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[Suggestion for a new, patient-oriented epilepsy classification].

The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes--at least as defined by the ILAE Task Force--group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.

Epilepsy↗

Topographic, bioclimatic, and vegetation characteristics of three ecoregion classification systems in North America: comparisons along continent-wide transects.

Ecoregion classification systems are increasingly used for policy and management decisions, particularly among conservation and natural resource managers. A number of ecoregion classification systems are currently available, with each system defining ecoregions using different classification methods and different types of data. As a result, each classification system describes a unique set of ecoregions. To help potential users choose the most appropriate ecoregion system for their particular application, we used three latitudinal transects across North America to compare the boundaries and environmental characteristics of three ecoregion classification systems [Küchler, World Wildlife Fund (WWF), and Bailey]. A variety of variables were used to evaluate the three systems, including woody plant species richness, normalized difference in vegetation index (NDVI), and bioclimatic variables (e.g., mean temperature of the coldest month) along each transect. Our results are dominated by geographic patterns in temperature, which are generally aligned north-south, and in moisture, which are generally aligned east-west. In the west, the dramatic changes in physiography, climate, and vegetation impose stronger controls on ecoregion boundaries than in the east. The Küchler system has the greatest number of ecoregions on all three transects, but does not necessarily have the highest degree of internal consistency within its ecoregions with regard to the bioclimatic and species richness data. In general, the WWF system appears to track climatic and floristic variables the best of the three systems, but not in all regions on all transects.

Classification↗

Gastric carcinoma classification in the WHO 6th edition (2026): Updated framework and emerging entities.

The sixth edition of the WHO Classification of Digestive System Tumours (2026) represents an important step in the continuing evolution of gastric carcinoma classification. While preserving morphology as the foundation of diagnosis, it incorporates advances in molecular pathology, genotype-phenotype correlations, tumour evolution, and predictive biomarker assessment. This review summarizes the development of the WHO classification from the third edition (2000) to the sixth edition (2026) and highlights its relationship with other major classification systems, including those of Laurén, Nakamura, and the Japanese Gastric Carcinoma Association (JGCA). Major histological categories remain largely unchanged; however, several important conceptual and diagnostic refinements have been introduced. These include recognition of crawling-type adenocarcinoma as a distinctive variant of tubular adenocarcinoma, subclassification of poorly cohesive carcinoma into signet-ring cell and non-signet-ring cell subtypes, introduction of the concept of pure signet-ring cell carcinoma, and increased emphasis on tumour evolution. The sixth edition also expands and refines the spectrum of uncommon gastric carcinoma subtypes, including gastric carcinoma with lymphoid stroma, AFP-producing carcinoma, micropapillary adenocarcinoma, gastric adenocarcinoma of fundic-gland type, and gastric sarcomatoid carcinoma. Crucially, molecular subgroups originally proposed by The Cancer Genome Atlas (TCGA) and actionable biomarkers-including HER2 (ERBB2), Claudin 18.2, mismatch repair deficiency/microsatellite instability (dMMR/MSI), and programmed death-ligand 1 (PD-L1)-have transitioned from research-based categories into essential tools for precision oncology. Rather than providing exhaustive diagnostic criteria, this review offers a conceptual framework and encourages consultation of the original WHO text for full details. These advances illustrate the transition of gastric carcinoma classification from a predominantly morphology-based system toward an integrated histomolecular framework that more closely links pathological diagnosis with tumour biology, prognostication, and therapeutic stratification.

Crawling-type adenocarcinoma↗

A novel ensemble machine learning for robust microarray data classification.

Microarray data analysis and classification has demonstrated convincingly that it provides an effective methodology for the effective diagnosis of diseases and cancers. Although much research has been performed on applying machine learning techniques for microarray data classification during the past years, it has been shown that conventional machine learning techniques have intrinsic drawbacks in achieving accurate and robust classifications. This paper presents a novel ensemble machine learning approach for the development of robust microarray data classification. Different from the conventional ensemble learning techniques, the approach presented begins with generating a pool of candidate base classifiers based on the gene sub-sampling and then the selection of a sub-set of appropriate base classifiers to construct the classification committee based on classifier clustering. Experimental results have demonstrated that the classifiers constructed by the proposed method outperforms not only the classifiers generated by the conventional machine learning but also the classifiers generated by two widely used conventional ensemble learning methods (bagging and boosting).

Algorithms↗

Using discordance to improve classification in narrative clinical databases: an application to community-acquired pneumonia.

