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Clustering and group selection of multiple criteria alternatives with application to space-based networks.

In many real-world problems, the range of consequences of different alternatives are considerably different. In addition, sometimes, selection of a group of alternatives (instead of only one best alternative) is necessary. Traditional decision making approaches treat the set of alternatives with the same method of analysis and selection. In this paper, we propose clustering alternatives into different groups so that different methods of analysis, selection, and implementation for each group can be applied. As an example, consider the selection of a group of functions (or tasks) to be processed by a group of processors. The set of tasks can be grouped according to their similar criteria, and hence, each cluster of tasks to be processed by a processor. The selection of the best alternative for each clustered group can be performed using existing methods; however, the process of selecting groups is different than the process of selecting alternatives within a group. We develop theories and procedures for clustering discrete multiple criteria alternatives. We also demonstrate how the set of alternatives is clustered into mutually exclusive groups based on 1) similar features among alternatives; 2) ideal (or most representative) alternatives given by the decision maker; and 3) other preferential information of the decision maker. The clustering of multiple criteria alternatives also has the following advantages. 1) It decreases the set of alternatives to be considered by the decision maker (for example, different decision makers are assigned to different groups of alternatives). 2) It decreases the number of criteria. 3) It may provide a different approach for analyzing multiple decision makers problems. Each decision maker may cluster alternatives differently, and hence, clustering of alternatives may provide a basis for negotiation. The developed approach is applicable for solving a class of telecommunication networks problems where a set of objects (such as routers, processors, or intelligent autonomous vehicles) are to be clustered into similar groups. Objects are clustered based on several criteria and the decision maker's preferences.

Journal Article↗

Errors in surgical neuropathology and the influence of cognitive biases: the psychology of intelligence analysis.

CONTEXT: A significant difficulty that pathologists encounter in arriving at a correct diagnosis is related to the way information from various sources is processed and assimilated in context. OBJECTIVE: These issues are addressed by the science of cognitive psychology. Although cognitive biases are the focus of a number of studies on medical decision making, few if any focus on the visual sciences. DATA SOURCES: A recent publication authored by Richards Heuer, Jr, The Psychology of Intelligence Analysis, directly addresses many of the cognitive biases faced by neuropathologists and anatomic pathologists in general. These biases include visual anticipation, first impression, and established mindsets and subconsciously influence our critical decision-making processes. CONCLUSIONS: The book points out that while biases are an inherent property of cognition, the influence of such biases can be recognized and the effects blunted.

Cognition↗

A knowledge acquisition tool in analytical pathology based on multi-media relational database.

The need for a knowledge based expert system for efficient decision making in the field of pathology has been well accepted. To build the knowledge-base for such an expert system is a painstaking task. This work is an attempt to provide the pathologists a powerful and user-friendly tool that will help them in the process of building the knowledge-base for medical diagnosis by closely looking at the specimen images and their extracted feature values. The tool is based on multi-media relational database and software like VAX Rally (4GL), ILIAD and SAS to provide a wide-range comparative study between feature data and image data; and also their statistical analysis.

Artificial Intelligence↗

Decision threshold adjustment in class prediction.

Standard classification algorithms are generally designed to maximize the number of correct predictions (concordance). The criterion of maximizing the concordance may not be appropriate in certain applications. In practice, some applications may emphasize high sensitivity (e.g., clinical diagnostic tests) and others may emphasize high specificity (e.g., epidemiology screening studies). This paper considers effects of the decision threshold on sensitivity, specificity, and concordance for four classification methods: logistic regression, classification tree, Fisher's linear discriminant analysis, and a weighted k-nearest neighbor. We investigated the use of decision threshold adjustment to improve performance of either sensitivity or specificity of a classifier under specific conditions. We conducted a Monte Carlo simulation showing that as the decision threshold increases, the sensitivity decreases and the specificity increases; but, the concordance values in an interval around the maximum concordance are similar. For specified sensitivity and specificity levels, an optimal decision threshold might be determined in an interval around the maximum concordance that meets the specified requirement. Three example data sets were analyzed for illustrations.

Algorithms↗

Predictors of reading skill development in children with early cochlear implantation.

