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PubMed1990

Impact of technology in health care and health administration: hospitals and alternative care delivery systems.

Applications as outlined above and many more that have not yet even been identified--but that will be invented and developed--will have an enormous impact on the health care industry. Clearly, capital requirements to purchase this technology will go up and thus exert further pressure for the reduction of personnel. Computers and robots will replace a significant percentage of health care personnel; overall health care costs as a percent of gross national product will nevertheless probably continue to rise in spite of improvements in productivity. Added costs will be offset in part by the use of technology in areas that will impact efficiency. Because of these accelerating uses of sophisticated technology, future administrators will have a greater appreciation for what technology can offer. Practical uses of robotics, expert systems, and artificial intelligence will require administrators to be technologically proficient.

Delivery of Health Care↗
PubMed2006

Association of CHRM2 with IQ: converging evidence for a gene influencing intelligence.

The cholinergic neurotransmitter system is thought to be involved in many aspects of memory, attention, and higher cognition. In the Collaborative Study on the Genetics of Alcoholism (COGA) sample, we have previously reported linkage and association to the cholinergic muscarinic 2 receptor gene (CHRM2) on chromosome 7 with evoked EEG oscillations (Jones et al. 2004), providing evidence that this gene may be involved in human brain dynamics and cognition. In addition, a small number of genetic markers were genotyped in CHRM2 in the Minnesota Twin and Family Study (Comings et al. 2003) and a Dutch family study (Gosso et al. 2006, in press) and both research groups found evidence that this gene may be involved in intelligence. In the COGA sample, we have extensively genotyped SNPs within and flanking the CHRM2 gene. We find evidence of association with multiple SNPs across CHRM2 and Performance IQ, as measured by the Wechsler Adult Intelligence Scale-Revised (WAIS-R). These results remain significant after taking into account alcohol dependence and depression diagnoses in the sample.

Alcoholism↗
PubMed1999

[Influence of intelligence level of the type I diabetic patients handling hi-tech glycemia monitoring system on the effectiveness of intensive insulin treatment].

An intensive care system designed and developed in IBBE PAS allows for electronic storage and automatic transmission of BG values and other parameters directly from a patient's BG meter and electronic logbook (Glucometer M+ Bayer) to central clinical computer by telematic connection. Despite effort made to keep the system as simple as possible, its proper handling still requires some additional skills from the patient. Thus, effectiveness of the intensive insulin treatment supported by the system may be influenced by the patient's intelligence level. The aim of this work was to evaluate influence of the intelligence level of type 1 diabetic patients equipped with designed system on effectiveness of a long-term intensive insulin treatment. The study group consisted of 17 type 1 diabetic pregnant women randomly divided in two sub-groups. Eight patients used the transmission system and the remaining 9 patients were treated classically. Patient's intelligence level was assessed according Wechsler scale. Analysis of variance indicated that intelligence level did not influence significantly on average result of the treatment (p > 0.05) in whole study group and in both subgroups. Generally, in patients with lower (93 +/- 2.0) and higher (114.1 +/- 1.2) intelligence level glycemic control indices were found to be similar and did not differ significantly. Performed analysis indicated that the designed system could be properly handled by diabetic patients within wide range of intelligence level. However, despite not statistically significant influence of the patients intelligence level on obtained glycemic control, tendency was observed to obtain better average long-term glycemic control in patients with lower intelligence level using telematic data transmission in comparison with the patients treated in classical way (SDWG = 7.0 +/- 0.4 vs. 8.1 +/- 1.0 mmol/l and J = 30.3 +/- 4.4 vs. 39.0 +/- 12.2).

Adult↗
PubMed2006

Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department.

INTRODUCTION: Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED). METHODS: Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer's ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements. RESULTS: Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5 min and 32s +/- 1 min and 21s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90+/-7%, and the emergency physician asked 55+/-18%, of the important historical elements. These groups were statistically different with a p-value of <0.00001. CONCLUSION: This feasibility study has shown that the computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient.

Adult↗
PubMed2006

Temporal abstraction in intelligent clinical data analysis: a survey.

