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Steering through the murky waters of a scientific conflict: situated and symbolic models of clinical cognition.

The situated action perspective, which embraces a diversity of views, challenges several of the fundamental assumptions of the symbolic information-processing framework underlying cognitive science and artificial intelligence. In this paper, we consider the following issues; symbolic representations, plans and actions, distributed cognition, and the transfer of learning. We evaluate each of these issues in terms of research and theories in clinical cognition and examine the implications for education and training, and for the integration of intelligent systems in medical practice. We argue for a reconceptualization of the symbolic framework in terms of the way the role of internal representations and cognitive activities are perceived. However, symbolic representations are integral to medical cognition and should continue to be central in any theoretical framework. A re-examination of cognitive science in medicine in terms of the relationship among physicians, technology, and the workplace could prove to be constructive in bridging the gap between theory and practice.

Artificial Intelligence↗

Lexical production in children with Williams syndrome: spontaneous use of gesture in a naming task.

This study investigates lexical organization and lexical retrieval in children with Williams syndrome (WS), by examining both naming accuracy and accompanying use of gestures in a picture-naming task. Ten children with the genetic disorder of Williams syndrome (age range: 9.5-12.9) were compared with 20 typically developing children, 10 matched for chronological age (CA) and 10 for mental-age (MA). Lexical production was measured by administering the Boston Naming test (BNT). Older typically developing children performed significantly better than the other two groups. No differences in accuracy were found between the children with WS and the typically developing children matched for mental-age. The overall distribution of error types displayed by children with WS indicate that the lexical-semantic organization is similar to that of typically developing children. However, compared to controls, the WS group produced more iconic gestures during the task, in patterns that suggest the existence of specific word-finding difficulties in these children. Results are discussed within the framework of recent theories on the role of gesture in speech production.

Adolescent↗

Material-specific and non-specific attention deficits in children and adolescents following temporal-lobe surgery.

Attentional control in children and adolescents with unilateral temporal-lobe excisions was examined using two experimental tasks, a lexical-decision and a spatial-cue task, and a standardized vigilance task. Participants with left temporal excisions took longer than controls to reorient their attention after invalid cues compared to neutral cues in the lexical task and they made more errors on all three of the tasks. Participants with right temporal excisions differed from controls in the number of errors made on the spatial task. No differences were found between the lesion and control groups on reaction-time measures of the spatial task. The results suggest that a material-specific inhibition impairment, as well as a more general sustained attention deficit, may result after a left temporal excision in childhood or adolescence. These deficits are considered in the context of neuroanatomical models of attentional control.

Adolescent↗

Visualisation of biomedical datasets by use of growing cell structure networks: a novel diagnostic classification technique.

BACKGROUND: Medical research produces large multivariable datasets that are difficult to visualise and interpret intuitively. We describe a novel growing cell structure (GCS) technique that compresses multidimensional datasets into two dimensional maps with colour overlays that can be visually interpreted. METHODS: The two-dimensional map is self-discovered from the training set by distribution of cases to different nodes according to similarity between the cases at each node. Nodes are added to the map until there is no further significant reduction in error. The Parzen window method is used to estimate the probability distribution of the training cases, and this probability is converted to posterior class probabilities by use of Bayes' theorem. Classification performance can be assessed by means of receiver operating characteristic (ROC) curves. Colour maps of the values of each input variable at each node are constructed, which illustrate the relation between each input variable and the overall distribution of cases in the network map. FINDINGS: From a dataset of 11 input variables from 692 fine-needle aspirate samples from breast lesions, a 32-node network produced an area under the ROC curve of 0.96, which was not significantly different from that for logistic regression (0.98, z=1.09, p>0.05). Colour maps of the input variables showed that some variables had discrete distributions over exclusively benign or malignant areas of the network, and were thus discriminant, whereas others, such as foamy macrophages, covered both benign and malignant regions. INTERPRETATION: This technique produces dimensional compression that allows multidimensional data to be displayed as two-dimensional colour images. This envisioning of information allows the highly developed visuospatial abilities of human observers to perceive subtle inter-relations in the dataset.

Artificial Intelligence↗

Machine learning for survival analysis: a case study on recurrence of prostate cancer.

Machine learning techniques have recently received considerable attention, especially when used for the construction of prediction models from data. Despite their potential advantages over standard statistical methods, like their ability to model non-linear relationships and construct symbolic and interpretable models, their applications to survival analysis are at best rare, primarily because of the difficulty to appropriately handle censored data. In this paper we propose a schema that enables the use of classification methods--including machine learning classifiers--for survival analysis. To appropriately consider the follow-up time and censoring, we propose a technique that, for the patients for which the event did not occur and have short follow-up times, estimates their probability of event and assigns them a distribution of outcome accordingly. Since most machine learning techniques do not deal with outcome distributions, the schema is implemented using weighted examples. To show the utility of the proposed technique, we investigate a particular problem of building prognostic models for prostate cancer recurrence, where the sole prediction of the probability of event (and not its probability dependency on time) is of interest. A case study on preoperative and postoperative prostate cancer recurrence prediction shows that by incorporating this weighting technique the machine learning tools stand beside modern statistical methods and may, by inducing symbolic recurrence models, provide further insight to relationships within the modeled data.

