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Application of the EXPERT consultation system to accelerated laboratory testing and interpretation.

The EXPERT consultation system-building tool, a knowledge-based artificial intelligence program developed at Rutgers University, has been applied to the development of a laboratory consultation system facilitating sequential laboratory testing and interpretation. Depending on the results of a basic panel of laboratory tests, the system requests that specific secondary tests be performed. Input of these secondary findings can result in requests for tertiary testing, to complete the database necessary for interpretation. Interpretation of all results is based upon final inferences from the collected findings through a series of rules, a hierarchical network that yields an efficient production system not easily obtained through conventional programming. The rules included in this model are based upon initial results for total protein, calcium, glucose, total bilirubin, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, thyroxin, hemoglobin, mean corpuscular volume, and the concentrations of four drugs. Pertinent clinical history items included are jaundice, diabetes, thyroid disease, medications, and ethanol. Implementing this system in a laboratory-based accelerated testing program involving outpatients maximized the effective use of laboratory resources, eliminated useless testing, and provided the patient with low-cost laboratory information.

Adolescent↗

Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.

A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.

Adult↗

The potential of expert systems in nursing.

The newly emerging technology of expert systems will not replace nursing decision-makers and problem-solvers, but it does promise to serve them as effective "intelligent assistants." An examination of what expert systems are, where expert systems are being used, whether they are possible and economically feasible in nursing, and the benefits, limitations, and future of expert systems, suggest that there is the potential for the development and use of expert systems in some areas of nursing practice, administration, and education. It is the role of nursing administrators to identify and to support the development of those applications that are the most promising.

Computer-Assisted Instruction↗

[Radiological reasoning and its computer-based simulation. Reasons to use computer-based diagnostic systems developed on shells].

Research on the medical applications of artificial intelligence has increased the knowledge of logical and methodological principles of clinical reasoning. Thus, computer-based diagnostic systems are developed on the basis of progress in this field, because thorough knowledge is necessary to obtain efficient simulation. This work was aimed at analyzing the structure of medical and radiological reasoning and at discussing the modalities to simulate it with computer-based diagnostic systems. The diagnostic process includes two steps: data collection and data interpretation; radiological reasoning involves the following 5 steps: procedural, executive, observative, interpretative and communicative. Each of them needs a different approach to simulation, considering, in its development, the different characteristics of each kind of reasoning. The expert system shells on the market are necessary tools to develop expert systems, but they cannot cover the whole of processes taking place during radiological work. Therefore, a particular, radiology-aimed shell should be developed to help the radiologist.

Artificial Intelligence↗

Multiband compression limiting for hearing-impaired listeners.

Four multiband compression limiters and two linear amplification systems were compared in terms of the intelligibility of consonant-vowel-consonant (CVC) nonsense syllables for two hearing-impaired listeners over a 30 dB range of input levels. Each system incorporated one of two frequency-gain characteristics and one of three limiting characteristics (no limiting, moderate limiting, or severe limiting). The subjects were instructed to choose overall listening levels that would permit speech spanning the range of input levels to be as intelligible as possible and comfortable for long-term listening. Relative to linear amplification, the overall gain selected by the subjects increased by roughly 5 and 11 dB for the moderate and severe limiter, respectively. With linear amplification, the maximum score, 82 percent correct, was obtained at the highest input level and scores fell roughly 34 percentage points as input level was reduced. With compression limiting, although the maximum scores, 81 percent and 79 percent correct, were obtained at lower input levels, performance was comparable to that with linear amplification. Also, scores spanned a range of only 22 and 9 percentage points across the range of input levels with the moderate and severe limiter, respectively. This benefit was due to the improved scores provided by compression limiting at the low input levels. However, this advantage was offset somewhat by the disadvantage provided by compression at high input levels relative to linear amplification. Error analysis indicated that the spectral degradations introduced by independent compression of 16 frequency bands may have caused the reduced intelligibility at higher input levels.

Adult↗

An integrative model for in-silico clinical-genomics discovery science.

Human Genome discovery research has set the pace for Post-Genomic Discovery Research. While post-genomic fields focused at the molecular level are intensively pursued, little effort is being deployed in the later stages of molecular medicine discovery research, such as clinical-genomics. The objective of this study is to demonstrate the relevance and significance of integrating mainstream clinical informatics decision support systems to current bioinformatics genomic discovery science. This paper is a feasibility study of an original model enabling novel "in-silico" clinical-genomic discovery science and that demonstrates its feasibility. This model is designed to mediate queries among clinical and genomic knowledge bases with relevant bioinformatic analytic tools (e.g. gene clustering). Briefly, trait-disease-gene relationships were successfully illustrated using QMR, OMIM, SNOMED-RT, GeneCluster and TreeView. The analyses were visualized as two-dimensional dendrograms of clinical observations clustered around genes. To our knowledge, this is the first study using knowledge bases of clinical decision support systems for genomic discovery. Although this study is a proof of principle, it provides a framework for the development of clinical decision-support-system driven, high-throughput clinical-genomic technologies which could potentially unveil significant high-level functions of genes.

