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are specific to an institution from the more generic parts of the MLM. The order in which the MLM must be invoked are indicated by the priority, which can be a number from 1 (last) to 99 (first). It is a rarely used optional slot. An MLM can be activated by an event, or by a direct call from an MLM or an application programme which is specified by the evoke slot. A real medical condition or rule to test for is contained in the logic slot which may include compound calculations. The action slot creates a message that is sent to the health care provider, such as sending an alert to the destination, evoking other MLMs and returning values. The urgency slot is optional; it can be a number from 1 to 99 which indicates the importance of an MLMs action or message.
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third slot is the version which specifies the version used. It also maintains a track of updates to the MLMs. A version slot is followed by institution and author slots that specify where the MLM is written and the person who wrote it. The sixth slot is the specialist slot that names the person in the institution liable for validating and installing the MLM in the institution. This slot is always meant to be blank when transferring information from one institution to another. This slot is followed by date and validation slots which show the date at which MLM was last updated. The validation level is set by the specialist, it indicates that the MLM is only used for testing. These slots are used for knowledge base maintenance and change control.
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This category contains the actual medical knowledge of the MLM. It consists of type, data, priority, evoke, logic and action slots. The way in which MLM is used is known by type slot. Terms used in the rest of the MLM are defined by the data slot. Its goal is to separate those parts of the MLM that
445:
The syntax offers potential users help deciding if the standard is appropriate for their purposes. It offers users and implementors knowledge of how parts of the standard were designed to be used. It also provides authors of other standards an insight that might be helpful in their own attempts in
408:
in Salt Lake City has contributed much to this standard as well as body of knowledge. Indiana
University's section of Children's Health Services Research within the School of Medicine extensively uses Arden Syntax MLMs to control clinical decision support within the CHICA (Child Health Improvement
1215:
keyword slot. The citation and link slots are optional. References to literature that support MLM's medical behaviour are included in the citation slot. Institution specific links to other sources of information such as electronic textbooks and educational modules are contained in the links slot.
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to generate alerts, interpretations, and to screen and manage messages to clinicians. This syntax is used to share medical knowledge within and across many health service institutions. Rule sets, called
Medical Logic Modules (MLMs), comprise enough logic to make a single medical decision. Medical
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about the MLM. The maintenance category consists of slots that indicate maintenance information unrelated to the medical knowledge in the module. The first slot is the title which gives a brief description of the module followed by a file name, a distinct identifier used to specify the MLM. The
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The unit of representation in the Arden syntax is the
Medical Logic Module (MLM). A Medical logic Module is composed of four categories, namely maintenance, library, knowledge and resources, with appropriate slots. Arden Syntax is an instance of a Knowledge Resource-Centric Knowledge Integration
454:
The main aim of fuzzy Arden syntax is to provide easy method in processing of uncertain data which routinely appears in medicine. New concepts are incorporated into Arden syntax by fuzzy Arden syntax in order to assist in processing information that may not be completely defined. For example, a
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This category contains five slots called purpose, explanation, keywords, citations and links. The purpose slot explains what a particular MLM is used for, whereas the explanation slot illustrates how an MLM works. Terms that can be used to search through a knowledge base of MLM is supplied by a
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The
Regenstrief Institute, an international non-profit medical research organization "recognized for its role in improving quality of care, increasing efficiency of healthcare delivery, preventing medical errors and enhancing patient safety", uses Arden Syntax MLMs in its CARE system to deliver
267:
and IBM Health
Industry Marketing in Atlanta, Georgia, between 1989 and 1993. IBM provided program funding, S/370 mainframe hardware, software, peripheral equipment, and other materials for the work, and program management oversight of the collaborative effort.
409:
through
Computer Automation) pediatric clinical decision support system, an ambulatory CDS that has been running within Indianapolis-area health systems for 11 years. Arden syntax is implemented at LDS hospital, Salt Lake City, Utah, using the HELP system.
459:. Use of fuzzy logic in knowledge base provide physicians with more precise information on the degree of the presence of nosocomial infections, that aids to recognize borderline cases and allows former detection of an infection onset and its decline.
