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PubMed2000

Enhancing the expressiveness of structured reporting systems.

The overall goal of this research is to build a structured reporting system that reduces the cost, delays, and inconvenience associated with conventional dictation and speech recognition systems. We have implemented such a structured reporting system for radiology that replaces current dictation and transcription processes by allowing radiologists and other imaging professionals to select imaging findings from a medical lexicon. The system uses an imaging-specific information model, called a "description set,' to organize selected terms in a relational database. Unique features of the knowledge representation that enhance its expressiveness include its ability to codify uncertainty about an imaging observation and to represent explicitly the logical relationships among imaging findings. In addition, the system does not require the user to fill in "blanks' in a static text template. Instead, it allows entry of terms in arbitrary order and uses automated text-generation techniques to create a text report that referring physicians are accustomed to receiving. In parallel, the system also produces a multimedia report that the referring physician can use as a quick reference. Unlike the results of conventional dictation or speech recognition, each finding is coded in a relational database for later information processing. Thus, the structured report database can be used to index images by content, to provide real-time decision support, to enhance radiologists' performance, to conduct exploratory clinical research, and to transmit imaging report data to computer-based patient record systems.

Abstracting and Indexing↗
PubMed1989

Optimizing radiologic workup: an artificial intelligence approach.

The increasing complexity of diagnostic imaging is presenting an ever expanding variety of radiologic test options to clinicians. As a result, it is becoming more difficult for referring physicians to select an appropriate sequence of tests. The current economic pressures on medicine make it particularly important that resources be used judiciously. Radiologic workup often involves a sequence of tests that lead from presenting signs and symptoms to a definitive diagnosis or intervention. This sequence ideally begins with simple, inexpensive, safe, non-invasive tests and progresses to more complex, expensive, and hazardous tests only if the simpler tests are insufficient to establish a diagnosis. DxCON is a developmental artificial intelligence-based computer system that gives advice to physicians about the optimum sequencing of radiologic tests. DxCON evaluates basic clinical information and a physician's proposed workup plan. The system then creates an analysis of the strengths and weaknesses of his plan. The domain chosen to explore computer-based workup advice is the radiologic workup of obstructive jaundice.

Cholestasis↗
PubMed2006

A sequential injection electronic tongue employing the transient response from potentiometric sensors for anion multidetermination.

Intelligent and automatic systems based on arrays of non-specific-response chemical sensors were recently developed in our laboratory. For multidetermination applications, the normal choice is an array of potentiometric sensors to generate the signal, and an artificial neural network (ANN) correctly trained to obtain the calibration model. As a great amount of information is required for the proper modelling, we proposed its automated generation by using the sequential injection analysis (SIA) technique. First signals used were steady-state: the equilibrium signal after a step-change in concentration. We have now adapted our procedures to record the transient response corresponding to a sample step. The novelty in this approach is therefore the use of the dynamic components of the signal in order to better discriminate or differentiate a sample. In the developed electronic tongue systems, detection is carried out by using a sensor array formed by five potentiometric sensors based on PVC membranes. For the developed application we employed two different chloride-selective sensors, two nitrate-selective sensors and one generic response sensor. As the amount of raw data (fivefold recordings corresponding to the five sensors) is excessive for an ANN, some feature extraction step prior to the modelling was needed. In order to attain substantial data reduction and noise filtering, the data obtained were fitted with orthonormal Legendre polynomials. In this case, a third-degree Legendre polynomial was shown to be sufficient to fit the data. The coefficients of these polynomials were the input information fed into the ANN used to model the concentrations of the determined species (Cl-, NO3- and HCO3-). Best results were obtained by using a backpropagation neural network trained with the Bayesian regularisation algorithm; the net had a single hidden layer containing three neurons with the tansig transfer function. The results obtained from the time-dependent response were compared with those obtained from steady-state conditions, showing the former superior performance. Finally, the method was applied for determining anions in synthetic samples and real water samples, where a satisfactory comparison was also achieved.

Algorithms↗
PubMed2000

Intracranial pressure processing with artificial neural networks: classification of signal properties.