OBJECTIVE: Intelligent clinical data analysis systems require precise qualitative descriptions of data to enable effective and context sensitive interpretation to take place. Temporal abstraction (TA) provides the means to achieve such descriptions, which can then be used as input to a reasoning engine where they are evaluated against a knowledge base to arrive at possible clinical hypotheses. This paper surveys previous research into the development of intelligent clinical data analysis systems that incorporate TA mechanisms and presents research synergies and trends across the research reviewed, especially those associated with the multi-dimensional nature of real-time patient data streams. The motivation for this survey is case study based research into the development of an intelligent real-time, high-frequency patient monitoring system to provide detection of temporal patterns within multiple patient data streams. RESULTS: The survey was based on factors that are of importance to broaden research into temporal abstraction and on characteristics we believe will assume an increasing level of importance for future clinical IDA systems. These factors were: aspects of the data that is abstracted such as source domain and sample frequency, complexity available within abstracted patterns, dimensionality of the TA and data environment and the knowledge and reasoning underpinning TA processes. CONCLUSION: It is evident from the review that for intelligent clinical data analysis systems to progress into the future where clinical environments are becoming increasingly data-intensive, the ability for managing multi-dimensional aspects of data at high observation and sample frequencies must be provided. Also, the detection of complex patterns within patient data requires higher levels of TA than are presently available. The conflicting matters of computational tractability and temporal reasoning within a real-time environment present a non-trivial problem for investigation in regard to these matters. Finally, to be able to fully exploit the value of learning new knowledge from stored clinical data through data mining and enable its application to data abstraction, the fusion of data mining and TA processes becomes a necessity.

Artificial Intelligence↗
PubMed1998

[Leukocyte differentiation by MICRO21 system using neural networking as a type of artificial intelligence].

NeuralVision is a type of artificial intelligence that has the ability to identify specific microscopic objects. The MICRO21 system uses neural networking to analyze the features of blood cells; color, shape, size, and density, just as a technologist would. The basic nucleated blood cell processing procedure of the MICRO21 is divided into three general categories; location, segmentation, and classification. Classification takes place using the Neural Network and is fine tuned during post-processing. We evaluated the performance of the MICRO21 automated differential vs. manual differential method. The intra-assay of leukocyte differentiation by MICRO21 was fairly good in normal samples with normal leukocyte counts. The neutrophils, lymphocytes and eosinophils count correlated well between MICRO21 and visual count. Post-processing was performed after the Neural Network has initially classified the cell, in which the confidence levels of MICRO21 to visual count was 87%. By post-processing, coincidence ratio of cell-by-cell by MICRO21 and visual count has been improved to 97%. Based on the above, MICRO21 is an effective and efficient system for locating, storing and displaying images of white blood cells, in which the technologist could determine specific characteristics of cells in each laboratory. Furthermore, the system may be applied to any blood cell and would be important from the perspective of cytological and morphological analysis, such as blood cells in bone marrow and body fluid, in the future.

Artificial Intelligence↗
PubMed2005

Wearable healthcare systems, new frontiers of e-textile.

There is a growing need of renovation in our health care managing systems; people need to be more interactive and more conscious of their own health condition in a way to adjust incorrect lifestyles, to obtain a personalized therapy tuned to their own physiological reactions and on their own environmental condition. To gain knowledge of a citizen's health status and to monitor without harassing them (until they refuse any medical supervision), a comfortable remote monitoring of important physiological parameters is necessary. The approach is therefore to integrate system solutions into functional clothes with integrated textile sensors. The combination of functional clothes and integrated electronics and on-body processing, is defined as e-textile and gives rise to intelligent biomedical clothes. Systems, designed to be minimally invasive, are based on smart textile technologies, where conductive and piezoresistive materials in the form of fiber and yarn are used to realize clothes, in which knitted fabric sensors and electrodes are distributed and connected to an electronic portable unit. These systems are able to detect, acquire and transmit physiological signals. They are conformable to the human body, and move towards improving the patient's quality of life and their autonomy. These systems are also cost-effective in providing around-the-clock assistance, in helping physicians to monitor for example cardiac patients during periods of rehabilitation, and in addition result in decreased hospitalization time. Finally, by providing direct feedback to the users, they improve their awareness and potentially allow better control of their own condition, while the simultaneous recording of vital signs permits parameter extrapolation and inter-signal elaboration that contributes to produce alert messages and personalized synoptic tables of the patient's health.

Biomedical Technology↗
PubMed2005

A fusion-based clinical decision support for disease diagnosis from endoscopic images.

This paper presents an intelligent decision support system designed on a decision fusion framework coupled with a priori knowledge base for abnormality detection from endoscopic images. Sub-decisions are made based on associated component feature sets derived from the endoscopic images and predefined algorithms, and subsequently fused to classify the patient state. Bayesian probability computations are employed to evaluate the accuracies of sub-decisions, which are utilized in estimating the probability of the fused decision. The overall detectability of abnormalities by using the proposed fusion approach is improved in terms of detection of true positive and true negative conditions when compared with corresponding results from individual methods.

Algorithms↗
PubMed1992

A knowledge base for predicting protein localization sites in eukaryotic cells.

To automate examination of massive amounts of sequence data for biological function, it is important to computerize interpretation based on empirical knowledge of sequence-function relationships. For this purpose, we have been constructing a knowledge base by organizing various experimental and computational observations as a collection of if-then rules. Here we report an expert system, which utilizes this knowledge base, for predicting localization sites of proteins only from the information on the amino acid sequence and the source origin. We collected data for 401 eukaryotic proteins with known localization sites (subcellular and extracellular) and divided them into training data and testing data. Fourteen localization sites were distinguished for animal cells and 17 for plant cells. When sorting signals were not well characterized experimentally, various sequence features were computationally derived from the training data. It was found that 66% of the training data and 59% of the testing data were correctly predicted by our expert system. This artificial intelligence approach is powerful and flexible enough to be used in genome analyses.

