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The User is always right…(even when they are wrong)

Making knowledge representation useful & usable

Alan RectorSchool of Computer Science, University of ManchesterNorthwest institute of BioHealth Informatics

rector@cs.man.ac.ukwww.clinical-esciences.orgwww.co-ode.org

Open GALEN

© University of Manchester

with thanks to Jeremy Rogers, Anthony Nowlan,and the SWBP, OWL, CO-ODE & Protégé teams

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• Solution space– Logics– Rules– Frames– Planners– Logic programming– Bayes nets– Decision theory– Fuzzy sets– Open / closed world– …

• Problem space– Answer questions– Advising on actions– Hazard monitoring– Creating forms– Discovering resources– Constraint actions– Assess risk– …

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• Solution space– Logics– Rules– Frames– Planners– Logic programming– Bayes nets– Decision theory– Fuzzy sets– Open / closed world– …

• Problem space– Answer questions– Advising on actions– Hazard monitoring– Creating forms– Discovering resources– Constraint actions– Assess risk– …

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Problem space & solution space

``

Guidelines, Patterns, Tools

Problem space

Solutionspace

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The knowledge principle

• A system exhibits intelligent understanding and action at a high level of competence primarily because of the specific knowledge that it contains about its domain of endeavor.– Ed Feigenbaum: The Age of Intelligent

Machines: Knowledge Processing--From File Servers to Knowledge Servers, 1990

• Knowledge comes from domain experts:Derived from and delivered to the problem space

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…and a Key Reference Point

• We argue that logical soundness, completeness, and worst-case complexity are inadequate measures for evaluating the utility of representation services, and that this evaluation should employ the broader notions of utility and rationality …”

– Two theses of knowledge representation: Language restrictions, taxonomic classification and the utility of representation services.Doyle, J and Patil, R, Artificial Intelligence, 1991. 48: p. 261-297

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Where 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

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

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… and 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)

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Some Recent User Experiences

• Two companies building clinical systems– Intelligent forms creation and constraint management

• Mastering a combinatorial explosion of ≥107

– Workshops, Training and subcontracting

• NHS National Programme for IT: – Additional constraints to UML and between UML and

terminology/ontology• Different implementation of the standard don’t fit

– Managing SNOMED• Large ≥450K ters DL based terminology

• Biologists research groups– Two four day workshops

• The Anatomy community trying to harmonise vertebrate anatomy

– Workshops towards a common vertebrate anatomy

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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”

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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

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The rest of the talk

• Our experiences– Our original application:

Fractal tailoring of data input forms– Building large terminologies

• Logic as the clips for “Conceptual Lego”• Untangling and normalisation

– Working with biologists

• Observations on Knowledge Resources and “Ontologies”– Things we have found – Things we need

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Where we started:A 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

• …without getting caught in the combinatorial explosion

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Clinergy/ Pen&PAD

• Nice product, bad timing.

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Forms

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and more forms

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Generated Text

And automatic (Read) code generation

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But there are combinatorially many 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

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Fractal tailoring of reusable resources:example of data collection forms for trials

Renin dependent Hypertension at

St Stevens Hospitals for the National

Hypertension Survey

Hypertension Renin Dependent

Hypertension`In St Stevens Hospital

National Hypertension Survey

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Problems:

The exploding bicycle(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

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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 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

23

Building large Terminologies Logic for “Conceptual Lego”

hand

extremity

body

acute

chronic

abnormalnormal

ischaemicdeletion

bacteriumpolymorphism

cell

protein

gene

infection

inflammation

Lung

expression

virusmucus

polysacharide

24

Logic as the clips for “Conceptual Lego”

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

“Hand which isanatomically normal”

25

Build complex representations from modularisedprimitives

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

26

Normalising (untangling) Ontologies

StructureFunction

Part-wholeStructure Function

Part-w

hole

27

Untangling and EnrichmentUsing 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^

28

Modularised into structure and function ontologies (all primitive)

29

Unified ontology after classification

30

Ontology normalisation:Enforced 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

31

Led almost by accident to methods for Integrating multiple big vocabularies

32

And to real world problemsThe Coding of ChocolateAn 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

?