Data mining in electronic medical records may facilitate clinical research, but much of the structured data may be miscoded, incomplete, or non-specific. The exploitation of narrative data using natural language processing may help, although nesting, varying granularity, and repetition remain challenges. In a study of community-acquired pneumonia using electronic records, these issues led to poor classification. Limiting queries to accurate, complete records led to vastly reduced, possibly biased samples. We exploited knowledge latent in the electronic records to improve classification. A similarity metric was used to cluster cases. We defined discordance as the degree to which cases within a cluster give different answers for some query that addresses a classification task of interest. Cases with higher discordance are more likely to be incorrectly classified, and can be reviewed manually to adjust the classification, improve the query, or estimate the likely accuracy of the query. In a study of pneumonia--in which the ICD9-CM coding was found to be very poor--the discordance measure was statistically significantly correlated with classification correctness (.45; 95% CI .15-.62).

Adult↗

The development of the globally harmonized system (GHS) of classification and labelling of hazardous chemicals.

The hazards of chemicals can be classified using classification criteria that are based on physical, chemical and ecotoxicological endpoints. These criteria may be developed be iteratively, based on scientific or regulatory processes. A number of national and international schemes have been developed over the past 50 years, and some, such as the UN Dangerous Goods system or the EC system for hazardous substances, are in widespread use. However, the unnecessarily complicated multiplicity of existing hazard classifications created much unnecessary confusion at the user level, and a recommendation was made at the 1992 Rio Earth summit to develop a globally harmonized chemical hazard classification and compatible labelling system, including material safety data sheets and easily understandable symbols, that could be used for manufacture, transport, use and disposal of chemical substances. This became the globally harmonized system for the Classification and Labelling of Chemicals (GHS). The developmental phase of the GHS is largely complete. Consistent criteria for categorising chemicals according to their toxic, physical, chemical and ecological hazards are now available. Consistent hazard communication tools such as labelling and material safety data sheets are also close to finalisation. The next phase is implementation of the GHS. The Intergovernmental Forum for Chemical Safety recommends that all countries implement the GHS as soon as possible with a view to have the system fully operational by 2008. When the GHS is in place, the world will finally have one system for classification of chemical hazards.

Australia↗

Revision of the CEAP classification for chronic venous disorders: consensus statement.

The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into "Reporting Standards in Venous Disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the American Venous Forum, working with an international liaison committee, has recommended a number of practical changes, detailed in this consensus report. These include refinement of several definitions used in describing CVD; refinement of the C classes of CEAP; addition of the descriptor n (no venous abnormality identified); elaboration of the date of classification and level of investigation; and as a simpler alternative to the full (advanced) CEAP classification, introduction of a basic CEAP version. It is important to stress that CEAP is a descriptive classification, whereas venous severity scoring and quality of life scores are instruments for longitudinal research to assess outcomes.

Chronic Disease↗

Statistical principles for ecological status classification of Water Framework Directive monitoring data.

Bias, precision and confidence of the classification framework are crucial elements for decisions to invest large sums to improve the ecological quality. In this study, the statistical principles for classification in relation to WFD are outlined and exemplified. Indicator adjustment to seasonal variation and other significant covariates reduces bias and improves precision. Precision is generally improved using annual means with seasonal adjustment instead of seasonal means. For classification I argue that the balance between costs of monitoring and reduction measures is only fully maintained by the fail-safe approach. The required monitoring efforts to ensure a precise classification are substantially higher than envisaged in WFD, for nutrients and phytoplankton measurements as high as 500 observations to characterise a water body. It must be ensured that sufficient monitoring data become available for classification, while indicator bias and precision is improved through modelling and further development of measurement techniques.

Classification↗

Unsupervised image classification of medical ultrasound data by multiresolution elastic registration.

Thousands of medical images are saved in databases every day and the need for algorithms able to handle such data in an unsupervised manner is steadily increasing. The classification of ultrasound images is an outstandingly difficult task, due to the high noise level of these images. We present a detailed description of an algorithm based on multiscale elastic registration capable of unsupervised, landmark-free classification of cardiac ultrasound images into their respective views (apical four chamber, two chamber, parasternal long axis and short axis views). We validated the algorithm with 90 unselected, consecutive echocardiographic images recorded during daily clinical work. When the two visually very similar apical views (four chamber and two chamber) are combined into one class, we obtained a 93.0% correct classification (chi2 = 123.8, p < 0.0001, cross-validation 93.0%; chi2 = 131.1, p < 0.0001). Classification into the 4 classes reached a 90.0% correct classification (chi2 = 205.4, p < 0.0001, cross-validation 82.2%; chi2 = 165.9, p < 0.0001).

Algorithms↗

Proposed new classification scheme for chemical injury to the human eye.