OBJECTIVE: The present study sought to document the word reading and comprehension levels attained by children who were implanted by 5 yr of age. It was hypothesized that the improved speech perception abilities acquired with cochlear implantation would promote phonological coding skills and facilitate the acquisition of beginning reading skills. DESIGN: Three subtests from diagnostic reading assessment batteries standardized on hearing children were administered to 181 children between 8 yr 0 mo and 9 yr 11 mo of age who had 4 to 6 yr of implant experience. In addition, a battery of processing measures was administered including a lexical decision task, a rhyme task and the digit span subtest of the Wechsler Intelligence Scale for Children. RESULTS: Over half of the children scored within the average range for their age compared with the normative data for hearing children. Reading competence was associated with higher nonverbal intelligence, higher family socio-economic status, female gender and later onset of deafness (between birth and 36 mo). After variance due to these child and family characteristics was removed, reading competence was associated with mainstream educational placement, use of an updated implant speech processor with a wide dynamic range, and speech processing characteristics that included longer memory span and use of phonological coding strategies. Reading outcome was most highly predicted by linguistic competence and, secondarily, by speech production skill. CONCLUSION: Children who experience severe to profound deafness early in their development have a better prognosis for normal literacy development than ever before. To the extent that use of a cochlear implant is associated with greater use of phonological coding strategies for decoding print, longer working memory spans for short-term storage of phonemes, words and sentences and accelerated language development for reading comprehension, it should have a facilitative effect on the acquisition of literacy.

Canada↗

The hospital consultant's secretary.

Analysis of work done by the secretaries attached to one medical unit in a general hospital showed that much was discretionary in character and entailed making decisions. Work in the unit was made easier and more efficient by this intelligent use of initiative by the secretaries. At present the pay given to medical secretaries in hospital is below a level that would be commensurate with their responsibility.

Economics↗

NMRES: an artificial intelligence expert system for quantification of cardiac metabolites from 31phosphorus nuclear magnetic resonance spectroscopy.

The application of high-resolution 31Phosphorus Nuclear Magnetic Resonance (31P NMR) Spectroscopy in biology and medicine has provided new insights into biochemical processes and also a unique assessment of metabolites. However, accurate quantification of biological NMR spectra is frequently complicated by: (a) non-Lorentzian form of peak lineshapes, (b) contamination of peak signals by neighboring peaks, (c) presence of broad resonances, (d) low signal-to-noise ratios, and (e) poorly defined sloping baselines. Our objectives were to develop an expert system that captures and formalizes 31P NMR spectroscopists' expert knowledge, and to provide a reliable, efficient, and automated system for the interpretation of biological spectra. The NMR Expert System (NMRES) was written in the C and OPS5 programming languages and implemented on a Unix-based (Ultrix) mainframe system with XWindows bit-map graphics display. Expert knowledge was acquired from NMR spectroscopists and represented as production rules in the knowledge base. A heuristic weights method was employed to determine the confidence levels of potential peaks. Statistical and numerical methods were used to facilitate processing decisions. NMR spectra obtained from studies of ischemic neonatal and immature hearts were used to assess the performance of the expert system. The expert system performed signal extraction, noise treatment, resonance assignment, intracellular pH determination, and metabolite intensity quantitation in about 10 s per 4 KB (kilobyte) spectrum. The peak identification success rate was 98.2%. Peak areas and pH estimated by the expert system compared favorably with those determined by human experts. We conclude that the expert system has provided a framework for reliable and efficient quantification of complex biological 31P NMR spectra.

Artificial Intelligence↗

An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

Artificial Intelligence↗

Interactive volume visualization using "intelligent movies".

High quality visualization of medical volume models as performed by the VOXEL-MAN and similar systems is still too time consuming and the interaction complicated when sophisticated tools like dissection are used. We hence developed a new paradigm allowing to create simpler derivatives of the model, called "intelligent movies". These are in QuickTime or QuickTime VR format which allow interactive exploration with two degrees of freedom. As a decisive novelty, we extended it by a pixelwise link to the knowledge base which may be queried in the image context. Thus scenes emphasizing a selected aspect of the volume model may be created as intelligent movies, which a user (referring physician, student) can explore largely with the functionality of VOXEL-MAN, but in real time--on any standard PC--and also via a JAVA applet within web browsers. This is shown with the example of 3D interactive anatomical atlases and clinical cases.