33

…but logic & formal ontology 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

34

Intermediate Representations“Close to user forms”

From this:

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))>))))

35

Intermediate Representations“Close to user forms”

To just the yellow parts of this:"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

From 3-6 monthsmonths training to 3-6 daysdays training

36

global cycle &work at centre

local cycles: work by users

Supports Loosely coupled distributedontology 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

37

A simple recent example: “Manchester OWL syntax”

• owns.Dog someValuesFrom(owns,Dog) owns SOME Dog

• owns.Dog allValuesFrom(owns,Dog) owns ONLY

Dog Or for one client just:

38

Users face a complex landscape

Courtesy of Hodgson, TopQuadran via Carole Goblet

39

Inhabited by many tribes,Each tribe in its own teepee

Descriptionlogic

Fuzziness

BeliefRevision

Bayesiananalysis

NaturalLanguage

KR Logics

Logic programming

Complexity theory

Defaultlogics

Argumentation

40

and what feel like class divides

41

The chain of theorem envy

Too scruffytoo ad hocDoesn’t understand!

Too neat Too academic!Doesn’t understand!

ApplicationBuilder

Knowledge Engineer

KR Researcher

PureLogician/Mathematician

Too scruffytoo ad hocDoesn’t understand!

Too nea! Too academic!Doesn’t understand!

Too scruffytoo ad hocDoesn’t understand!

Too neat Too academic!Doesn’t understand!

Too scruffytoo ad hocDoesn’t understand!

Too neat Too academic!Doesn’t understand!

The chain of value

No one person can understand it all - must manage the chain

42

Incomplete! Undecidable!Higher order! No semantics!

… but logicians are often seen as policemen

… and seem to insist on solving harder problems than the user actually has

… often without examples of why not

43

…or insist users understand the solution space

And don’t come back until you have the semantics clear

The semantics isyour job! Meet users where they are

44

Remember: logic is hard &most users are symbolophobes

• How many OWL experts here could get all of the following in the correct subsumption hierarchy first time?

– p some A– p some ASub– pSub some A– pSub some ASub– p all A– p all ASub– pSub all A– pSub all ASub

– p exactly 1 A– p exactly 1 ASub– pSub exactly 1 A– pSub exactly 1 ASub

45

Matching problems and solutions is worthwhile sciencen & craft

• Patterns, guidelines and tools

• Reformulations of users’ “solutions”

• Collaborations with behavioural scientists

• Challenges and demonstrations

Some observations…

46

Working with users:The basics

• Do something useful - First do the right thing!

• Make it usable– Find a champion & users– Embrace users’ attempts at solution

• At least it is probably useful– an example; a working specification

– Watch, ask, listen, and believe• There is no point in arguing with somebody that it is easy• There Is no point in arguing with somebody that they understand• Get help -

– Involve behavioural scientists

• Involve the implementers• Build for feedback

• Accept that clever things may be useless

47

The interesting may not be useful

• Of medical decision support systems in the literature in 1995– 70% addressed diagnosis (est)

• Success rate of evaluated medical decision support systems in the literature in 1995– Alarms 75%– Treatment Management 65%– Diagnosis 17%

48

And you can only tell if its useful if you know “What’s it for?”

• Tens of Millions spent on SNOMED’s 450K codes– Only 10K have ever been used

• And still many applications find 50%-75% missing

• Hard to predict users’ needs– So build it “just in time” if possible

• The web is a great tool

49

Some arguments only have answers wrt problems• Open vs closed world reasoning

– Querying National Rail Enquiries: “Is there a train from Windermere that gets me to Sheffield tonight?”

• “No”– Possibly false, but useful

» I can’t get better information

• “Might be”– True but not useful & possibly misleading

– Querying FoaF“Does Alan have any friends?”

• “Don’t know”– At least not misleading

• “No”– Wrong

50

…which emphasizes again that:

Metaknowledge is knowledge

• The railway timetable is presumed complete– But how do I know?

• Do I trust the resource to tell me or depend on my experience?

• Biographies in FoaF are probably incomplete– But how do I know?

• What about some other data somewhere on the Semantic Web?

• Even if I can’t reason with it I need it!

