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Bleeding predisposition assessments in tonsillectomy/adenoidectomy patients using fuzzy interquartile encoded neural networks.

A fuzzy set theoretic methodology is described that serves as a classification preprocessing strategy for supervised feed-forward neural networks. This methodology, fuzzy interquartile encoding, determines the respective degrees to which a feature belongs to a collection of fuzzy sets that overlap at the respective quartile boundaries of the feature. These membership values are subsequently used in place of the original feature. This transformation has a normalizing effect on the feature space and is more robust to feature outliers. Its effectiveness is scrutinized using several synthetic data sets with various underlying distributions. Fuzzy interquartile encoding is shown to consistently improve the discriminatory power of the underlying classifiers. The methodology is also applied to two biomedical data sets relating to tonsillectomy and/or adenoidectomy patients who may or may not have had a predisposition to excessive bleeding during their operation. The features of the first data set are blood sample test results acquired from a coagulation laboratory and the class labels are one of three hemostatic defects as identified by the reference tests. The second data set consists of patient responses to queries from a bleeding tendency questionnaire. Normal and abnormal class labels were derived from a hematology expert system designed in consultation with a pediatric hematologist. Fuzzy interquartile encoding effected an 11% improvement in the classification accuracy of the underlying neural network classifier with the former data set and 18% with the latter.

Adenoidectomy↗

Estimation of respiratory parameters via fuzzy clustering.

The results of monitoring respiratory parameters estimated from flow-pressure-volume measurements can be used to assess patients' pulmonary condition, to detect poor patient-ventilator interaction and consequently to optimize the ventilator settings. A new method is proposed to obtain detailed information about respiratory parameters without interfering with the expiration. By means of fuzzy clustering, the available data set is partitioned into fuzzy subsets that can be well approximated by linear regression models locally. Parameters of these models are then estimated by least-squares techniques. By analyzing the dependence of these local parameters on the location of the model in the flow-volume-pressure space, information on patients' pulmonary condition can be gained. The effectiveness of the proposed approaches is demonstrated by analyzing the dependence of the expiratory time constant on the volume in patients with chronic obstructive pulmonary disease (COPD) and patients without COPD.

Airway Resistance↗

On the use and usefulness of fuzzy sets in medical AI.

Since its inception fuzzy set theory has been regarded as a formalism suitable to deal with the imprecision intrinsic to many medical problems. Based on a literature survey on the first 30 years, we investigate the impact fuzzy set theory has had on the work in medical AI and point out what it is most appreciated for.

Artificial Intelligence↗

Report of research activities in fuzzy AI and medicine at USF CSE.

Several projects involving the use of fuzzy and neuro-fuzzy methods in medical applications, developed by members of the Department of Computer Science and Engineering, University of South Florida, Tampa, Florida, are briefly reviewed. The successful applications are emphasized.

Artificial Intelligence↗

Multicriteria fuzzy assignment method: a useful tool to assist medical diagnosis.

The aim of this paper is to provide a concise portrayal of medical applications of a new fuzzy classification method called PROAFTN, which uses a multicriteria decision aid approach. The review summarises and discusses medical applications of the proposed method in acute leukemia, astrocytic and bladder tumours. Although still an investigative method, the preliminary results are very encouraging and demonstrate the potential performances of this procedure for solving medical classification problems.

Artificial Intelligence↗

Mining association rules with improved semantics in medical databases.

The discovery of new knowledge by mining medical databases is crucial in order to make an effective use of stored data, enhancing patient management tasks. One of the main objectives of data mining methods is to provide a clear and understandable description of patterns held in data. We introduce a new approach to find association rules among quantitative values in relational databases. The semantics of such rules are improved by introducing imprecise terms in both the antecedent and the consequent, as these terms are the most commonly used in human conversation and reasoning. The terms are modeled by means of fuzzy sets defined in the appropriate domains. However, the mining task is performed on the precise data. These "fuzzy association rules" are more informative than rules relating precise values. We also introduce a new measure of accuracy, based on Shortliffe and Buchanan's certainty factors [Shortliffe E, Buchanan B. Math Biosci 1975;23:351-79]. Also, the semantics of the usual measure of usefulness of an association rule, called support are discussed and some new criteria are introduced. Our new measures have been shown to be more understandable and appropriate than ordinary ones. Several experiments on large medical databases show that our new approach can provide useful knowledge with better semantics in this field.

Databases, Factual↗

EvIdent: a functional magnetic resonance image analysis system.

EvIdent (EVent IDENTification) is a user-friendly, algorithm-rich, exploratory data analysis software for quickly detecting, investigating, and visualizing novel events in a set of images as they evolve in time and/or frequency. For instance, in a series of functional magnetic resonance neuroimages, novelty may manifest itself as neural activations in a time course. The core of the system is an enhanced variant of the fuzzy c-means clustering algorithm. Fuzzy clustering obviates the need for models of the underlying requisite biological function, models that are often statistically suspect.