Intracranial pressure (ICP) is commonly used by neurosurgeons as a source of valuable information about the current condition of the neurosurgical patient. Nevertheless, despite years of effort, extracting clinically valuable information from the ICP signal is still problematical. Approaches, using current values of ICP, may fail to disclose imminent risk, because unpredictable factors can rapidly change the properties of the signal. An alternative approach is to determine some global characteristics of the signal within a longer time interval and such statistical analyses have been proposed by several authors. A further, rarely considered, problem is assessment of the results obtained from the point of view of their practical utility and/or such classification of the obtained properties of the signal that they correspond to certain clinical states of the patient. While this might be a typical task for discriminant analysis, we approached the analysis using an alternative methodology, that of computational intelligence, implemented in artificial neural networks (ANN). We tested two variants of the ANN algorithms for classification and discrimination of global properties of the ICP signal. In a "dynamic pattern classification" the network was presented with several sections of ICP records together with information from the expert-neurosurgeon, classifying 4 risk groups. In this mode no data pre-processing was carried out, in contrast to our second approach, in which the signal had been pre-processed using published statistical analyses and only these intermediate coefficients were fed into the ANN classifier. The results obtained with both classification methods at their current stage of training were similar and approximated to a 70% rate of judgements consistent with the expert scoring. Nevertheless, the method based on the assessment of global parameters from the ICP record looks more promising, because it leaves the possibility for modification of the set of parameters analysed. The new parameters may include information extracted not only from the ICP signal, but also from other diagnostic modalities, like colour coded Doppler ultrasonography. The ultimate goal of this work is to build up a pseudo-intelligent computer expert system, which would be able to reason from a reduced set of input information, available from a standard monitoring modality, because it had been taught salient links between these data and higher-order data, upon which expert scoring was based.

Cerebral Hemorrhage↗
PubMedDate not supplied

Relationship of the Wender Utah Rating Scale to objective measures of attention.

The Wender Utah Rating Scale (WURS) is a 25-item self-report questionnaire for the retrospective assessment of childhood attention-deficit hyperactivity disorder (ADHD) symptoms; high scores indicate greater symptoms. The current study used 35 male Veterans Affairs outpatients to determine if WURS scores were associated with objective measures of current attentional functioning, including the Trail Making Test, Gordon Diagnostic System, Wechsler Adult Intelligence Scale-Revised digit span and digit symbol subtests, and Wechsler Memory Scale-Revised mental control subtest. Participants included both adults diagnosed with ADHD (n = 14) and non-ADHD adults (n = 21). After Bonferroni correction, Pearson product moment correlation coefficients revealed that greater symptoms on the WURS were associated with poorer digit symbol performance (r = -0.69, P < .05). To determine which indices best predicted WURS scores, scores on attention tests and demographic variables were entered into a stepwise multiple regression analysis. Digit symbol performance was the only significant predictor of WURS scores (R(2) = 0.59, P < .01). Thus, poor performance on a sensitive, but nonspecific, measure of attention with executive function, response speed, and visuomotor coordination components was related to greater self-report of childhood ADHD symptoms.

Adult↗
PubMed2004

A clinical management system for patient participatory health care support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration.

We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow.

Hospital Information Systems↗
PubMedDate not supplied

Methods in informatics: using data derived from a systematic review of health care texts to develop a concept map for use in the neonatal intensive care setting.

A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 health care texts were systematically reviewed yielding 153 separate statements related to assessing premature infants' feeding readiness. Following this procedure, a pile sort method was conducted wherein an expert neonatal nurse practitioner (NNP) grouped the statements according to similarity in meaning. Ten piles of terms emerged from this process. Each pile was "named," depicting discrete components used when assessing premature infants' readiness for nipple feeding. Using these public data and the private knowledge of the NNP informant, a concept map was constructed to illustrate a framework for decision support development and to examine the map's usefulness for structuring knowledge that will provide input to an intelligent decision support system.

Computational Biology↗
PubMed2002

Enhanced clinical consulting--moving toward the core competencies of laboratory professionals.

The large menu of laboratory assays available today makes it increasingly difficult for the non-specialist to order all necessary tests, avoid medical errors, and still contain cost. Curbside consultations, "intelligent" laboratory information systems, and medical information from the Internet cannot fully fill the need for expert advice on test selection and interpretation of laboratory results. In this communication, we show the need for a more active role for laboratory physicians to select and interpret tests, demonstrate that existing attempts to deal with this issue are insufficient, and describe the model system which we have instituted at our institution. We combine reflexive testing algorithms with narrative interpretations provided by medical laboratory professionals and thereby enable physicians to obtain relevant laboratory results and to arrive at a definitive diagnosis without having to order individual tests. In our experience, such an arrangement can significantly improve the quality of care and reduce the cost per case by decreasing the time to diagnosis, the number of tests ordered, and the number of patient visits. In addition, interpretations provide a new source of professional revenue for the expert laboratory physician. This leads to a new role for laboratory professionals, in which their expertise in the selection and interpretation of laboratory tests is fully utilized.

