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A proposal to classify happiness as a psychiatric disorder.

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains--that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.

Affect↗

Diagnostic criteria and the use of ICD-10 codes to define and classify minor head injury.

BACKGROUND: Epidemiological research on the incidence of traumatic head injuries relies on the correct definition and classification of the injury. OBJECTIVE: To address the use of diagnostic criteria and ICD-10 codes to define minor head injury in Swedish hospitals managing patients with head injury. METHODS: A questionnaire was mailed to all 76 Swedish hospitals managing head injuries. The hospitals were asked what diagnostic criteria they use to define minor head injury, and which ICD-10 codes they use to classify such injuries. RESULTS: 72 hospitals (95%) responded to the survey. The most common criterion was loss of consciousness (76%), followed by post-traumatic amnesia (38%). Almost half the hospitals used other signs and symptoms to define minor head injury. The ICD-10 code S.06 (intracranial injury) was used by 51 of the hospitals (91%). CONCLUSIONS: It is essential that there should be common definitions, classifications, and registration of minor head injuries. The wide variation in definition and classification found in this study emphasises the importance of improved implementation of the present guidelines.

Craniocerebral Trauma↗

Some factors influencing interobserver variation in classifying simple pneumoconiosis.

Three experienced physician readers assessed the chest radiographs of 743 men from a coal mining community in West Virginia for the signs of simple pneumoconiosis, using the ILO U/C 1971 Classification of Radiographs of the Pneumoconioses. The number of films categorised by each reader as showing evidence of simple pneumoconiosis varied from 63 (8.5%) to 114 (15.3%) of the 743 films classified. The effect of film quality and obesity on interobserver agreement was assessed by use of kappa-type analytic procedures for measuring agreement on categorical data. Poor film quality and obesity both affected agreement adversely. Poor quality films were disproportionately frequent in obese individuals, as defined by the Quetelet index. On control of film quality by stratification, the effect of obesity on interobserver profusion agreement was no longer evident.

Coal Mining↗

Defining and classifying medical error: lessons for patient safety reporting systems.

BACKGROUND: It is important for healthcare providers to report safety related events, but little attention has been paid to how the definition and classification of events affects a hospital's ability to learn from its experience. OBJECTIVES: To examine how the definition and classification of safety related events influences key organizational routines for gathering information, allocating incentives, and analyzing event reporting data. METHODS: In semi-structured interviews, professional staff and administrators in a tertiary care teaching hospital and its pharmacy were asked to describe the existing programs designed to monitor medication safety, including the reporting systems. With a focus primarily on the pharmacy staff, interviews were audio recorded, transcribed, and analyzed using qualitative research methods. RESULTS: Eighty six interviews were conducted, including 36 in the hospital pharmacy. Examples are presented which show that: (1) the definition of an event could lead to under-reporting; (2) the classification of a medication error into alternative categories can influence the perceived incentives and disincentives for incident reporting; (3) event classification can enhance or impede organizational routines for data analysis and learning; and (4) routines that promote organizational learning within the pharmacy can reduce the flow of medication error data to the hospital. DISCUSSION: These findings from one hospital raise important practical and research questions about how reporting systems are influenced by the definition and classification of safety related events. By understanding more clearly how hospitals define and classify their experience, we may improve our capacity to learn and ultimately improve patient safety.

Humans↗

Comparison of clinical and epidemiological characteristics of pelvic inflammatory disease classified by endocervical cultures of Neisseria gonorrhoeae and Chlamydia trachomatis.

We compared the clinical and epidemiological characteristics of 89 women with pelvic inflammatory disease (PID) seen at a clinic for sexually transmitted diseases during 1982 and 1983. Patients were classified into four groups by having endocervical cultures positive for Neisseria gonorrhoeae only (24), Chlamydia trachomatis only (16), both organisms (14), or neither organism (35). More women with cultures positive for N gonorrhoeae were black (p less than 0.005), had a sexual partner with gonorrhoea (p less than 0.005), and had a purulent vaginal discharge (p less than 0.05). No other significant differences were found between groups regarding age, exposure to a sexual partner with non-gonococcal urethritis, history of trichomoniasis, parity, use of antibiotics, contraceptive history, duration of abdominal pain, relation of pain to the phase of the menstrual cycle, abdominal rebound tenderness, reproductive tract signs, or febrility. In women presenting to outpatient clinics, PID tends to be mild and the diagnosis unreliable. Though C trachomatis is emerging as an important aetiological agent, we found no clinical indicators that could distinguish chlamydial from gonococcal PID.