Algorithms↗

A fuzzy approach to computer-assisted myocardial ischemia diagnosis.

The aim of the project is to introduce and implement in medical practice a fuzzy expert system specialized in the non-invasive diagnosis of myocardial ischemia. The system is able to embed and process medical knowledge independently of the way it is expressed (quantitatively or qualitatively, numerically or linguistically). It implements a novel medical diagnostic technique, has minimal computational requirements, performs an accurate diagnosis, is flexible and user-friendly. It is currently being tested in health care institutions and is used as a tool for different analyses and studies.

Artificial Intelligence↗

The graphical presentation of decision support information in an intelligent anaesthesia monitor.

This contribution examines the graphical presentation of decision support information generated by an intelligent monitor, named SENTINEL, developed for use during anaesthesia. Clinicians make diagnoses in real-time during operations by examining clinically significant trends in multiple signals. SENTINEL attempts to mimic this decision process by using a system of fuzzy trend templates. SENTINEL's implementation of fuzzy trend templates is capable of providing the dual fuzzy measures of belief and plausibility, which are derived from the theory of evidence. It is thus capable of generating fairly rich diagnostic decision support information. However, for SENTINEL to be effective, the visual presentation of this information must be intuitive to the anaesthetist, who may not be familiar with the theory of evidence. This paper discusses techniques that are being evaluated to meet the requirements of the SENTINEL anaesthesia monitor. Specifically, the paper presents methods for highlighting clinically significant trends in physiological (or derived) signals by superimposing a coloured band on the signal that reflects fuzzy output from the intelligent monitor. This paper also discusses the intuitive graphical presentation of binary diagnostic fuzzy measures, including their further interpretation and presentation as crisp "alarm" and "warning" conditions.

Anesthesia, General↗

An interactive framework for an analysis of ECG signals.

In this study, we introduce and discuss a development of a highly interactive and user-friendly environment for an ECG signal analysis. The underlying neural architecture being a crux of this environment comes in the form of a self-organizing map. This map helps discover a structure in a set of ECG patterns and visualize a topology of the data. The role of the designer is to choose from some already visualized regions of the self-organizing map characterized by a significant level of data homogeneity and substantial difference from other regions. In the sequel, the regions are described by means of information granules-fuzzy sets that are essential in the characterization of the main relationships existing in the ECG data. The study introduces an original method of constructing membership functions that incorporates class membership as an important factor affecting changes in membership grades. The study includes a comprehensive descriptive modeling of highly dimensional ECG data.

Artificial Intelligence↗

Fuzzy detection of EEG alpha without amplitude thresholding.

Intelligent automated systems are needed to assist the tedious visual analysis of polygraphic recordings. Most systems need detection of different electroencephalogram (EEG) waveforms. The problem in automated detection of alpha activity is the large inter-individual variability of its amplitude and duration. In this work, a fuzzy reasoning based method for the detection of alpha activity was designed and tested using a total of 32 recordings from seven different subjects. Intelligence of the method was distributed to features extracted and the way they were combined. The ranges of the fuzzy rules were determined based on feature statistics. The advantage of the detector is that no alpha amplitude threshold needs to be selected. The performance of the alpha detector was assessed with receiver operating characteristic (ROC) curves. When the true positive rate was 94.2%, the false positive rate was 9.2%, which indicates good performance in sleep EEG analysis.

Adult↗

Automatic detection of distorted plethysmogram pulses in neonates and paediatric patients using an adaptive-network-based fuzzy inference system.

Despite the fact that pulse oximetry has become an essential technology in respiratory monitoring of neonates and paediatric patients, it is still fraught with artefacts causing false alarms resulting from patient or probe movement. As the shape of the plethysmogram has always been considered as a useful visual indicator for determining the reliability of SaO(2) numerical readings, automation of this observation might benefit health care providers at the bedside. We observed that the systolic upstroke time (t(1)), the diastolic time (t(2)) and heart rate (HR) extracted from the plethysmogram pulse constitute features, which can be used for detecting normal and distorted plethysmogram pulses. We developed a technique for classifying plethysmogram pulses into two categories: valid and artefact via implementations of fuzzy inference systems (FIS), which were tuned using an adaptive-network-based fuzzy inference system (ANFIS) and receiver operating characteristics (ROC) curves analysis. Features extracted from a total of 22,497 pulse waveforms obtained from 13 patients were used to systematically optimise the FIS. A further 2843 waveforms obtained from another eight patients were used for testing the system, and visually classified into 1635 (58%) valid and 1208 (42%) distorted segments. For the optimum system, the area under the ROC curve was 0.92. The system was able to classify 1418 (87%) valid segments and 897 (74%) distorted segments correctly. The calculations of the system's performance showed 87% sensitivity, 81% accuracy and 74% specificity. In comparison with the 95% confidence interval (CI) thresholding method, the fuzzy system showed higher specificity (P=0.008,P<0.01), and no significant difference was found between the two methods in terms of sensitivity (P=0.720,P>0.05) and accuracy (P=0.053,P>0.05). We therefore conclude that the algorithm used in this system has some potential in detecting valid and distorted plethysmogram pulse. However, further evaluation is needed using larger patient groups.