Algorithms↗
PubMed2000

[Tele-micro-surgery system].

This paper describes a master-slave type tele-micro-surgical system with an intelligent user interface. To enhance the accuracy and the rigidity of the slave-manipulator, multi-circular guides were adopted for the degrees of rotational freedom. To increase the operability of the system, an "anti-shadow" technique was used and the 3D relative information was presented on a 2D display. Furthermore, the anti-shadow was processed using a real-time tracking vision system to guide the slave-manipulator to the target position automatically. Multi-axis force information was converted into auditory information to transmit the reality of the surgical field. It took approximately 25 minutes to suture a 1 mm diameter artificial micro-blood-vessel using the system. The carotid artery of a rat with a diameter of 0.3 mm was also successfully sutured.

Animals↗
PubMed2006

GEDA: new knowledge base of gene expression in drug addiction.

Abuse of drugs can elicit compulsive drug seeking behaviors upon repeated administration, and ultimately leads to the phenomenon of addiction. We developed a procedure for the standardization of microarray gene expression data of rat brain in drug addiction and stored them in a single integrated database system, focusing on more effective data processing and interpretation. Another characteristic of the present database is that it has a systematic flexibility for statistical analysis and linking with other databases. Basically, we adopt an intelligent SQL querying system, as the foundation of our DB, in order to set up an interactive module which can automatically read the raw gene expression data in the standardized format. We maximize the usability of this DB, helping users study significant gene expression and identify biological function of the genes through integrated up-to-date gene information such as GO annotation and metabolic pathway. For collecting the latest information of selected gene from the database, we also set up the local BLAST search engine and nonredundant sequence database updated by NCBI server on a daily basis. We find that the present database is a useful query interface and data-mining tool, specifically for finding out the genes related to drug addiction. We apply this system to the identification and characterization of methamphetamine-induced genes' behavior in rat brain.

Animals↗
PubMed1994

Dimensions of health system reform.

During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross-national comparison of experiences and rigorous social experimentation. Maybe then reform will be a more systematic effort, and nations will be better able to learn from each other.

Delivery of Health Care↗
PubMed2003

The systemizing quotient: an investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences.

Systemizing is the drive to analyse systems or construct systems. A recent model of psychological sex differences suggests that this is a major dimension in which the sexes differ, with males being more drawn to systemize than females. Currently, there are no self-report measures to assess this important dimension. A second major dimension of sex differences is empathizing (the drive to identify mental states and respond to these with an appropriate emotion). Previous studies find females score higher on empathy measures. We report a new self-report questionnaire, the Systemizing Quotient (SQ), for use with adults of normal intelligence. It contains 40 systemizing items and 20 control items. On each systemizing item, a person can score 2, 1 or 0, so the SQ has a maximum score of 80 and a minimum of zero. In Study 1, we measured the SQ of n = 278 adults (114 males, 164 females) from a general population, to test for predicted sex differences (male superiority) in systemizing. All subjects were also given the Empathy Quotient (EQ) to test if previous reports of female superiority would be replicated. In Study 2 we employed the SQ and the EQ with n = 47 adults (33 males, 14 females) with Asperger syndrome (AS) or high-functioning autism (HFA), who are predicted to be either normal or superior at systemizing, but impaired at empathizing. Their scores were compared with n = 47 matched adults from the general population in Study 1. In Study 1, as predicted, normal adult males scored significantly higher than females on the SQ and significantly lower on the EQ. In Study 2, again as predicted, adults with AS/HFA scored significantly higher on the SQ than matched controls, and significantly lower on the EQ than matched controls. The SQ reveals both a sex difference in systemizing in the general population and an unusually strong drive to systemize in AS/HFA. These results are discussed in relation to two linked theories: the 'empathizing-systemizing' (E-S) theory of sex differences and the extreme male brain (EMB) theory of autism.

Adult↗
PubMed1990

Identification of rodent carcinogens by an expert system.