Artificial Intelligence↗

A novel paradigm for telemedicine using the personal bio-monitor.

The foray of solid-state technology in the medical field has yielded an arsenal of sophisticated healthcare tools. Personal, portable computing power coupled with the information superhighway open up the possibility of sophisticated healthcare management that will impact the medical field just as much. The full synergistic potential of three interwoven technologies: (1) compact electronics, (2) World Wide Web, and (3) Artificial Intelligence is yet to be realized. The system presented in this paper integrates these technologies synergistically, providing a new paradigm for healthcare. Our idea is to deploy internet-enabled, intelligent, handheld personal computers for medical diagnosis. The salient features of the 'Personal Bio-Monitor' we envisage are: (1) Utilization of the peripheral signals of the body which may be acquired non-invasively and with ease, for diagnosis of medical conditions; (2) An Artificial Neural Network (ANN) based approach for diagnosis; (3) Configuration of the diagnostic device as a handheld for personal use; (4) Internet connectivity, following the emerging bluetooth protocol, for prompt conveyance of information to a patient's health care provider via the World Wide Web. The proposal is substantiated with an intelligent handheld device developed by the investigators for pediatric cardiac auscultation. This device performed accurate diagnoses of cardiac abnormalities in pediatrics using an artificial neural network to process heart sounds acquired by a low-frequency microphone and transmitted its diagnosis to a desktop PC via infrared. The idea of the personal biomonitor presented here has the potential to streamline healthcare by optimizing two valuable resources: physicians' time and sophisticated equipment time. We show that the elements of such a system are in place, with our prototype. Our novel contribution is the synergistic integration of compact electronics' technology, artificial neural network methodology and the wireless web resulting in a revolutionary new paradigm for healthcare management.

Adolescent↗

Recognizing names in biomedical texts: a machine learning approach.

MOTIVATION: With an overwhelming amount of textual information in molecular biology and biomedicine, there is a need for effective and efficient literature mining and knowledge discovery that can help biologists to gather and make use of the knowledge encoded in text documents. In order to make organized and structured information available, automatically recognizing biomedical entity names becomes critical and is important for information retrieval, information extraction and automated knowledge acquisition. RESULTS: In this paper, we present a named entity recognition system in the biomedical domain, called PowerBioNE. In order to deal with the special phenomena of naming conventions in the biomedical domain, we propose various evidential features: (1) word formation pattern; (2) morphological pattern, such as prefix and suffix; (3) part-of-speech; (4) head noun trigger; (5) special verb trigger and (6) name alias feature. All the features are integrated effectively and efficiently through a hidden Markov model (HMM) and a HMM-based named entity recognizer. In addition, a k-Nearest Neighbor (k-NN) algorithm is proposed to resolve the data sparseness problem in our system. Finally, we present a pattern-based post-processing to automatically extract rules from the training data to deal with the cascaded entity name phenomenon. From our best knowledge, PowerBioNE is the first system which deals with the cascaded entity name phenomenon. Evaluation shows that our system achieves the F-measure of 66.6 and 62.2 on the 23 classes of GENIA V3.0 and V1.1, respectively. In particular, our system achieves the F-measure of 75.8 on the "protein" class of GENIA V3.0. For comparison, our system outperforms the best published result by 7.8 on GENIA V1.1, without help of any dictionaries. It also shows that our HMM and the k-NN algorithm outperform other models, such as back-off HMM, linear interpolated HMM, support vector machines, C4.5, C4.5 rules and RIPPER, by effectively capturing the local context dependency and resolving the data sparseness problem. Moreover, evaluation on GENIA V3.0 shows that the post-processing for the cascaded entity name phenomenon improves the F-measure by 3.9. Finally, error analysis shows that about half of the errors are caused by the strict annotation scheme and the annotation inconsistency in the GENIA corpus. This suggests that our system achieves an acceptable F-measure of 83.6 on the 23 classes of GENIA V3.0 and in particular 86.2 on the "protein" class, without help of any dictionaries. We think that a F-measure of 90 on the 23 classes of GENIA V3.0 and in particular 92 on the "protein" class, can be achieved through refining of the annotation scheme in the GENIA corpus, such as flexible annotation scheme and annotation consistency, and inclusion of a reasonable biomedical dictionary. AVAILABILITY: A demo system is available at http://textmining.i2r.a-star.edu.sg/NLS/demo.htm. Technology license is available upon the bilateral agreement.