Adult↗

Direct explanations for the development and use of a multi-layer perceptron network that classifies low-back-pain patients.

Using a new method published by the first author, this article shows how direct explanations can be provided to interpret the classification of any input case by a standard multilayer perceptron (MLP) network. The method is demonstrated for a real-world MLP that classifies low-back-pain patients into three diagnostic classes. The application of the method leads to the discovery of a number of mis-diagnosed training and test cases and to the development of a more optimal low-back-pain MLP network.

Humans↗

Electrophysiological properties of neurons in intact rat dorsal root ganglia classified by conduction velocity and action potential duration.

1. L4 and L5 dorsal root ganglia of rats aged 4-5 wk were isolated in vitro with their dorsal roots and sciatic nerves intact. With the use of intracellular microelectrodes, conduction velocity (CV) was determined along both peripheral and central axons and active and passive membrane properties were investigated with the use of a single-electrode switching clamp. 2. Neurons were classified into one of the three subgroups, A alpha/beta, A delta, and C, on the basis of a combination of axonal CV and action potential duration. Soma diameters overlapped between these groups. 3. Action potentials elicited by nerve stimulation in all cells and by a somatic current step in A alpha/beta-cells were always blocked by tetrodotoxin (TTX) 0.1-1 microM), whereas somatic action potentials in a proportion of A delta-cells and all C cells were TTX-resistant. 4. Passive electrical properties differed significantly between A alpha/beta-, A delta-, and C cells. The contribution of the additional membrane of the axons to the recorded electrical properties was analyzed with the use of a compartmental model of the neurons (see APPENDIX). 5. Most neurons discharged only a single action potential at the onset of a depolarizing current step, but 33% of A alpha/beta-cells fired repetitively throughout the step. This was associated with a lower threshold for action potential initiation by depolarizing current and a shorter afterhyperpolarization than in other A alpha/beta-cells. 6. Afterhyperpolarizations varied in size and duration between neurons and most were either not or only slightly affected by replacing Ca2+ in the bathing solution with Co2+ or Ba2+ or by adding tetraethylammonium (1 and 10 mM). Outward tail currents following an active response could be fitted with one fast exponential (time constant = 13 +/- 1 ms, mean +/- SE) and, in 65% of cells, one to three slower time course currents (to which exponentials with time constants of approximately 50, 300, or 1,500 ms could be fitted). A very slow late-onset current (detected in 33% of C cells) resembled a Ca(2+)-dependent K+ conductance described in several other neurons. 7. Voltage transients showed "sag" during maintained hyperpolarizing current steps in 90% of A alpha/beta-cells and 70% of A delta-cells but only 13% of C cells. Time-dependent inward currents were recorded when membrane potential was hyperpolarized. These currents had mean activation time constants of approximately 40 ms at -120 mV and were Cs+ sensitive and Ba2+ insensitive. 8. The proportion of neurons with a transient outward current, IA, increased as CV decreased (36% of A alpha/beta-cells, 56% of A delta-cells, 63% of C cells). Outward currents in cells of all subgroups had either one or two of three inactivation time constants (means approximately 22, 120, and 800 ms). 9. This study shows that many of the electrical characteristics of isolated dorsal root ganglion neurons can be demonstrated in intact ganglia in which the neurons can be better identified functionally. The currents underlying the afterhyperpolarization in these cells are diverse across all subgroups and require further investigation. The electrical effects of retaining the axonal projections of the cells and the use of microelectrodes filled with 0.5 M KC1 are discussed in relation to the differences from data recorded in dissociated neurons.

Action Potentials↗

The validity and reliability of 6 sets of clinical criteria to classify Alzheimer's disease and vascular dementia in cases confirmed post-mortem: added value of a decision tree approach.