Artificial Intelligence↗

Evaluating a case-based discovery system: a case-study in content-oriented evaluation.

Research in case-based reasoning has explored the ideas of retrieving and adapting previous experience in the form of cases. The retrieval process uses an index vocabulary which attempts to capture content and context of previous cases. Current approaches to empirical evaluation of case-based reasoning systems often do not consider the crucial role which a content-oriented index vocabulary plays in the various stages of the case-based reasoning process. We will address this issue by describing an evaluation of our case-based discovery system IULIAN. Based on this description, we will propose a general schema for content-oriented evaluation of case-based reasoning systems.

Artificial Intelligence↗

Classification and regression trees--studies of HIV reverse transcriptase inhibitors.

In this paper, the application of Classification And Regression Trees (CART) is presented for the analysis of biological activity of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). The data consist of the biological activities, expressed as pIC50, of 208 NNRTIs against wild-type HIV virus (HIV-1) and four mutant strains (181C, 103N, 100I, 188L) and the computed interaction energies with the Reverse Transcriptase (RT) binding pocket. CART explains the observed biological activity of NNRTIs in terms of interactions with individual amino acids in the RT binding pocket, i.e., the original data variables.

Algorithms↗

Application of fuzzy functions for visual presentation of medical data.

While interpretation of medical data is very often an ambiguous process, computers usually display results of recommendations, provided by both human experts and computer algorithms, as concrete data. This study proposes a visual presentation of relative degrees of uncertainty along with "standard" concrete medical data. A medical parameter (mean arterial pressure) is dynamically evaluated during surgery for being too low or too high. Fuzzy membership functions are utilized to display degrees of deviation in the form of a clear and concise pie chart. Thus, in the Operating Room the anesthesiologist can be provided with an easy statistical assessment of uncertainty of existing recommendations.

Algorithms↗

Drug choice as a self-handicapping strategy in response to noncontingent success.

In two closely related experiments, college student subjects were instructed to choose between a drug that allegedly interfered with performance and a drug that allegedly enhanced performance. This choice was the main dependent measure of the experiment. The drug choice intervened between work on soluble or insoluble problems and a promised retest on similar problems. In Experiment 1, all subjects received success feedback after their initial problem-solving attempts, thus creating one condition in which the success appeared to be accidental (noncontingent on performance) and one in which the success appeared to be contingent on appropriate knowledge. Males in the noncontingent-success condition were alone in preferring the performance-inhibiting drug, presumably because they wished to externalize probable failure on the retest. The predicted effect, however, did not hold for female subjects. Experiment 2 replicated the unique preference shown by males after noncontingent success and showed the critical importance of success feedback.

Achievement↗

Intellectual performance and ego depletion: role of the self in logical reasoning and other information processing.

Some complex thinking requires active guidance by the self, but simpler mental activities do not. Depletion of the self's regulatory resources should therefore impair the former and not the latter. Resource depletion was manipulated by having some participants initially regulate attention (Studies 1 and 3) or emotion (Study 2). As compared with no-regulation participants who did not perform such exercises, depleted participants performed worse at logic and reasoning (Study 1), cognitive extrapolation (Study 2), and a test of thoughtful reading comprehension (Study 3). The same manipulations failed to cause decrements on a test of general knowledge (Study 2) or on memorization and recall of nonsense syllables (Study 3). Successful performance at complex thinking may therefore rely on limited regulatory resources.

Cognition↗

Cognitive estimation and affective judgments in alcoholic Korsakoff patients.

Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions ('size,' 'weight,' 'quantity,' and 'time') and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients' results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome.

Aged↗

The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia.

A neuropsychological paradigm is introduced that provides a measure of a bias against disconfirmatory evidence (BADE), and its correspondence with delusions in people with schizophrenia and schizoaffective disorder was investigated. Fifty-two patients diagnosed with schizophrenia or schizoaffective disorder (36 were acutely delusional) and 24 healthy control participants were presented with delusion-neutral pictures in each trial, and were asked to rate the plausibility of four written interpretations of the scenario depicted by that picture. Subsequently, new pictures that provided background information about the depicted scenario were successively presented, and participants were requested to adjust their ratings, taking into account this new information. Two of the interpretations appeared tenable initially but ultimately proved to be implausible, one appeared untenable initially but eventually proved to be plausible, and one appeared untenable at all stages. A BADE was observed for delusional compared to non-delusional patients, as well as for all patients compared to controls. In addition, regardless of symptom profile, patients were more accepting of implausible interpretations than controls. The present work suggests that deficits in reasoning may contribute to the maintenance of delusions via an impairment in the processing of disconfirmatory evidence.