Abstracting and Indexing↗

Equilibration and cognition: a review and elaboration of Piaget's genetic epistemology.

Piaget's concept of equilibration--and its current status--has been briefly reviewed. Two fundamental and essentially related issues were identified: the question of conformity between cognitive structures and their referent external reality and, from a cognitive viewpoint, the description of a "growing self-regulatory adaptive system." These issues were reconsidered in relation to, and elaborated on the basis of, relevant ideas mainly from philosophy, cybernetics, and artificial intelligence. A model of a cognitive homeostatic system was developed from an innate subsystem to a learning-based control hierarchy that additionally involves a naturomorphic cognitive subsystem and an abstract cognitive subsystem. The process of equilibration of cognitive structures was approached in terms of the information processing characteristics of these two cognitive subsystems and their inherent sources of error, and the theoretical requirements for ensuring conformity between cognitive structures and their external referents have been indicated. The model, which takes into account these requirements, constitutes a systematic description of a learning based "growing self-regulating adaptive system."

Cognition↗

Computerized radiographic mass detection--part II: Decision support by featured database visualization and modular neural networks.

Based on the enhanced segmentation of suspicious mass areas, further development of computer-assisted mass detection may be decomposed into three distinctive machine learning tasks: 1) construction of the featured knowledge database; 2) mapping of the classified and/or unclassified data points in the database; and 3) development of an intelligent user interface. A decision support system may then be constructed as a complementary machine observer that should enhance the radiologists performance in mass detection. We adopt a mathematical feature extraction procedure to construct the featured knowledge database from all the suspicious mass sites localized by the enhanced segmentation. The optimal mapping of the data points is then obtained by learning the generalized normal mixtures and decision boundaries, where a is developed to carry out both soft and hard clustering. A visual explanation of the decision making is further invented as a decision support, based on an interactive visualization hierarchy through the probabilistic principal component projections of the knowledge database and the localized optimal displays of the retrieved raw data. A prototype system is developed and pilot tested to demonstrate the applicability of this framework to mammographic mass detection.

Artificial Intelligence↗

A multi-agent system architecture for geographic information gathering.

World Wide Web (WWW) is a vast repository of information, including a great deal of geographic information. But the location and retrieval of geographic information will require a significant amount of time and effort. In addition, different users usually have different views and interests in the same information. To resolve such problems, this paper first proposed a model of geographic information gathering based on multi-Agent (MA) architecture. Then based on this model, we construct a prototype system with GML (Geography Markup Language). This system consists of three tiers-Client, Web Server and Data Resource. Finally, we expatiate on the process of Web Server.

Algorithms↗

Data mining and structuring of executable data analysis reports: guideline development and implementation in a narrow sense.

In this paper we present a data mining scenario that supports development of automated web-based documentation of data analysis for diagnosis and treatment. The documents can be seen as guidelines in a narrow sense, and are designed to include executable modules for the corresponding decision support systems. Our aim is to discuss the possibilities of identifying certain types of diagnoses and treatments for which guidelines can be generated and computerised more systematically.

Artificial Intelligence↗

"Desktop knowledge": a new focus for medical education and decision support.

Physicians today are faced with "data overload" and, paradoxically, "information underload"--the inability to locate pertinent, needed knowledge in a sea of data with which they are inundated. Increasingly, the professional functions of the physician are becoming focused on the desktop workstation, in terms of its ability to provide "windows" into local databases and knowledge resources, and to serve as an access port to other networked resources. A challenge we now face is to develop means for structuring the vast potentially available knowledge resources in such a manner that access to pertinent knowledge can be facilitated, and to develop acceptable interfaces to the knowledge resources so that a user can effectively navigate through them. The complexity of this task is due to the nature of the knowledge resources--knowledge can be in a variety of forms, ranging from textual and pictorial material, to structured representations, to more dynamic embodiments in the form of procedures. In the Decision Systems Group we have focused on the development of a prototype desktop knowledge management environment known as Explorer-2, with the objective of providing a consistent interface for access to a wide variety of knowledge. Our accomplishments to date encompass the incorporation into the Explorer-2 environment of adaptations of textbook chapters and books, image data bases, simulations, and expert systems. Navigational aids are provided by a semantic net browser using both MeSH and augmented taxonomies and by a graphical overview map.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗

The principles and prototyping of a knowledge-based diabetes management system.