Algorithms↗
PubMed2002

Effect of posterior temporal-parietal hematoma on orbital frontal chemistry in relation to a cognitive and anxiety state: a combined 1H-MRS and neuropsychological study of an unusual case as compared with 16 healthy subjects.

The authors report the unusual case of a 58-year-old woman (MJP) suffering from left temporal throbbing headache, associated with confusion. Magnetic resonance imaging showed a 5 x 3 x 2 cm hematoma at the left posterior temporal--parietal junction (PTPJ). Repeated MRI of MJP's brain performed during a 4-month follow-up period showed decrease in hematoma size (2.3 x 1.5 x 1) with evidence for development of encephalomalacia and resorption of blood products involving the area of hemorrhage. MJP had mild transcortical sensory aphasia characterized by difficulty with reading and processing, with semantic paraphasic errors while speaking and some difficulty with repetition. MJP had remained normotensive and seizure free, on Vasotec therapy and Dilantin prophylaxis. An in vivo proton magnetic resonance spectroscopy (1H-MRS) performed during an 8-month follow-up period showed reduced concentration for N-acetyl aspartate (NAA) by 19.3% (F=4.09, P<0.04), and myo-inositol by 32.0% (F=5.16, P<0.02) in the left orbital frontal cortex (OFC) as compared with 16 healthy subjects (age- and sex-matched). Cognitive tests (the Wechsler abbreviated scale of intelligence (WASI) and the Stroop color--word interference) showed a significant impairment suggesting involvement of higher-order cognitive functioning (memory, learning, and general intelligence) and attentional system. The Spielberger state-trait anxiety inventory (STAI) showed increased anxiety at the moment of the current examination and decreased tendency to be anxious over a long period of time. The Beck Anxiety and Depression Inventory revealed minimal anxiety and mild to moderate levels of depression. It is hypothesized that the PTPJ hematoma triggered long-distance pathways linking PTPJ area and frontal lobe, including OFC, which resulted in abnormal chemical changes in the left OFC and in cognitive tests impairment, and in long-term anxiety state changes.

Anxiety↗
PubMed2001

Detection of hemodynamic changes in clinical monitoring by time-delay neural networks.

Small changes that occur in a patient's physiology over long periods of time are difficult to detect, yet they can lead to catastrophic outcomes. Detecting such changes is even more difficult in intensive care unit (ICU) environments where clinicians are bombarded by a barrage of complex monitoring signals from various devices. Early detection accompanied by appropriate intervention can lead to improvement in patient care. Neural networks can be used as the basis for an intelligent early warning system. We developed time-delay neural networks (TDNN) for classifying and detecting hemodynamic changes. A matrix of physiological parameters were extracted from raw signals collected during cardiovascular experiments in mongrel dogs. These matrices represented several episodes of stable, decreasing, and increasing cardiac filling in normal, exerted, and heart failure conditions. The TDNN were trained with these matrices and subsequently tested to predict unseen cases. The TDNN perform remarkably not only in identifying all hemodynamic conditions, but also in quickly detecting their changes. On average, the networks were able to detect the hemodynamic changes in less than 1 s after the onset. Based on the results of this pilot investigation, the use of this form of TDNN to successfully predict hemodynamic conditions appears to be promising.

Animals↗
PubMed2004

Purification and characterization of a protease from Pseudomonas aeruginosa grown in cutting oil.

The Pseudomonas aeruginosa san-ai strain was isolated from water-soluble cutting oil used for cooling and lubrication during industrial metal-working processes. This strain, which is grown in a high alkaline (pH 10) mixture of surfactants and mineral oil, produces an extracellular proteolytic enzyme. We have purified and characterized this 18 kDa protease. The P. aeruginosa san-ai protease functions optimally at pH 9.0 and 60 degrees C. Additionally, it is a Zn-containing metalloenzyme, and its monomeric structure contains at least one disulfide bond. Because the enzyme is stable in the presence of organic solvents, it is suitable for peptide synthesis. Furthermore, the P. aeruginosa san-ai protease could be used in an intelligent drug delivery system (DDS) designed for applications in the metal industry for prevention of putrefaction of cutting oil.