Adult↗

Tolerance to missing data using a likelihood ratio based classifier for computer-aided classification of breast cancer.

While mammography is a highly sensitive method for detecting breast tumours, its ability to differentiate between malignant and benign lesions is low, which may result in as many as 70% of unnecessary biopsies. The purpose of this study was to develop a highly specific computer-aided diagnosis algorithm to improve classification of mammographic masses. A classifier based on the likelihood ratio was developed to accommodate cases with missing data. Data for development included 671 biopsy cases (245 malignant), with biopsy-proved outcome. Sixteen features based on the BI-RADS lexicon and patient history had been recorded for the cases, with 1.3 +/- 1.1 missing feature values per case. Classifier evaluation methods included receiver operating characteristic and leave-one-out bootstrap sampling. The classifier achieved 32% specificity at 100% sensitivity on the 671 cases with 16 features that had missing values. Utilizing just the seven features present for all cases resulted in decreased performance at 100% sensitivity with average 19% specificity. No cases and no feature data were omitted during classifier development, showing that it is more beneficial to utilize cases with missing values than to discard incomplete cases that cannot be handled by many algorithms. Classification of mammographic masses was commendable at high sensitivity levels, indicating that benign cases could be potentially spared from biopsy.

Algorithms↗

Computerized content analysis of writings of Mahatma Gandhi.

Three brief excerpts from the autobiographical writings of Mohandas K. Gandhi were analyzed for neuropsychobiological content using the PCAD 2000 computer program. The computer software produces scores on 13 scales such as anxiety, hostility, cognitive impairment, and depression; compares the assigned scores with norms derived from 5-minute speech samples taken from normal, medically and psychiatrically healthy adults and children; and suggests DSM-IV diagnostic categories for consideration. The results demonstrate an objective, repeatable method for achieving insight into the mental states and traits of historic figures based on their writings.

Adult↗

Public health medicine and the district health authority.

The 1991 National Health service reforms have greatly changed the role of district health authorities. These bodies employ most public health physicians in England and thus the focus of public health departments has changed with the reforms. Presents the results of a series of semi-structured interviews with the board members of two health authorities about the role of public health. Board members outlined several roles for the specialty including defining key issues, interpreting technical issues, intelligence gathering, developing links with clinicians and legitimizing health authority decisions. There were some concerns about the corporacy of public health departments. There was a great deal of support for health promotion, but some reluctance to be drawn into political issues. Also explored were alternative sources of advice on health policy, such as the views of general practitioners.

Health Care Reform↗

An artificial intelligent algorithm for tumor detection in screening mammogram.

Cancerous tumor mass is one of the major types of breast cancer. When cancerous masses are embedded in and camouflaged by varying densities of parenchymal tissue structures, they are very difficult to be visually detected on mammograms. This paper presents an algorithm that combines several artificial intelligent techniques with the discrete wavelet transform (DWT) for detection of masses in mammograms. The AI techniques include fractal dimension analysis, multiresolution markov random field, dogs-and-rabbits algorithm, and others. The fractal dimension analysis serves as a preprocessor to determine the approximate locations of the regions suspicious for cancer in the mammogram. The dogs-and-rabbits clustering algorithm is used to initiate the segmentation at the LL subband of a three-level DWT decomposition of the mammogram. A tree-type classification strategy is applied at the end to determine whether a given region is suspicious for cancer. We have verified the algorithm with 322 mammograms in the Mammographic Image Analysis Society Database. The verification results show that the proposed algorithm has a sensitivity of 97.3% and the number of false positive per image is 3.92.

Algorithms↗

A system for automatic measurement of circadian activity deviations in telemedicine.

A system for the automatic measurement of the circadian activity deviations in telemedicine has been developed within the framework of a "Health Integrated Smart Home Information System" (HIS2). HIS2 is an experimental platform for the evaluation and the development of technologies in order to ensure the security and quality of life for patients who need home based medical monitoring. Location sensors are placed in each room of the HIS2, allowing the monitoring of patient's successive activity phases within the patient's home environment. We proceeded with a sampling in an hourly schedule to detect weak rhythmic variations. Based on numerous measurements, we established a mean value with confidence limits. These also allowed us to define a zone within which the patient's activity is qualified to be "predictable." Alerts are set off if the patient's activity deviates from this zone.

Activities of Daily Living↗