This paper describes the principles and prototyping of a computer-based system being developed to assist in the management of diabetes mellitus. Unlike other approaches based upon mathematical modelling or the use of computer algorithms, this system adopts one derived from artificial intelligence, seeking to incorporate the dynamics of glucose and insulin in a manner which reflects their clinical importance. The resultant logical model (qualitative algebra) defines the relationships between changes in insulin dose and site and time of injection and glycaemic response. In this manner the computer-based system, implemented in Prolog, can be used to provide advice concerning insulin therapy by means of making qualitative predictions of patient outcome of blood glucose profile resulting from alternative insulin regimens.

Blood Glucose↗

Issues in the development of an industrial bioprocess advisory system.

The background and motivation for the construction of a fault detection and advisory system for an industrial fermentation process plant are described. Here, the knowledge extracted from the operators (implemented in the form of production rules) is integrated with multivariate data-based methods for fault detection. The industrial benefits arising from this integrated system include: (1) reduced variability, (2) increased mean performance levels, (3) reduced operator-training time and (4) knowledge management in the broader organization.

Algorithms↗

MedKit: a helper toolkit for automatic mining of MEDLINE/PubMed citations.

UNLABELLED: MEDLINE/PubMed is one of the most important information sources for bioinformatics text mining. However, there remain limitations in working with MEDLINE/PubMed citations. For example, PubMed imposes an upper limit of 10,000 for downloading PMID list or citations; and MEDLINE files are too large for most off-the-shelf XML parsers. We developed a Java package, MedKit, to work-around the limitations, as well as provide other useful functionalities, e.g. random sampling. Its four modules (querier, sampler, fetcher and parser) can work independently, or be pipelined in various combinations. It can be used as a stand-alone GUI application, or integrated into other text-mining systems. Text mining researchers and others may download and use the toolkit free for non-commercial purposes. AVAILABILITY: http://metnetdb.gdcb.iastate.edu/medkit CONTACT: berleant@iastate.edu.

Abstracting and Indexing↗

Text similarity: an alternative way to search MEDLINE.

MOTIVATION: The most widely used literature search techniques, such as those offered by NCBI's PubMed system, require significant effort on the part of the searcher, and inexperienced searchers do not use these systems as effectively as experienced users. Improved literature search engines can save researchers time and effort by making it easier to locate the most important and relevant literature. RESULTS: We have created and optimized a new, hybrid search system for Medline that takes natural text as input and then delivers results with high precision and recall. The combination of a fast, low-sensitivity weighted keyword-based first pass algorithm to cast a wide net to gather an initial set of literature, followed by a unique sentence-alignment based similarity algorithm to rank order those results was developed that is sensitive, fast and easy to use. Several text similarity search algorithms, both standard and novel, were implemented and tested in order to determine which obtained the best results in information retrieval exercises. AVAILABILITY: Literature searching algorithms are implemented in a system called eTBLAST, freely accessible over the web at http://invention.swmed.edu. A variety of other derivative systems and visualization tools provides the user with an enhanced experience and additional capabilities. CONTACT: Harold.Garner@UTSouthwestern.edu.

Abstracting and Indexing↗

Spectral feature enhancement for people with sensorineural hearing impairment: effects on speech intelligibility and quality.

People with sensorineural hearing loss often have difficulty understanding speech in background noise at speech-to-noise ratios (0 to +6 dB) for which normally hearing people have little difficulty. Spectral analysis of speech in noise at these ratios typically shows that the major spectral prominences in the speech (formants) are well represented, but the spectral valleys between the formants are filled with noise. Hearing impaired people have a reduced ability to pick out the spectral prominences, and are more affected by the noise filling in the valleys, partly because of their reduced frequency selectivity. This paper describes a 16-channel bandpass filter bank, implemented in analog electronics, that attempts to enhance spectral features of speech in noise to improve intelligibility for the hearing impaired. Each channel generates an 'activity function' that is proportional to the magnitude of the signal envelope in that channel, averaged over a short period of time. A positively weighted activity function from the nth channel is combined with negatively weighted functions from channels n-2, n-1, n+1, and n+2, giving a correction signal used to control the gain of the bandpass signal in the nth channel. Recombining the bandpass signals results in an enhancement of spectral features of the speech in noise. Two different experiments are described here, one using the activity function as described, and the other using a non-linear transform of the activity function. In both experiments, several different weighting patterns were used in calculating the correction signal. The intelligibility of speech in noise processed by the system was measured for subjects with moderate sensorineural hearing loss. In both experiments, no improvement in intelligibility was found. However, subjective ratings of the stimuli used in Experiment 2 indicated that some subjects judged the processed stimuli to have both higher quality and higher intelligibility than unprocessed stimuli.

Electronics↗