311:,a second MLM is activated by the storage of a blood potassium result and the third activated by the storage of blood digoxin level. Twelve are research MLM examples, which include the ability to identify patients with abnormal cervical
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At
Columbia-Presbyterian Medical center, 40 Arden syntax MLMs have been implemented in which 18 of those are clinical MLMs, including 4 interpretations and 14 alerts. For example, a user is alerted by three MLMs to the presence of
404:
reminders or hints to clinicians regarding patient treatment recommendations (e.g., the next clinic appointment, based on rules applied to the digitized notes and pertinent patient data stored in the system). Additionally,
275:, in recognition of important milestones achieved there in the development and refinement of the syntax and its implementation. (Originally purchased by Edward Henry Harriman in 1885, the estate was given to
330:, and others at CPMC, under the leadership of Paul D. Clayton. In a related effort under the same program, another prototype implementation of the syntax was developed by Peter Ludemann using
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using Arden syntax standard ranging from a few to several dozens of MLMs. These systems are
Hepaxpert, Thyrexpert, Toxopert and RHEUMexpert. The Hepaxpert system helps in interpretation of
1884:, Grunwald D, Lochau M, Marschollek M, Song B, Wolf KH (2012). "Arden2ByteCode: a one-pass Arden Syntax compiler for service-oriented decision support systems based on the OSGi platform".
455:
fuzzy logic has been used in knowledge base in Moni–ICU system at clinical institute of hospital hygiene of the Vienna general hospital. It is a system that detects and constantly checks
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Starren, J.B.; Hripcsak, G.; Jordan, D.; Allen, B.; Weissman, C.; Clayton, P.D. (1994). "Encoding a post-operative coronary artery bypass surgery care plan in the Arden Syntax".
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IBM's artificial intelligence product, KnowledgeTool, provided the original basis for MLM syntax representation and processing, as enhanced and applied by CPMC researchers Drs.
424:
serology test results, whereas the
Thyrexpert system helps in interpretation of thyroid hormone test results. The Toxopert system helps in interpretation of time sequences of
416:
comprises a clinical database, medical database dictionary, and a knowledge base component. Syntax for the knowledge base is Arden syntax. Samwald et al. group developed many
183:
1946:"Proposal for Fulfilling Strategic Objectives of the U.S. Roadmap for National Action on Decision Support through a Service-oriented Architecture Leveraging HL7 Services"
263:
Arden Syntax and its first applications were conceived and developed as the primary deliverables of a multimillion-dollar joint research and development program between
1700:
1381:
Song, B.; Wolf, K.-H.; Gietzelt, M.; Al
Scharaa, O.; Tegtbur, U.; Haux, R.; Marschollek, M. (2009). "Decision Support for Teletraining of COPD Patients".
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The code is written in a way close to natural language and readable, with several syntactic features such as flexible list handling that can be filtered.
264:
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logic modules are written in Arden syntax, and are called by a program – an event monitor – when the condition they are written to help with occurs.
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A clinically important situation such as a medication interaction or dangerous laboratory result arises, the provider is warned by an alert message.
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Management messages are used for administrative purposes such as managing bed assignments, same day admissions and discharges from the hospital.
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Since it is divided into various categories, it allows usage of various operators and statements at the same time, leading to inconsistencies.
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Standard might be written in two separate documents, one for users to develop Arden syntax MLMs and the other for developers of Arden syntax
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used for representing and sharing medical knowledge. This clinical and scientific knowledge language is used in an executable format by
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when patients meeting certain characteristics either for a clinical trial or quality assurance concern are admitted to the hospital.
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An interpretation is a nonemergency message designed to supply a provider with supportive information such as an interpretation of
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Kim, Sukil; Haug, Peter J.; Rocha, Roberto A.; Choi, Inyoung (2008). "Modeling the Arden Syntax for medical decisions in XML".
503:-based compilers or similar tools to translate the MLMs to an intermediate form which is executed later. Other developers use
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Jenders, RA; Hripcsak, G; Sideli, RV; Dumouchel, W; Zhang, H; Cimino, JJ; Johnson, SB; Sherman, EH; Clayton, PD (1995).
456:
405:
1588:"Medical decision support: Experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center"
106:
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Vetterlein, Thomas; Mandl H; Adlassnig K (2010). "Fuzzy arden syntax: A fuzzy programming language for medicine".
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MLMs for producing large metadata by the standard, which is vital for making large collections of MLMs manageable.
334:. IBM program management and AI technology services were provided by Terry Rankin, Pete Smith, and Eddie Sanders.
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Architecture, where the knowledge resources command the delivery mechanisms of clinical decision support system.
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and their inpatient location to enroll the patient in a study, and the remaining ten are administrative MLMs.
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The name "Arden" comes from the location of the IBM/CPMC conferences and working sessions, Arden House, in
255:. Arden syntax version 2.0 was published by HL7 in 1999. Arden syntax version 2.10 is the current version.
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291:. The house and grounds became a National Historic Landmark in 1966, and it is now a conference center.)
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and optimising MLMs by converting them to single-assignment declarative form. The open source compiler
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Hripcsak, George; Ludemann, Peter; Pryor, T. Allan; Wigertz, Ove B.; Clayton, Paul D. (August 1994).