PURPOSE: Various ocular alkali burn classification schemes have been published and used to grade human chemical eye injuries for the purpose of identifying treatments and forecasting outcomes. The ILSI chemical eye injury classification scheme was developed for the additional purpose of collecting detailed human eye injury data to provide information on the mechanisms associated with chemical eye injuries. This information will have clinical application, as well as use in the development and validation of new methods to assess ocular toxicity. METHODS: A panel of ophthalmic researchers proposed the new classification scheme based upon current knowledge of the mechanisms of eye injury, and their collective clinical and research experience. Additional ophthalmologists and researchers were surveyed to critique the scheme. The draft scheme was revised, and the proposed scheme represents the best consensus from at least 23 physicians and scientists. RESULTS: The new scheme classifies chemical eye injury into five categories based on clinical signs, symptoms, and expected outcomes. Diagnostic classification is based primarily on two clinical endpoints: (1) the extent (area) of injury at the limbus, and (2) the degree of injury (area and depth) to the cornea. CONCLUSIONS: The new classification scheme provides a uniform system for scoring eye injury across chemical classes, and provides enough detail for the clinician to collect data that will be relevant to identifying the mechanisms of ocular injury.

Animal Testing Alternatives↗

Stuttering and the International Classification of Functioning, Disability, and Health: an update.

UNLABELLED: The World Health Organization (WHO) recently presented a multidimensional classification scheme for describing health status and the experience of disablement. This new framework, the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), is a revision of WHO's prior framework for describing the consequences of disorders, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; WHO, 1980). In previous papers, Yaruss had shown how the original ICIDH could be adapted to describe the consequences of stuttering at several levels that are relevant to the communication and life experiences of the person who stutters. The current manuscript presents an update of the Yaruss (1998) model that accounts for the new structure of the ICF. A comparison of the WHO's ICIDH and ICF frameworks is presented, followed by an analysis of how the ICF can be adapted to describe the speaker's experience of the stuttering disorder. Emphasis is placed on the fact that stuttering involves more than just observable behaviors. Specifically, the speaker's experience of stuttering can involve negative affective, behavioral, and cognitive reactions (both from the speaker and the environment), as well as significant limitations in the speaker's ability to participate in daily activities and a negative impact on the speaker's overall quality of life. LEARNING OUTCOMES: As a result of reading this manuscript, participants, willgain an understanding of the updates to the World Health Organization's original International Classification of Impairments, Disabilities, and Handicaps that are seen in the International Classification of Functioning, Disability, and Health understand how the ICF can be applied to the study of stuttering recognize that health conditions such as stuttering are affected by both internal and external factors, and can involve more than just observable behaviors that are seen on the surface.

Disability Evaluation↗

A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints.

Interarch occlusal relationships are defined by temporomandibular joint (TMJ) position. Determination of the most physiologic joint position is a logical prerequisite for occlusal analysis. Existing classification systems for occlusion do not consider TMJ position or condition when relating the mandibular arch to the maxillary arch or the range of adaptive changes that can affect the position of the condyles or influence long-term occlusal stability. If the relationship between occlusion and TMJ position is as important as many clinicians believe, condylar position must be defined precisely as an essential control in any clinical study that purports to evaluate the relationship between occlusion and any masticatory system disorder to include temporomandibular disorders. This article presents a new classification system that defines the relationship between maximal intercuspation and the position and condition of the TMJs. The classification uses guidelines that are specific enough to be consistent and verifiably reproducible. A recently introduced term, "adapted centric posture," is used in this classification to distinguish deformed TMJs that have remodeled or adapted to a conformation that can comfortably accept maximal loading. This classification is necessary because deformed but adapted joints may within certain conditions function with the same degree of comfort as intact, properly aligned condyle disk assemblies in centric relation.

Adaptation, Physiological↗

Classification of developmental delays.

Developmental delay is frequently used to identify children with delay in meeting developmental milestones in one or more streams of development. There is no consensus on the specific definition. Developmental delay is best viewed generically as a chief complaint rather than a diagnosis. A child suspected to have delays should always be assessed in each of the major streams of development: expressive and receptive language, including social communication; visual problem solving (nonverbal cognition); motor development; neurobehavioral development; and social-emotional development. A model developed by the National Center for Medical Rehabilitation Research is used to compare existing classifications of developmental delays. This model defines the five domains in the disability process: pathophysiology, impairment, functional limitation, disability, and societal limitation. An etiology domain is added. This model is used to illustrate how existing classification systems of cerebral palsy, mental retardation, autism, and language delay draw on information from one or more domains. The model illustrates some of the conflicts between different systems. For example, most classification systems for cerebral palsy emphasize only impairment (spasticity, dyskinesias, and topography). The current definition and classification system for mental retardation focuses on functional limitations (IQ), disability, and societal limitations, ignoring pathophysiology and details of impairment. Given the complexity of neurodevelopmental disabilities, it is unlikely that a single classification system will fit all needs.