CASE, an artificial intelligence method for identifying structural determinants responsible for biological activity was applied to the U.S. National Toxicology Program (NTP) cancer bioassay results. CASE identified structures which were significantly associated with rodent carcinogenicity. On the basis of these structural determinants CASE exhibited a sensitivity of 0.98 and a specificity of 1.00. CASE showed a similarly remarkable performance in predicting the carcinogenicity, or lack thereof, of chemicals not in the NTP data base. A comparison between the activating structures (biophores) responsible for mutagenicity in Salmonella and rodent carcinogenicity showed a significant overlap, verifying that there are structural commonalities between the two phenomena. CASE also identified biophores significantly associated with the activity of non-genotoxic carcinogens, thereby suggesting the unexpected possibility that there is a structural commonality among the chemicals included in this group. A comparison between the biophores responsible for carcinogenicity in mice and rats resulted in the identification of common ("universal") biophores. It is suggested that agents which contain "universal" biophores are more likely to present a risk to human than carcinogens that do not possess such biophores. CASE also permitted the recognition of species-specific carcinogenic biophores. While the former are primarily electrophiles or potential electrophiles, the latter represent non-electrophilic structures.

Animals↗
PubMed2004

A general framework for learning rules from data.

With the aim of getting understandable symbolic rules to explain a given phenomenon, we split the task of learning these rules from sensory data in two phases: a multilayer perceptron maps features into propositional variables and a set of subsequent layers operated by a PAC-like algorithm learns Boolean expressions on these variables. The special features of this procedure are that: i) the neural network is trained to produce a Boolean output having the principal task of discriminating between classes of inputs; ii) the symbolic part is directed to compute rules within a family that is not known a priori; iii) the welding point between the two learning systems is represented by a feedback based on a suitability evaluation of the computed rules. The procedure we propose is based on a computational learning paradigm set up recently in some papers in the fields of theoretical computer science, artificial intelligence and cognitive systems. The present article focuses on information management aspects of the procedure. We deal with the lack of prior information about the rules through learning strategies that affect both the meaning of the variables and the description length of the rules into which they combine. The paper uses the task of learning to formally discriminate among several emotional states as both a working example and a test bench for a comparison with previous symbolic and subsymbolic methods in the field.

Algorithms↗
PubMed2000

Neurodevelopmental outcome of patients after the fontan operation: A comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions.

OBJECTIVE: To compare neurodevelopmental outcome (NDO) in patients with hypoplastic left heart syndrome (HLHS), other functional single ventricle lesions, and the standard population and to investigate predictors of NDO in the population of children with functional single ventricle (FSV). STUDY DESIGN: A time- and age-defined cohort of patients with the Fontan circulation was recruited to participate in neurodevelopmental testing, behavioral evaluation, and imaging of the central nervous system. The Wechsler Intelligence test was the primary measure of NDO. Analysis included comparison of patients with HLHS with other patients with functional single ventricles. Other potential clinical predictors of NDO were investigated. RESULTS: The mean Full Scale Wechsler Intelligence score was 101.4+/-5.4. For the HLHS subgroup the mean Full Scale Wechsler score was 93.8+/-7.3, and for the non-HLHS subgroup it was 107.0+/-7.0. Although the HLHS group had significantly lower scores than the non-HLHS subgroup, neither subgroup scored significantly different from the standard population on the Wechsler Scales. Socioeconomic status, circulatory arrest, and perioperative seizures also were predictive of neurodevelopmental outcome. CONCLUSION: Neurodevelopmental and behavioral outcome in patients who have undergone the Fontan procedure including patients with HLHS is good in the preschool and early school years, with Wechsler Intelligence scores generally in the normal range.

Central Nervous System↗
PubMed1999

[Smart card systems in health care (protection, key-functions, divided data bases, applications)].

Barely more than 15 years have passed since electronic memory cards appeared, their popularity has grown rapidly (first of all as a cash-saving device and later for other purposes, as well). This is due also to the growing interest towards development of the intelligence of information systems for the follow-up of patients' health condition and medical care in countries with a highly developed health and insurance system (need for the creation of data bases divided for individuals) and also to their commitment towards a better control of the quality and costs of health care. We can come to the conclusion that the aim of research, development and the creation of systems in health informatics is to prevent illness and to give a direct informatic support to medical and nursing activity carried out in the patients' interests. The smart card and the surrounding application systems are certainly the appropriate means for the achievement of these aims.

Databases as Topic↗
PubMed2001

A MeSH based intelligent search intermediary for Consumer Health Information Systems.

GIN Austria (Gesundheitsinformationsnetz Austria) offers patients and consumers reliable medical knowledge about diseases, wellness and disease management in an easy understandable way and enables them to quick and incessant access to informations about the Austrian health system and Austrian health organizations. To achieve full customer (patients, citizens) satisfaction to find relevant information we propose a concept of a vector-model oriented IR-Tool based on the controlled vocabulary of the MeSH Thesaurus (german version). By this approach users who are often not used to scientific terms and expressions are supported to build up their own query with MeSH Main Headings. In a second step broader and narrower Main Headings are added to the query vector by the system. For this calculation an adapted version of the Floyd-Warshall algorithm for directed, azyclic graphs is used. The tool is part of the GIN Search Modul, which will ease gathering health information from different heterogenous internet datasources.

Austria↗