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Anand, Vibha; Carroll, Aaron E.; Biondich, Paul G.; Dugan, Tamara M.; Downs, Stephen M. (2018).
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Samwald, Matthias; Fehre, Karsten; de Bruin, Jeroen; Adlassnig, Klaus-Peter (August 2012).
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Arden syntax is used in computerized care plans for the management of patients following
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Samwald, Matthias; Fehre, Karsten; De Bruin, Jeroen; Adlassnig, Klaus-Peter (2012).
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Problems related to adoption of Arden syntax are the "curly braces problem" and the
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Hripcsak, George (1994). "Writing Arden Syntax medical logic modules".
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927:/* If the height is lower than height_threshold, output a message */
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problem, which may be resolved in the future by the introduction of
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Arden syntax is tested for reliability and imprecision using tools
1086:"Your Diastolic Blood Pressure is too low (hypotension)"
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serology test results. Differential diagnosis decision support in
315:, etc. that notify the researcher of the details of the patient's
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is found by Yacc. These tools reduce ambiguities in the syntax.
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It allows easy encoding of several important medical concepts.
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International Journal of Clinical Monitoring and Computing
307:. One MLM is activated by storage of a pharmacy order by
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Journal of the American Medical Informatics Association
1475:"Pediatric decision support using adapted Arden Syntax"
179:
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called Arden4Eclipse supports MLM developers with an
1624:"Providing solutions for clinical decision support"
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may be too technical for most readers to understand
1995:"How to write Arden Syntax MLMs – An introduction"
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1539:"The arden syntax for medical logic modules"
1170:"Der Normalbereich von 60 bis 90"
921:/* the value in braces is specific to your
247:Arden syntax was formerly a standard under
50:Learn how and when to remove these messages
1537:Pryor, T. Allan; Hripcsak, George (1993).
1234:Fast Healthcare Interoperability Resources
1140:"The normal range from 60 to 90"
384:Developers are encouraged to document and
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251:, published in 1992, and is now part of
220:Learn how and when to remove this message
202:Learn how and when to remove this message
186:, without removing the technical details.
147:Learn how and when to remove this message
1921:Clinical Decision support The Road Ahead
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888:/* read the diastolic blood pressure */
83:Please improve this article by adding
1703:. Medexter Healthcare. Archived from
1677:. Medexter Healthcare. Archived from
1651:. Medexter Healthcare. Archived from
412:A medical decision support system at
184:make it understandable to non-experts
7:
1993:Fehre, Karsten (February 17, 2012).
265:Columbia Presbyterian Medical Center
1770:Artificial Intelligence in Medicine
1479:Artificial Intelligence in Medicine
551:that, when used together, create a
446:future designing of new languages.
1383:Methods of Information in Medicine
533:integrated development environment
326:, George Hripcsak, Steve Johnson,
14:
1809:Journal of Biomedical Informatics
1735:Computers and Biomedical Research
1426:Computers in Biology and Medicine
1335:Journal of Biomedical Informatics
1277:Computers in Biology and Medicine
283:in 1950 following its use by the
241:clinical decision support systems
31:This article has multiple issues.
1731:"Rationale for the Arden Syntax"
861://en.wikipedia.org/Hypotension;;
418:clinical decision support system
373:Health Level Seven International
253:Health Level Seven International
163:
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1944:Kawamoto, K; Lobach, D (2007).
39:or discuss these issues on the
1886:Comput Methods Programs Biomed
1859:10.1016/j.ijmedinf.2008.01.001
527:. The accompanying plugin for
399:coronary artery bypass surgery
356:A Screen is a message sent to
1:
499:Several developers have used
85:secondary or tertiary sources
1782:10.1016/j.artmed.2010.01.003
1491:10.1016/j.artmed.2015.09.006
1438:10.1016/0010-4825(94)90010-8
1289:10.1016/0010-4825(94)90002-7
1038:diastolic_pressure_threshold
930:diastolic_pressure_threshold
457:hospital-acquired infections
432:is offered by RHEUMexpert.
342:Arden syntax is used when:
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2000:. Medexter. Archived from
1898:10.1016/j.cmpb.2011.11.003
1626:. Medexter. Archived from
523:that is executable on the
1821:10.1016/j.jbi.2012.02.001
1348:10.1016/j.jbi.2012.02.001
1919:Greenes, Robert (2007).