Data from 204 participants from the Oxford Project to Investigate Memory and Ageing, who were diagnosed post-mortem using the histopathological criteria of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), were used to assess the validity of the clinical criteria for Alzheimer's disease (AD) of the 'National Institute of Neurological and Communicative Disorders and Stroke/the Alzheimer's Disease and Related Disorders Association' (NINCDS/ADRDA). Cases who had been diagnosed as NINCDS/ADRDA 'probable AD' in life were usually confirmed at autopsy, but half of the NINCDS/ADRDA 'negative' cases were not (low specificity). It was hypothesized that the overall clinical impression may have taken precedence over the use of the actual criteria. We therefore investigated the validity and reliability of the clinical criteria using a computerized 'dementia diagnosis system' for each of 6 sets of criteria [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), NINCDS/ADRDA and three sets of criteria specifically for vascular dementia (VaD): NINCDS-AIREN, State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), and Vascular Cognitive Impairment (VCI)] to classify a subset (n = 96) of the cases confirmed post-mortem. The use of the computerized system significantly (p = 0.01) increased the specificity (81%, similar to sensitivity) of the NINCDS/ADRDA diagnoses, which were shown to have 'moderate' inter-rater reliability. The DSM-IV criteria had good validity for AD when compared with post-mortem confirmation and showed 'substantial' inter-rater reliability. The ADDTC and VCI criteria for VaD had good specificity (88%) and sensitivity (75%), but only for one rater. The DSM-IV and NINCDS-AIREN criteria for VaD showed poor validity and inter-rater reliability. We conclude that the forced use of decision trees through a computerized system enhances the accuracy of the clinical diagnoses of dementia.

Aged↗

A framework for classifying study designs to evaluate health care interventions.

Researchers who are trained in epidemiology recognise and use the standard range of designs, i. e. retrospective and prospective cohort studies and case control studies, for studying aetiological questions. The application of study designs to health care interventions is more complex. Researchers may modify familiar designs, in response to specific problems posed by the interventions being evaluated, and an unambiguous nomenclature has not been established. Also, researchers who set out to evaluate interventions are not always trained in epidemiology and often use familiar study design labels in an ambiguous or inappropriate manner. The susceptibility to bias of different study designs is a critical consideration for users of research evidence. Sources of bias are the same for all studies, i. e. selection, performance, detection and attrition bias, but the susceptibility of studies is likely to vary depending on their design. Evidence of associations between features of study designs, specific biases and their consistent influence on effect estimates is lacking. A framework for classifying study design will be proposed, based on key features of study designs, i. e. what researchers actually did. This framework may (a) help to reduce the ambiguity about study design labels, and uncertainty about how a study was actually carried out, and (b) help methodological researchers to gather evidence about associations between different study design features and susceptibility to bias.

Bias↗

Personality characteristics of depressed patients classified according to family history.

Personality traits were assessed in a series of 148 patients classified according to Winokur into depression pure disease (DPD), depression spectrum disease (DSD) and sporadic depression (SD) with the addition of a fourth group: family history positive-others (FH + .O) comprised of patients with psychiatric disorders among first-degree relatives other than those taken into account by Winokur. Personality was assessed by means of a Swedish inventory, the KSP, comprised of 15 subscales assumed to measure relatively stable traits. DSD patients appeared to be most deviant from the other groups in most variables. Statistically significant differences were obtained for the variable socialization, which measures the internalization of social rules on which the DSD patients scored lowest, and variables of aggression on which the DSD patients scored higher than all the others.

Adult↗

Analysis of 75 cases of acute myeloid leukaemia classified according to the FAB classification.

75 cases of acute myeloid leukaemia were retrospectively classified according to the French-American-British (FAB) classification. It was found that: (1) the proposed classification was easily applicable and reproducible; (2) M2 subtype was the most frequent (48%); (3) splenomegaly was absent in M1 subtype, and (4) in M2 subtype, a considerable number of cases presented with normal neutrophil and platelet counts.

Adult↗

A sensitivity index F, useful to classify patients with glaucoma simplex.

Using a new method to determine the scotoma pressure by means of an Amsler grid chart and an ophthalmodynamometer in addition to three other parameters (the brachialis blood pressure and the intra-ocular pressure), a sensitivity factor F was calculated, useful to classify patients with visual field defects due to glaucoma simplex.

Glaucoma↗

Toward optimal classifier system performance in non-Markov environments.

