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  <Title>Scenario forms for web information seeking and summarizing in bone marrow transplantation</Title>
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Abstract
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    <Paragraph position="0"> This paper presents the user-centered interface of a summarization system for physicians in Bone Marrow Transplantation (BMT). It serves both retrieval and summarization, eliciting the query and presenting multi-document summaries in a situation-specific organization. Introduction: User-centered scenario forms for retrieval and summarization This paper presents the user interface of a summarization system for physicians in Bone Marrow Transplantation (BMT). The interface has users state well-articulated questions that serve as summarization targets and basis for retrieval queries, and it displays summarization results in an organization that fits the user's situation. Although user interfaces have attracted almost no interest in summarization research so far, we think that a suitable user-oriented interface is important for a summarization system. This paper deals with such an interface, not with the summarization procedures the interface enables. In good user-centered design attitude (Norman and Draper, 1986), we developed the user interface first, and are still equipping it component by component with the intended functionality.</Paragraph>
    <Paragraph position="1"> Our users are highly specialized physicians in Bone Marrow Transplantation (BMT), a lifecritical field of internal medicine. They need answers to their questions that are fast, to the point, and prepared for direct application. Using question/answer scenario forms derived from empirical scenario descriptions, they can specify their current situation and the missing knowledge items with the help of a domain-specific ontology. The system accepts the filled out question scenario, projects it to a query for search engines and Medline (the most common medical reference retrieval engine), and starts the search. Retrieved documents are downloaded, preprocessed, and then checked for passages where question terms accumulate.</Paragraph>
    <Paragraph position="2"> These passages are examined by summarization agents that follow strategies of human summarizers (Endres-Niggemeyer 1998). Accepted statements enter the summary, under the heading given by the scenario element that asked for them. Thus the summary organizes new knowledge in a fashion that mirrors the user's situation. All the time, the user-centered interface keeps users in their own task environment. null To produce summaries that fit users' information needs, reasonably precise question statements are required. Questions (think of Who? Why? etc.) also have well-known qualities as text organizers, so that they can serve summary organization, the query items switching to headings for (partial) summaries when answers are delivered.</Paragraph>
    <Paragraph position="3"> Well-structured queries are most easily elicited by a convenient form. With a suitable choice of real-life scenarios (ideas inspired by Carroll, 2000), users can formulate their search and summarizing requests by filling out such a form, simply stating what they know and what they are missing in a given situation. Where the user identifies a knowledge gap (a question), the system will feed in the respective summary items if possible.</Paragraph>
    <Paragraph position="4"> In order to mediate between the users' and the system perspective, we equip the scenario forms with intermediary structures - a detailed interpretation for summarizing and an abridged one for IR. Within these interpretations, the form itself is represented by constants, the user query provides variables.</Paragraph>
    <Paragraph position="5"> In the following, we explain where our inspiration for the interface came from, how its design aims are met, ensued by empirical modeling and implementational details.</Paragraph>
    <Paragraph position="6"> 1 Background and related approaches While graphical output of summaries was already addressed in the 80ies, interest in user interfaces of summarization systems is more recent. Aone et al. (1999) as well as Strzalkowski et al. (1999) and Ando et al. (2000) describe graphical user interfaces of their summarizers. White, Ruthven and Joemon (2001) positively evaluate a summarization function and interface added to Altavista and Google. Buyukkokten et al. (w.d.) summarize for hand-helds. Their small screens make them consider the user interface. Kan, McKeown and Klavans (2001) see summarization on top of an IR task, as we do. They intend to replace the common ranked output lists of retrieval or search engines by a multi-document summary structure. Our graphical user interface applies findings and principles of user-centered information seeking. We are not aware of any earlier approaches that deal with user-centered query formulation in summarization.</Paragraph>