Journal Article↗
PubMed1995

Graft copolymers that exhibit temperature-induced phase transitions over a wide range of pH.

There are many potential applications of 'intelligent' aqueous polymer systems in medicine, biotechnology, industry and in environmental problems. Many of these polymer systems undergo reversible phase transitions--for example, abrupt changes in volume--in response to external stimuli such as temperature, pH or the nature of the solvent. Most of the polymers studied previously are responsive to only one kind of stimulus. But for some applications, independent responsiveness to several factors, such as temperature and pH, may be required. Here we describe a polymer that undergoes marked solubility changes in water in response to temperature and/or pH changes. The polymer is prepared by grafting temperature-sensitive side chains onto a pH-sensitive backbone. We also find that block copolymers, in which the temperature- and pH-sensitive units alternate along the chain, show similar behaviour.

Acrylamides↗
PubMed2000

[The electronic patient recrod: an essential part of using telematics in health care].

The DIADOQ CPR supports the explicit representation of the medical acts, facts and main inferences underlying the process of health care delivery. A controlled vocabulary is maintained by a frame-based concept system. This representation is the foundation for a consistent and comparable recording of patient data and for the flexible adaptation of screen forms to clinical contexts. The explicit and structured representation of the process of health care delivery enables the tight integration of knowledge-based decision support in the CPR system.

Artificial Intelligence↗
PubMedDate not supplied

Giving the older driver enough perception-reaction time.

Many types of behavior slow with age, and older drivers require more time to process information and make decisions. How greater response time requirements relate to the design of the highway environment and to features of new in-vehicle technologies is discussed. The design requirements for many different aspects of roadway geometrics and traffic control devices are based on design driver perception-reaction times. However, without knowing how much slower older drivers are than the design driver, it is difficult to determine whether they are adequately protected by current design practice and, if not, what the desired change in design should be. Attempts to address this have been hampered by the lack of directly relevant data, the situation-specific nature of certain findings, and the older driver's ability to compensate for declines in basic skills. Also discussed are the promise and problems of new in-vehicle technologies for providing the older driver with adequate time to act. These intelligent vehicle highway systems (IVHS) may speed navigational decision making and recognition of hazards and maneuver requirements. However, the possibility for interfering with quick responding also arises, and IVHS systems might disadvantage the older driver in other ways.

Aged↗
PubMed2005

Evolving telemedicine/ehealth technology.

This paper describes emerging technologies to support a rapidly changing and expanding scope of telemedicine/telehealth applications. Of primary interest here are wireless systems, emerging broadband, nanotechnology, intelligent agent applications, and grid computing. More specifically, the paper describes the changes underway in wireless designs aimed at enhancing security; some of the current work involving the development of nanotechnology applications and research into the use of intelligent agents/artificial intelligence technology to establish what are termed "Knowbots"; and a sampling of the use of Web services, such as grid computing capabilities, to support medical applications. In addition, the expansion of these technologies and the need for cost containment to sustain future health care for an increasingly mobile and aging population is discussed.

Algorithms↗
PubMed2005

Ichthyosis follicularis, alopecia and photophobia (IFAP) syndrome treated with acitretin.

We describe a 3-year-old male patient with the ichthyosis follicularis, alopecia and photophobia (IFAP) syndrome, who developed cutaneous and ocular involvement in infancy. In addition, he had growth retardation and borderline intelligence; no other systemic involvement was found on detailed investigation. A moderate response to acitretin therapy (1 mg/kg) administered for 6 months was observed, with improvement in cutaneous features and corneal erosions and no change in alopecia or photophobia.

Abnormalities, Multiple↗
PubMed1996

Extrapolation from animals to man. The integration of pharmacokinetics and pharmacodynamics.

This paper has focused on the difficulties of extrapolating toxicological or pharmacological data obtained from animals to those expected in man. For some drugs, under certain conditions, there may be no problem, but for many, this is clearly not the case. Differences in apparent activity are impossible to reconcile without "normalizing" the dose for differences in pharmacokinetics and metabolism. The increasing use of artificial intelligence and expert systems in drug investigations may provide a greater insight into why these differences may occur and allow prediction but, in the end, they must be tested in the experiments undertaken. The use of kinetic dynamic relationships in different species will certainly help in this regard and, wherever possible, should be included in experimental design to build up a database of experience since such information is sadly lacking. But we must interpret with caution the data produced by those that continue to extrapolate animal data to humans without some attempt to discuss in detail the validity of their assumptions.

Animals↗