Wilson's (1994) bit-register memory scheme was incorporated into the XCS classifier system and investigated in a series of non-Markov environments. Two extensions to the scheme were important in obtaining near-optimal performance in the harder environments. The first was an exploration strategy in which exploration of external actions was probabilistic as in Markov environments, but internal "actions" (register settings) were selected deterministically. The second was use of a register having more bit-positions than were strictly necessary to resolve environmental aliasing. The origins and effects of the two extensions are discussed.

Algorithms↗

Local reinforcement and recombination in classifier systems.

We investigate classifier systems' reward schemes by way of an example that highlights the interaction of local reward schemes and recombination. We contrast averaging schemes and maximizing schemes. Our example illustrates a sense in which certain recombination operators mesh more gracefully with averaging schemes than with maximizing schemes.

Algorithms↗

A neural learning classifier system with self-adaptive constructivism for mobile robot control.

For artificial entities to achieve true autonomy and display complex lifelike behavior, they will need to exploit appropriate adaptable learning algorithms. In this context adaptability implies flexibility guided by the environment at any given time and an open-ended ability to learn appropriate behaviors. This article examines the use of constructivism-inspired mechanisms within a neural learning classifier system architecture that exploits parameter self-adaptation as an approach to realize such behavior. The system uses a rule structure in which each rule is represented by an artificial neural network. It is shown that appropriate internal rule complexity emerges during learning at a rate controlled by the learner and that the structure indicates underlying features of the task. Results are presented in simulated mazes before moving to a mobile robot platform.

Algorithms↗

Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function.

Current guidelines for asthma care categorize asthma severity based on the frequency of asthma symptoms, medication use, and lung function measures. The objective of this study was to determine whether lung function measures are consistent with levels of asthma severity as defined by the National Asthma Education and Prevention Program/Expert Panel Report 2 Guidelines. Parents of children aged 5-18 years with asthma seen in two outpatient subspecialty clinics completed questionnaires regarding asthma medication use and symptom frequency over the preceding 1 and 4 weeks, respectively. All children performed spirometry. When asthma severity was based on the higher severity of asthma symptom frequency or medication use, asthma was mild intermittent in 6.9% of participants, mild persistent in 27.9%, moderate persistent in 22.4%, and severe persistent in 42.9%. FEV(1) % predicted did not differ by level of asthma severity. FEV(1)/FVC decreased as asthma severity increased (p < 0.0001) and was abnormal in 33% of the participants, and a greater percentage of participants had an abnormal FEV(1)/FVC as asthma severity increased (p = 0.0001). In children, asthma severity classified by symptom frequency and medication usage does not correlate with FEV(1) categories defined by National Asthma Education and Prevention Program Guidelines. FEV(1) is generally normal, even in severe persistent childhood asthma, whereas FEV(1)/FVC declines as asthma severity increases.

Adolescent↗

Classifying severity of cystic fibrosis lung disease using longitudinal pulmonary function data.

RATIONALE: The study of genetic modifiers in cystic fibrosis (CF) lung disease requires rigorous phenotyping. One type of genetic association study design compares polymorphisms in patients at extremes of phenotype, requiring accurate classification of pulmonary disease at varying ages. OBJECTIVE: To evaluate approaches to quantify severity of pulmonary disease and their ability to discriminate between patients with CF at the extremes of phenotype. METHODS: DeltaF508 homozygotes (n = 828) were initially classified as "severe" (approximate lowest quartile of FEV(1) (% pred) for age, 8-25 yr) or "mild" disease (highest quartile of FEV(1) for age, > or = 15 yr). FEV(1) measurements from the 5 yr before enrollment (total = 18,501 measurements; average 23 per subject) were analyzed with mixed models, and patient-specific estimates of FEV(1) (% pred) at ages 5, 10, 15, 20, and 25 yr and slope of FEV(1) versus age were examined for their ability to discriminate between groups using receiver operating characteristics (ROC) curve areas. RESULTS: Logistic regression of severity group on mixed model (empirical Bayes) estimates of intercept and slope of FEV(1) (% pred) versus age discriminated better than did classification using FEV(1) slope alone (ROC area = 0.995 vs. 0.821) and was equivalent to using estimated FEV(1) at 20 yr of age as a single discriminator. The estimated survival percentile from a joint survival/longitudinal model provided equally good classification (ROC area = 0.994). CONCLUSIONS: In CF, estimated FEV(1) (% pred) at 20 yr of age and the estimated survival percentile are useful indices of pulmonary disease severity.

Adolescent↗