51

Get the user’s to own it

• The Gene Ontology is the most successful “ontology”/ “thesaurus”– Not rigorous; many faults– But owned by the biologists and does their job

• The Gene Ontology Next Generation project accepts and delivers in their format– The OWL is just another quality assurance tool

52

QA with users:The Logical answer isn’t always the right answer

“Slashed wrist”

“Cardiovascular Disorder”

The user is right - fix the axioms:

“Cardiovascular Disorder”

“Disorder or injury of Heart or Great Vessels or arterial system as a whole”

“Self inflicted laceration of radial artery”

“Disorder or injury of Heart or blood vessel”

53

…but may have to deal with differences in logic and language

• Logically:Four limbed animals do not subsume four legged animals– unless we represent explicitly our background

knowledge that four legged animals have no other limbs

• but we never say it

• how to convey the intuitions to users?

54

A logically incomplete solution may be good enough

• OWL “lists” don’t exclude multibranched trees (transitive orbits rather than transitive closure)

– Additional restrictions enforced via tools• Biologists find new knowledge about protein

motifs– Extra models don’t matter - tools keep them out

next next next next

follows

tools exclude

55

Expressivity is more important than constraints

• Draw all the inference the user expects from “sensible” premises– Users won’t mind if wrong inferences could

have been drawn from nonsense premises• Provided the nonsense premises can’t get in by

accident

56

Another example of nonstandard reasoning:

Commonalities and differences

• Classify all the proteins with phosphatase1 activities– Identify all the features in common

• Simple subgraph algorithm

– Create the generic abstraction– Classify again to find more phosphatases

• 20 new phosphatases– Some probably implicated in disease

– Classify by which tissue they come from• Repeat

– Try to understand why some tissues suffer from disease and some don’t

1”Phosphate-ase” - enzyme that breaks down phosphate bonds; the primarysource of energy in cells; can drive super-oxidation; prime source ofdamage in diabetes, extreme inflammation in Intensive Care Units, atherosclerosis, and probably much else

57

Hide formalisms Focus on meta-modelling

• Make the logic the assembly language– Build “compiler compilers” for close to user forms

• Ought to be a major focus of our research

– Transformations, import, export

• Support implementors and localisers– Tools to build user oriented special purpose tools,

languages and interfaces

• Build quick tools for common patterns– Tabbed outlines for taxonomies– Easy visualisation and specification of disjoints– Wizards and Patterns for features & value sets– Special tools for lists– …

58

Help users to work together

• Science is CooperativeE-Science is e-Cooperative

• Supporting cooperation requires new kinds of knowledge– Modularisation– Dependencies– Communication– User profiles – Views– Transforms– …

59

Seek evidence

• Use corpora, NLP & the Web– Experts often wrong about what really happens

• Beware of committee views

• Beware of dogma

60

Build environments to meet all the problems

The ontology/KR is just one of several modules

• Almost all applications require hybrid solutions– Just because you have a hammer, don’t be afraid of glue

API

Reference Management Multilingual Dictionaries

LanguageModule

Common Reference Model

OntologyModule

Code Store

Code MappingModule

ClientApplication

Server

Client

Extrinsics Store

Indexing, Defaults & Metadata

61

Find a sweet spot

62

The interesting is never enough

• Users want what they already have– They are unlikely to give up things

• Numbers and numeric ranges had to wait for OWL 1.1

• “Blood pressure between 90 and 140”• And not just integers• And we we still need quantities

– Between 90mmHg and 140mmHg

– And somewhere conversions

» 90mmHg = 1100 pascals

» 1 mile = 0.61 km Error missing Mars

63

Prioritize issues to users’ requirements - thank you OWL 1.1

• Role assertions– “Fracture of neck of femur” is a kind of

“Fracture of Femur”• hasLocus o isPartOf hasLocus

– Accept repurposing• There are alternative solutions for anatomy but

essential for other cases– “Uncle”– “Reified relations” (Ontological “qualities”)

64

…but features have to be implemented to help users

• All-All relations(“Cat lovers” - with thanks to Uli Sattler)

• “All licensed drivers are authorised to drive all cars”– Rare in biology

– ubiquitous in organisational and legal applications

…just knowing that it could be fixed doesn’t help users!