Anatomy, Cross-Sectional↗

[Evaluation of systemic activity of the brain by means of an artificial intelligence model].

The model based on the systems representation of informational brain mechanisms reproduces the principal stages of intellectual activities: afferent synthesis, decision making, acceptor of results of actions. The imitation of behavior of subjects in the special experimental environment with the model allows quantitative estimation of parameters of systemic stages in normal subjects of different ages and subjects with different brain dysfunctions, such as arteriosclerosis, schizophrenia, etc.

Adolescent↗

Optimized approach to decision fusion of heterogeneous data for breast cancer diagnosis.

As more diagnostic testing options become available to physicians, it becomes more difficult to combine various types of medical information together in order to optimize the overall diagnosis. To improve diagnostic performance, here we introduce an approach to optimize a decision-fusion technique to combine heterogeneous information, such as from different modalities, feature categories, or institutions. For classifier comparison we used two performance metrics: The receiving operator characteristic (ROC) area under the curve [area under the ROC curve (AUC)] and the normalized partial area under the curve (pAUC). This study used four classifiers: Linear discriminant analysis (LDA), artificial neural network (ANN), and two variants of our decision-fusion technique, AUC-optimized (DF-A) and pAUC-optimized (DF-P) decision fusion. We applied each of these classifiers with 100-fold cross-validation to two heterogeneous breast cancer data sets: One of mass lesion features and a much more challenging one of microcalcification lesion features. For the calcification data set, DF-A outperformed the other classifiers in terms of AUC (p < 0.02) and achieved AUC=0.85 +/- 0.01. The DF-P surpassed the other classifiers in terms of pAUC (p < 0.01) and reached pAUC=0.38 +/- 0.02. For the mass data set, DF-A outperformed both the ANN and the LDA (p < 0.04) and achieved AUC=0.94 +/- 0.01. Although for this data set there were no statistically significant differences among the classifiers' pAUC values (pAUC=0.57 +/- 0.07 to 0.67 +/- 0.05, p > 0.10), the DF-P did significantly improve specificity versus the LDA at both 98% and 100% sensitivity (p < 0.04). In conclusion, decision fusion directly optimized clinically significant performance measures, such as AUC and pAUC, and sometimes outperformed two well-known machine-learning techniques when applied to two different breast cancer data sets.

Algorithms↗

Development of a Computational Histology Artificial Intelligence-Powered Prognostic Biomarker in Colorectal Cancer in The Cancer Genome Atlas.

BACKGROUND: Risk stratification in colorectal cancer (CRC) plays an important role in treatment decision-making. As such, prognostic biomarkers that can augment risk stratification have clinical value. Quantitative histologic features from routine hematoxylin and eosin (H&E)-stained whole slide images (WSIs) provide a novel avenue for biomarker discovery. In this study, we explored the potential for a computational histology artificial intelligence (CHAI) platform to develop and validate a prognostic biomarker in CRC. METHODS: The Cancer Genome Atlas Colorectal Adenocarcinoma project was utilized for this study, with inclusion of all subjects (stage I-IV) with available digitized H&E specimens. The cohort was split into development and validation cohorts by a stratified random split. The previously developed CHAI platform was applied in the development cohort to construct a continuous risk score from histologic features associated with progression-free interval (PFI) that was dichotomized based on an optimized cutpoint for distinguishing PFI into a high risk CHAI (+) and lower risk CHAI (-). PFI was compared between CHAI (+) and CHAI (-) patients in the validation cohort in multivariable Cox proportional hazards models. Time-dependent area under the curve (tdAUC) and C-indices were also calculated for PFI. RESULTS: A total of 583 participants were included in the study, with 409 assigned to the validation cohort. The CHAI biomarker classified 229 participants (56%) as CHAI (+) and 180 (44%) as CHAI (-) in the validation set. CHAI (+) participants had worse PFI in a multivariable analysis adjusting for available clinicopathologic variables (hazard ratio (HR) = 2.65; 95% confidence interval (CI), 1.63-4.30). TdAUC for the CHAI biomarker was 0.60 (95% CI, 0.53-0.67) at 12 months, 0.62 (0.55-0.69) at 36 months, and 0.67 (0.55-0.79) at 60 months; the C-index was 0.62 (95% CI, 0.58-0.67). CONCLUSIONS: The CHAI platform was used to develop a prognostic digital pathology biomarker in CRC. This demonstrates the feasibility and potential to apply this artificial intelligence-based digital pathology biomarker platform for risk stratification in CRC and supports its further study.