1239:Electronic health record
1032:diastolic_blood_pressure
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891:diastolic_blood_pressure
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495:Technical implementation
367:Its advantages include:
1460:"Regenstrief Institute"
1201:This category contains
476:-based techniques like
303:use that might lead to
273:Orange County, New York
1747:10.1006/cbmr.1994.1023
924:runtime environment */
478:Virtual Medical Record
375:standards organization
72:relies excessively on
2033:Computer file formats
1395:10.3414/ME09-02-0005
525:Java Virtual Machine
414:Linkoping University
371:It is a part of the
351:liver function tests
1962:10.1197/jamia.m2298
519:translates MLMs to
393:Real-world examples
305:cardiac dysrhythmia
281:W. Averell Harriman
277:Columbia University
1555:10.1007/BF01133012
450:Fuzzy Arden syntax
1930:978-0-12-369377-8
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2007:on 2014-05-14.
1985:
1956:(2): 146–155.
1936:
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1815:(4): 711–718.
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317:medical record
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96:"Arden syntax"
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1707:on 2013-10-15
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1701:"Rheumexpert"
1696:
1693:
1681:on 2013-10-15
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1389:(1): 96–102.
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521:Java Bytecode
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70:This article
68:
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2014:
2002:the original
1988:
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1880:Gietzelt M,
1875:
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1763:
1738:
1734:
1709:. Retrieved
1705:the original
1695:
1683:. Retrieved
1679:the original
1669:
1657:. Retrieved
1653:the original
1649:"Thyrexpert"
1643:
1632:. Retrieved
1628:the original
1618:
1591:
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1546:
1542:
1482:
1478:
1468:
1454:
1432:(5): 411–7.
1429:
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1376:
1365:
1341:(4): 711–8.
1338:
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542:
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430:rheumatology
411:
406:LDS hospital
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293:
289:World War II
270:
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233:Arden syntax
232:
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192:January 2012
189:
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34:
33:Please help
30:
1776:(1): 1–10.
1370:Arden house
1197:Maintenance
1092:stdout_dest
954:destination
945:stdout_dest
876:data_driven
828:hypotension
777:explanation
654:institution
621:Hypotension
573:maintenance
557:interpreter
463:Limitations
297:hypokalemia
279:by his son
2022:Categories
1675:"Toxopert"
1634:2015-02-18
1594:: 169–73.
1499:1805/14229
1245:References
975:null_event
714:validation
690:specialist
666:University
137:March 2009
107:newspapers
74:references
36:improve it
1829:1532-0464
1485:: 15–23.
1219:Knowledge
1188:Structure
1101:resources
909:diastolic
864:knowledge
840:citations
747:diastolic
594:diastolic
561:programme
507:for both
488:compilers
441:Rationale
422:hepatitis
313:pathology
285:U.S. Navy
42:talk page
1980:17213489
1906:22206864
1867:18321775
1790:20167457
1517:26547523
1411:16854405
1403:20011809
1357:22342733
1228:See also
1203:metadata
1149:language
1119:language
1059:conclude
1047:conclude
1011:conclude
915:pressure
822:keywords
753:pressure
684:Devineni
669:Bundoora
600:pressure
553:compiler
470:compiler
436:Features
386:annotate
1971:2213469
1882:Goltz U
1755:7956129
1711:May 19,
1685:May 19,
1659:May 19,
1610:8563259
1601:2579077
1573:8270835
1564:2245504
1508:4818208
1446:7705074
1297:7705066
1210:Library
1107:default
816:message
810:writing
801:reading
795:example
762:patient
732:purpose
726:library
720:testing
681:Lakshmi
642:version
633:version
615:mlmname
609:patient
567:Example
539:Testing
535:(IDE).
529:Eclipse
509:parsing
309:digoxin
301:digoxin
259:History
178:Please
121:scholar
1978:
1968:
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1077:action
1002:number
960:stdout
771:limits
768:within
708:-06-02
675:author
505:Prolog
480:(vMR).
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2005:(PDF)
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1407:S2CID
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1128:'
1083:write
1068:endif
1062:false
1035:>=
1020:endif
1014:false
981:logic
969:evoke
912:blood
849:links
750:blood
738:check
663:Trobe
627:arden
597:blood
588:check
579:title
235:is a
128:JSTOR
114:books
1976:PMID
1925:ISBN
1902:PMID
1863:PMID
1825:ISSN
1786:PMID
1751:PMID
1713:2013
1687:2013
1661:2013
1606:PMID
1569:PMID
1513:PMID
1442:PMID
1399:PMID
1353:PMID
1293:PMID
1056:else
1050:true
1044:then
1008:then
903:last
900:read
882:data
870:type
855:http
804:data
783:This
705:2013
699:date
648:1.00
549:Yacc
547:and
511:and
501:Yacc
338:Uses
299:and
249:ASTM
100:news
1966:PMC
1958:doi
1894:doi
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1855:doi
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1778:doi
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1559:PMC
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1503:PMC
1495:hdl
1487:doi
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1391:doi
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1161:msg
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807:and
798:for
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759:the
744:the
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474:XML
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