65

…and don’t forget problems just because you have a work around

• Existing classifiers can’t cope with OWL KBs containing transitive relations and their inverses

– Catastrophic explosion by depth 3 x breadth 3

– Must choose is_part_of or has_part• Often distorts

– Could we use something like “e-connections”?

66

Test at scale

• Many users’ problems are BIG– Biological examples ≥ 10K concepts – Medical examples 20K…500K concepts

67

Use � the tricks of the trade (especially to reduce arguments)

• “Pericardium” (covering of the heart) & “Heart”: – To anatomists: they are two different organs– To the clinicians: they are parts of the same

functional unit

• The role hierarchy can let us support both views is_clinical_part_of

is_structural_part_of

68

…but hide them from (most) users

• Neither the anatomist nor the surgeon need to know about the other– In GALEN we had several different variants of

the intermediate representation compiler to deal with intractable arguments

• QA always passed by all

69

Make representations maintainable & evolvable(basic software engineering)

• Don’t be too clever(Avoid “Write once read never”)

– “Shortest S-Expression for a function”“Maximum code in a C ‘for’ statement”

– “Clever” inference in an OWL KB• Avoid

– Making inferences from domains/range» May better to check before inference * Or do inference in multiple step

– Complex disjoint axioms and disjunctions

• Design so all changes made in only one place– Normalise ontologies

• Be systematic - follow patterns

• Provide regression testing from the beginning– Preferably before building

• Support debugging

70

Remember: You are only one source of error

• Errors come from– Errors & low inter-rater reliability in input

• Often under 80%

– Errors in ontology axioms• Inevitable in a large ontology

– Implementation errors– “Lying to the system”

• Unsound workarounds for limited but complete systems

– The perversity of the universe - the Rumsfeld effect

• It is going to require empirical testing– The ONLY test that will be accepted for most

applications is empirical• Whether or not the algorithms are complete

71

My top next priority for OWL:

“What is it sensible…

• To ask– Everything is permitted unless it is forbidden

• Natural open world logical view– Sets of constraints

• To tell (sanctioning)– Everything is forbidden unless it is permitted

• Natural frames/OO/UML view– Sets of templates

72

But the basis for intelligent user interfaces

Needed by every user we have encountered

• It is sensible to ask about “Green entities”– There are entities that are green

• Is I sensible to ask about “Green dreams”– No: dreams have no colour

The more I know the less it is sensible to ask

• Is it sensible to tell that balls are green?– If it might sensibly be green

• The more I know, the more it is sensible to tell– A hard/impossible notion to capture in first order

theories

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Related: “Optional”

• What are the semantics of :– 0..n in UML?– or canonical graphs in Conceptual Graphs?– or sensible sanctions in GRAIL?– or slot attachment in Frames?– or minCardinality(0) in OWL?

• Supported by every formalism any user will ever have used– There must be something to it

• Even if it isn’t first order

• Needed by every data application we have encountered

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Related but different:“May”

• May – “What may cause pneumonia?”

What classes of bacteria may cause pneumonia?

• Hard to express in DLs/OWL– Need richer relations amongst properties

» causes may_causeAlmost captures it

» “Anything that acts has the potential to act”“Anything that does not have the potential to act, cannot act”…is there additional semantics?

» Very messy without special tools and operators in user language

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… others needs for a better match to biomedical knowledge

• Prototypical knowledgeThe heart is generally on the left but sometimes on the right

– Normative solutions OK for some things• “The normal hand has five digits”

• “The normal heart is on the left”

– Simple explicit exceptions OK for some things• “All human cells have nuclei except red blood cells”

– But otherwise need prototypical knowledge & exceptions• “Typically birds fly”

• “Typically gram positive bacteria are penicillin sensitive”

• Uncertainty - another step? a different formalism?– 70% of appendices are in right lower abdomen

• Can fuzziness/probability/… be contained in the same framework or do we need a true hybrid system?

– Needs to link to utilities and decision theory

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Summary: Help fill the gap

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Guidelines, Patterns, Tools, Modularity,Views, Environmentsmetadata, work arounds, hybrid systems, …

Problem space

Solutionspace Fit solutions to

problems

Support meta users & application builders

Watch, ask, listen to, & believe users

embrace users’ partial solutions as requirements

Design for modularity, maintenance & evolution

Look to user requirements forimplementation priorities