Artificial intelligence↗

Diabetic patients management exploiting case-based reasoning techniques.

In this paper we propose a case-based decision support tool, designed to help physicians in 1st type diabetes therapy revision through the intelligent retrieval of data related to past situations (or 'cases') similar to the current one. A case is defined as a set of variable values (or features) collected during a visit. We defined taxonomy of prototypical patients' conditions, or classes, to which each case should belong. For each input case, the system allows the physician to find similar past cases, both from the same patient and from different ones. We have implemented a two-steps procedure; (1) it finds the classes to which the input case could belong; (2) it lists the most similar cases from these classes, through a nearest neighbor technique, and provides some statistics useful for decision taking. The performance of the system has been tested on a data-base of 147 real cases, collected at the Policlinico S. Matteo Hospital of Pavia. The tool is fully integrated in the web-based architecture of the EU funded Telematic management of Insulin Dependent Diabetes Mellitus (T-IDDM) project.

Case-Control Studies↗

Supporting physicians in taking decisions in clinical guidelines: the GLARE "what if" facility.

GLARE (GuideLine Acquisition, Representation and Execution) is a domain-independent system for the acquisition, representation and execution of clinical guidelines. GLARE is unique in its approach to supporting the decision-making process of users/physicians faced with various alternatives in the guidelines. In many cases, the best alternative cannot be determined on the basis of "local information" alone (i.e., by considering just the selection criteria associated with the decision at hand), but must also take into account information stemming from relevant alternative pathways. Exploitation of "global information" available in the various pathways is made possible by GLARE through the "what if" facility, a form of hypothetical reasoning which allows users to gather relevant decision parameters (e.g., costs, resources, times) from selected parts of the guideline in a semi-automatic fashion. In particular, the extremely complex task of coping with temporal information involves the extension and adaptation of various techniques developed by the Artificial Intelligence (AI) community.

Decision Making, Computer-Assisted↗

Intelligence, reaction time, and inspection time.

Forty-eight subjects with IQ scores ranging from 57 to 138 discriminated between two lines of markedly different length, exposed for varying periods of time. Estimates of inspection time, lambda, a measure assumed to reflect the rate at which sensory input is processed, were obtained from the pattern of errors made by each subject and, therefore, independently from the reaction time (RT) required to respond. lambda correlated negatively with IQ scores. RTs of nonretarded subjects increased as stimulus-exposure duration decreased, whereas for retarded subjects RTs remained constant. This is interpreted as indicating differences between the groups in response strategy under conditions of difficult discrimination. The rate of information processing was also estimated in a different choice RT situation, using as an index the reciprocal of the slope of the function relating RT to degree of stimulus choice. Retarded subjects had slower rates and longer RTs than nonretarded subjects. A second experiment controlling for response-selection factors confirmed that this slowness could not be attributed to gross-movement difficulties and that a slower rate of information transmission seemed to be involved.

Adolescent↗

SIVA: a hybrid knowledge-and-model-based advisory system for intensive care ventilators.

The Sheffield Intelligent Ventilator Advisor is a hybrid knowledge-and-model-based advisory system designed for intensive care ventilator management. It consists of a top-level fuzzy rule-based module to give the qualitative component of the advice, and a lower-level model-based module to give the quantitative component of the advice. It is structured to offer adaptive patient-specific decision support. It can be operated in either invasive or noninvasive modes depending on the availability of data from invasive clinical measurements. The user can choose between the full-advisory mode and the clinician-directed mode. The advice given by the top-level module has been validated against retrospective real patient data and compared with intensivists expertise and performance under simulation conditions. Closed-loop simulations were performed assuming various clinical scenarios including sudden changes in the patient parameters such as the shunt or deadspace with noise and disturbances. They have shown that the advice given was appropriate and the blood gases resulting from the closed-loop decision support were acceptable. The system was also shown to be tolerant to noise and disturbances. It is implemented in MATLAB/SIMULINK and LabVIEW.

Artificial Intelligence↗