Activities of Daily Living↗

Muscular dystrophy: historical overview and classification in the genetic era.

Despite recent advances in molecular genetics, it has proven very difficult to arrive at an accurate and clinically useful classification of the muscular dystrophies. Much of this difficulty arises from confusion related to the term "muscular dystrophy" itself, as well as a general reluctance on the part of the neuromuscular community to abandon traditional, clinically based classifications. Nevertheless, advances in the understanding of the molecular defects of these disorders have permitted a foundation for classification based on molecular biology. This review presents a historical perspective on the classification of the muscular dystrophies, and furnishes the underpinnings of a genetic classification that can be used both at the bedside and in the research laboratory.

Classification↗

On the nature of global classification.

Molecular sequencing technology has brought biology into the era of global (universal) classification. Methodologically and philosophically, global classification differs significantly from traditional, local classification. The need for uniformity requires that higher level taxa be defined on the molecular level in terms of universally homologous functions. A global classification should reflect both principal dimensions of the evolutionary process: genealogical relationship and quality and extent of divergence within a group. The ultimate purpose of a global classification is not simply information storage and retrieval; such a system should also function as an heuristic representation of the evolutionary paradigm that exerts a directing influence on the course of biology. The global system envisioned allows paraphyletic taxa. To retain maximal phylogenetic information in these cases, minor notational amendments in existing taxonomic conventions should be adopted.

Biological Evolution↗

The International Classification of Health Problems for Primary Care.

Health problems of patients seen in the ambulatory setting are different from those encountered in the hospital, and the particular classification of diseases used should reflect these differences. The International Classification of Health Problems in Primary Care (ICHPPC) was designed for use by primary care physicians. It was tested in multiple sites in several countries for one year and has been approved by the World Organization of National Colleges and Academies of Family Medicine-General Practice and other groups concerned with the classification of diseases. The ICHPPC permits classification of the most important part of an ambulatory data see. Data generated by using this classification facilitate outreach to a practice population, construction of diagnostic profiles of health care providers, design of curriculum and health services research.

Ambulatory Care↗

Reliability of classification of fractures of the tibial plafond according to a rank-order method.

BACKGROUND: Many orthopedic classification systems, including those for tibial plafond fractures, are either unvalidated or have demonstrated problems with interobserver reliability. Classification of tibial plafond fractures according to a rank-order method has shown excellent interobserver reliability with several observers. The purpose of this study is to determine the reliability of a rank order classification of plafond fractures with a large number of observers. METHODS: A radiographic review study was completed by 69 orthopedists of varying training levels. Observers ranked 10 fractures of the tibial plafond based on anteroposterior and lateral ankle radiographs. Fractures were ranked in increasing severity from 1 to 10. No instructions were given regarding determination of severity. Agreement between rankings was analyzed by the intraclass correlation coefficient (ICC). RESULTS: Rankings were performed by viewing prints at the annual Orthopaedic Trauma Association meeting and through the Orthopaedic Trauma Association website using digital images. The overall ICC was 0.62. There was no difference in the ICC between traumatologists and general orthopedists (p > 0.5). Eleven observers commented that the radiographs did not represent the full spectrum of injury severity. CONCLUSIONS: The interobserver reliability of the rank-order classification in this study was fair to good, which is better than previously reported for plafond fracture classification systems. It remains to identify and validate a series of tibial plafond fractures that represent a full spectrum of injury and can be ranked with excellent interobserver reliability. A series of cases such as this may then serve a measurement standard for severity of bony injury against which individual cases may be reliably compared.

Classification↗

Discriminative nonlinear dimensionality reduction for improved classification.

Multi-Layer Perception (MLP) neural networks have been used extensively for classification tasks. Typically, the MLP network is trained explicitly to produce the correct classification as its output. For speech recognition, however, several investigators have recently experimented with an indirect approach: a unique MLP predictive network is trained for each class of data, and classification is accomplished by determining which predictive network serves as the best model for samples of unknown speech. Results from this approach have been mixed. In this report, we compare the direct and indirect approaches to classification from a more fundamental perspective. We show how recent advances in nonlinear dimensionality reduction can be incorporated into the indirect approach, and we show how the two approaches can be integrated in a novel MLP framework. We further show how these new MLP networks can be usefully viewed as generalizations of Learning Vector Quantization (LVQ) and of subspace methods of pattern recognition. Lastly, we show that applying these ideas to the classification of temporal trajectories can substantially improve performance on simple tasks.

Classification↗