    <Paragraph position="7"> Human-computer interaction and interface development are well-trodden research areas in IR (overviews by Hearst 1999; Marchionini and Komlodi, 1998). Especially in the Digital Libraries context there is plenty of work and new ideas about how to improve user access and to make retrieval interfaces more intuitive, both on the Internet and in specialized collections such as videos (see e.g. Mackinlay, Rao and Card, 1995, or Geisler et al., 2001). In IR, templates are frequent, but we see no user interfaces that consistently derive the query from a description of the user need. One possible reason for this is that most approaches deal with less well-defined environments, while in the setting of clinical BMT, users are in wellcircumscribed situations.</Paragraph>
    <Paragraph position="8"> Figure 1. User-oriented query formulation scenario: Adverse drug effects (simplified) Underlying disease chronic myelogenous leukemia ide effects included nausea, vomiting and diarrhea, muscle cramps, arthralgias, eriorbital edema, peripheral edema, dermatitis and myelosuppression. Most of hese were grade 1 or 2 toxicities. Grade 3/4 drug related adverse events included eutropenia (12%), thrombocytopenia (6%), dermatitis and eczema (3%), nausea nd vomiting (2%), and anemia (1%) [27].</Paragraph>
    <Paragraph position="9"> uthor Michael E. O'Dwyer and Brian J. Druker itle The Role of the Tyrosine Kinase Inhibitor STI571 in the Treatment of Cancer  thrombocytopenia. However, the occurrence of these cytopenias is dependent on the stage of the disease being treated and they were more frequent in patients with accelerated phase CML or blast crisis as compared to patients with chronic phase CML. Treatment with Glivec may be interrupted or the dose be reduced, as recommended in section (Dosage and method of administration).  The initial results of these phase II trials were presented at the annual meeting of the American Society of Hematology (ASH) in December 2000. In these studies patients were treated with STI571 at 400 to 600 mg daily dose. This dose range was based on analysis of pharmacokinetic and response data from the phase I study. In the dose finding study a dose level of 300mg appeared to be the threshold for significant therapeutic benefit. In addition, pharmacokinetic data showed that this dose achieved a trough level of 1uM, which is the in vitro IC50 for cellular proliferation. Finally, an analysis of responses in white blood counts and platelets over time suggested that doses of 400 to 600 mg were on the plateau of a dose-response curve, indicating that this dose range would be efficacious for phase II testing [26]. In phase II testing, 532 chronic phase patients who were refractory to or intolerant of interferon-a were treated with a STI571 dose of 400mg daily. Eligibility criteria in this study allowed inclusion of patients with up to 15% blasts and 15% basophils in the marrow or peripheral blood. After a median exposure of 254 days (86% of patients were treated for 6-12 months), 47% and 28% of patients achieved major and complete cytogenetic responses, respectively. Only 3% of patients discontinued treatment due to disease progression with only 2% of all patients stopping therapy due to adverse events. Side effects included nausea, vomiting and diarrhea, muscle cramps, arthralgias, periorbital edema, peripheral edema, dermatitis and myelosuppression. Most of these were grade 1 or 2 toxicities. Grade 3/4 drug related adverse events included neutropenia (12%), thrombocytopenia (6%), dermatitis and eczema (3%), nausea and vomiting (2%), and anemia (1%) [27]. Results of the phase II study in accelerated phase patients were equally impressive [28]. Overall, 91% of 233 patients showed some form of hematologic response, while 63% of patients achieved a complete hematologic response (CHR) with or without peripheral blood recovery, with 44% achieving a CHR with peripheral blood recovery (neutrophils &gt; 1.0 x 109/L and platelets &gt; 100 x 109/L). Twenty-one percent (21%) of patients achieved a major cytogenetic response with 14% complete responses. Overall, 41% of accelerated phase patients had some form of cytogenetic response. Again, these results were achieved without substantial toxicity. Not surprisingly, there was a higher incidence of grade 3/4 hematological toxicity in this patient population, 20%, 17% and 15% of patients developing grade 3/4 thrombocytopenia, anemia or neutropenia, respectively. However, only 