

► Not a matter of size,

► although grains are always smaller than the multiples they make up

© University of Manchester 135

Current ControversiesCurrent Controversies

► Mass vs Discrete entities► Do tissues exist as distinct from the organs they constitute?

► Structured mass entities► Tissues, cloth, …

► Scale► Fixed partitions vs case by case representation of “multiples”

© University of Manchester 136

Controversies: How to argue?Controversies: How to argue?

► Evidence is effect on representation► Is there a real difference or just labelling

►Are two solutions really isomorphic up to labelling?

► Relative expressiveness?

► Effect on hard cases?

► Understandability? / Repeatability?

►The views of domain experts

►Whether there is a transformation from untuitive form to

► Effect on performance?

►Small changes can have massive effects on classification time

© University of Manchester 137

Summary: Lessons from GALENSummary: Lessons from GALEN► Enumeration does not scale

► Logic is the assembly language: Develop compiler compilers for “close to user forms” or “Intermediate Representations”

► Normalise the ontology

► Having an upper ontology matters for agreement► Focus on the problems for your application

► GALEN provides a useful start fo bio-ontologies

► Part whole relations and locus are still problems► Acapted SEP triples work well for anatomy

► Size and collectivity are different

► The property hierarchy can help allow different views

► Controversies remain► Duals still a problem

► Tissues and other Mass Entities

www.opengalen.org; www.co-ode.orgwww.cs.man.ac.uk/~rector/ontologies/simple-top-bio