Adolescent↗

Evaluation of two different models of semi-automatic knowledge acquisition for the medical consultant system CADIAG-II/RHEUMA.

As part of a plan to promote semi-automatic knowledge acquisition for the medical consultant system CADIAG-II/RHEUMA, this study sought to explore and cope with the variability of results that may be anticipated when performing knowledge acquisition with patient data from different patient settings. Patient data were drawn both from a published study for the classification of rheumatoid arthritis (RA) and from a large database of rheumatological patient charts developed for the CADIAG-II/RHEUMA system. An analysis of the relationships between RA and selected CADIAG-II/RHEUMA symptoms was done using two models. In one of them, we controlled for the differences in baseline frequencies of symptoms and diseases in the two study populations as an important factor influencing the results of the calculations. Other factors that were identified included inconsistent definitions of symptoms and diseases, and the different composition of study groups in the two study populations. By eliminating differences in baseline frequencies as the most important bias, the results obtained from the two different knowledge sources became more consistent. All remaining inconsistencies and uncertainties about the contribution and relative importance of the factors were formalized using fuzzy intervals.

Arthritis, Rheumatoid↗

Rule-base derivation for intensive care ventilator control using ANFIS.

In recent years, much research has been done on the use of fuzzy systems in medicine. The fuzzy rule-bases have usually been derived after extensive discussion with the clinical experts. This takes a lot of time from the clinical experts and the knowledge engineers. This paper presents the use of the adaptive neuro-fuzzy inference system (ANFIS) in rule-base derivation for ventilator control. The change of the inspired fraction of oxygen (FiO(2)) advised by eight clinical experts responding to 71 clinical scenarios was recorded. ANFIS and a multilayer perceptron (MLP) were then used to model the relationship between the inputs (the arterial oxygen tension (PaO(2)), FiO(2) and the positive end-expiratory pressure (PEEP) level) and the change in FiO(2) suggested. Compared to a previous fuzzy advisor (FAVeM), both the ANFIS and the MLP were found to correlate with the clinicians' decision better (correlation coefficient of 0.694 and 0.701, respectively compared to 0.630). A formerly developed model-based radial basis network advisor (RBN-MB) was used for comparison. Closed-loop simulations showed that the ANFIS, MLP and the RBN-MB's performance were comparable to the clinicians' performance (correlation coefficients of 0.852, 0.962 and 0.787, respectively). The FAVeM's performance differed from the clinicians' performance (correlation coefficient of 0.332) but the resulting PaO(2) was still within safety limits.

Computer Simulation↗

A fuzzy cognitive map approach to differential diagnosis of specific language impairment.

This paper presents a computer-based model for differential diagnosis of specific language impairment (SLI), a language disorder that, in many cases, cannot be easily diagnosed. This difficulty necessitates the development of a methodology to assist the speech therapist in the diagnostic process. The methodology tool is based on fuzzy cognitive maps and constitutes a qualitative and quantitative computer model comprised of the experience and knowledge of specialists. The development of the model was based on knowledge from the literature and then it was successfully tested on four clinical cases. The results obtained point to its final integration in the future and to its valid contribution as a differential diagnosis model of SLI.

Autistic Disorder↗

Visualization and simulation techniques for surgical simulators using actual patient's data.

Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators.

Artificial Intelligence↗

Midpoints for fuzzy sets and their application in medicine.

Using Kosko's hypercube, we identify a fuzzy set with a point in a unit hypercube. A non-fuzzy or crisp subset of a set is a vertex of the hypercube. We introduce some new ideas: the definition of the fuzzy segment joining two given fuzzy subsets of a set, the set of midpoints between those two fuzzy subsets, and the set of equidistant points from given points. We present some basic properties and relations between these concepts and provide a complete description of fuzzy segments and midpoints. In the majority of cases, there is no unique midpoint; one has an infinite set of possibilities to choose from. This situation is totally different from classical Euclidean geometry where, for two given points, there is a unique midpoint. We use the obtained results to study two sets of medical data and present two applications in medicine: the fuzzy degree of two concurrent food and drug addictions, and a fuzzy representation of concomitant causal mechanisms of stroke.

Adolescent↗