2% of patients developed febrile neutropenia. Finally, results of the phase II study treating 260 myeloid blast crisis patients with STI571 were presented [29]. The overall response rate was 64% with 11% achieving complete remission (CR = &lt; 5% blasts) with peripheral blood recovery. Another 15% of patients cleared their marrows to less than 5% blasts but did not meet the criteria for CR due to persistent cytopenias. Lastly, 38% of patients were either returned to chronic phase or had partial responses. Cytogenetic responses were seen in 27% of cases with 15% major and 6% complete responses. Median survival was 6.8 months (8.6 months in patients treated with STI571 as first line therapy versus 4.4 months when STI571 was used as second line therapy). Thirty percent (30%) of patients were still alive at 14 months with a suggestion of a plateau on the survival curve. These results compare favorably in a historical context to chemotherapy for myeloid blast crisis in which the median survival is approximately 3 months. Toxicity was comparable to that seen in the accelerated phase study.</Paragraph>
    <Paragraph position="10"> Future directions in therapy of CML In addition to the ongoing phase II studies, a phase III randomized study, comparing STI571 with interferon and ara-C in newly diagnosed patients is ongoing. The results of this study, plus longer follow up on patients in the phase II studies will be required to determine the place of STI571 in CML treatment algorithms. From the results presented above, it is clear that STI571 works best when used early in the disease course, chronic phase as opposed to blast crisis. As it is possible that Bcr-Abl is the sole oncogenic abnormality in early stage disease, STI571 may be sufficient as a single agent in some patients with CML. With disease progression, additional genetic abnormalities may render CML cells less dependent on Bcr-Abl for survival. Thus, in blast crisis patients, it is clear that therapy with STI571 alone is insufficient for the vast majority of these patients.</Paragraph>
    <Paragraph position="11">  claims that users are entitled to state their information needs in their own thinking and working context. The research history reflects a long struggle for user-oriented information seeking as opposed to machine-driven query formulation in IR. The ASK (Anomalous State of Knowledge) hypothesis of Belkin, Oddy and Brooks (1982) gives the classic formulation of the problem: Users who ask are in difficulty, they lack a piece of knowledge and are busy restructuring their convictions. This is a bad moment to additionally confront them with an IR system, instead of adapting to their needs.</Paragraph>
    <Paragraph position="12"> Bates' (1989) landmark &amp;quot;berrypicking&amp;quot; model of information seeking pinpoints the advance in understanding of how human users seek and process information in natural environments.</Paragraph>
    <Paragraph position="13"> During an information seeking process, Bates (1989) observes many rounds of retrieving documents and learning with changing goals.</Paragraph>
    <Paragraph position="14"> Empirical data have confirmed her analysis (see Hearst, 1999). When Marchionini and Komlodi (1998) wrote their overview of information seeking interfaces, they put user-centered query interfaces on the research agenda.</Paragraph>
    <Paragraph position="15"> It is commonplace knowledge in IR that end users are not very proficient in IR tasks, because of missing background knowledge and practice. They have poor chances to overcome an &amp;quot;eternal novice&amp;quot; condition (Borgman, 1996). Therefore, the traditional work organization in IR includes intermediaries (cf.</Paragraph>
    <Paragraph position="16"> Ingwersen, 1992). For better retrieval results, they help with problem definition, structure the question strategy in a presearch interview, develop queries that promise retrieval success, execute the search, and check the retrieval result in a post-search interview.</Paragraph>
    <Paragraph position="17"> Our summarization follows a knowledge-based human-like style of argumentation (Endres-Niggemeyer, 1998). The main knowledge source is a BMT ontology comprising about 4400 concepts of the domain. Since users state their information need with concepts from this ontology, the ontology is also an important component of the user interface (see figures 1, 4). From an IR point of view, ontologies are legitimate offspring of thesauri. Many thesauri are used for indexing documents and formulating queries (see Lutes, 1998). By applying a domain ontology like a classic thesaurus, we use a practice that has stood the test of decades. null</Paragraph>
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