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Ovarian cancer diagnosis by hippocampus and neocortex-inspired learning memory structures.

Early detection and accurate staging of ovarian cancer are the keys to improving survival rate. However, at present there is no single diagnosis modality that is sufficiently sensitive. DNA microarray analysis is an emerging technique that has potential for ameliorating the hardship in early detection and staging of ovarian disease. However, microarray data is ultra-huge and difficult to analyze. Hence, computational intelligence methods are often utilized to assist in the diagnosis and analysis process. Fuzzy Neural Networks (FNN) are more suitable for this task as FNN provides not only the accuracy, but also the interpretability of its reasoning process. Hippocampus-inspired Complementary Learning FNN (CLFNN) is able to rapidly derive fuzzy sets and formulate fuzzy rules. CLFNN uses positive and negative learning, and hence it reduces the effect of the curse of dimensionality and is capable of modeling the dynamics of the problem space with relatively good classification performance. One of its successors, a hybrid of complementary hippocampal learning and associative neocortical learning called Pseudo Associative Complementary Learning (PACL), is a structure that seeks to functionally model the memory consolidation process. Both PACL and CLFNN have human-like reasoning that allows physicians to examine their computation using familiar terms. They can construct intuitive fuzzy rules autonomously to justify their reasoning, which is important to generate trust among the users. Hence, CLFNN and PACL are applied as a diagnostic decision support system in ovarian cancer diagnosis. The experimental results are encouraging.

Algorithms↗

Intelligence and musical improvisation.

We investigated whether somebody with a severe mental impairment could not only remember and reproduce music, but was also able to generate it. Musical improvisation requires the ability to recognize constraints and also demands inventiveness. Musical improvisations on a traditional, tonal and also on a whole tone scale composition were produced by a mentally handicapped and by a normal control musician. It was found that not only the control but also the handicapped subject could improvise appropriately within structural constraints, although with the tonal music the idiot-savant showed some stylistic latitude. It is concluded that cognitive processes such as musical input analysis, decision making, and output monitoring are independent of general intellectual status.

Adult↗

Methodology of management of dredging operations II. Applications.

This paper presents the new methodology of management of dredging operations. Derived partly from existing methodologies (OECD, PNUE, AIPCN), it aims to be more comprehensive, mixing the qualities and the complementarities of previous methodologies. The application of the methodology has been carried out on the site of the Port of Dunkirk (FRANCE). Thus, a characterization of the sediments of this site has allowed a zoning of the Port to be established in to zones of probable homogeneity of sediments. Moreover, sources of pollution have been identified, with an aim of prevention. Ways of waste improvement have also been developed, to answer regional needs, from a point of view of competitive and territorial intelligence. Their development has required a mutualisation of resources between professionals, research centres and local communities, according to principles of industrial ecology. Lastly, a tool of MultiCriteria Decision-Making Aid (M.C.D.M.A.) has been used to determine the most relevant scenario (or alternative, or action) for a dredging operation intended by the Port of Dunkirk. These applications have confirmed the relevance of this methodology for the management of dredging operations.

Algorithms↗

Issues in the definition and diagnosis of learning disabilities: a perspective on Guckenberger v. Boston University.

This article reviews issues related to the definition of learning disabilities in the context of the Guckenberger v. Boston University case. Four major questions are addressed: (a) Who is learning disabled? (b) How should learning disabilities be assessed? (c) Who is qualified to make a decision about whether or not an individual has a learning disability? and (d) What accommodations should be provided by a postsecondary institution and how should they be selected? Although these are complicated and difficult questions, it is possible to develop a simple, reasonable classification system for learning disabilities, and to conduct assessments based on a coherent and relevant set of achievement tests in which individuals who score below a cutoff are considered learning disabled. Scores on IQ tests are irrelevant and not useful and may even be discriminatory. The issues of decision making regarding learning disabilities and appropriate accommodations remain significant dilemmas for the field; resolution of these issues seems virtually impossible without agreement on appropriate procedures for the definition, identification, and assessment of learning disabilities.

Adult↗

Contraceptive management for female adolescents with mental retardation and handicapping disabilities.

Adolescent girls with mental retardation and handicapping disabilities have a need for sexual counseling and contraceptive management. Societal attitudes have changed, allowing these patients to experience normal and satisfying sexuality. The reproductive health concerns of these patients are extensive. Contraceptive selection varies with regard to the mental and physical capabilities of individual patients. The use of barrier methods, intrauterine devices, oral contraceptives, intramuscular medroxyprogesterone acetate, and sterilization has been discussed thoroughly in the past. No formal studies have been performed to evaluate the use of subdermal levonorgestrel implants in patients with mental retardation and physical disabilities.

Adolescent↗

Family life education needs of mentally disabled adolescents.

This study identifies the family life education needs of minimally and mildly mentally disabled adolescents as a basis for curriculum development. Respondents were 134 students from 11 school districts in a midwestern state. Through the administration of 50 needs statements, they were asked to indicate the magnitude of need and the extent to which the need was being met. Special education teachers were allowed to assist in reading or interpreting the directions and needs statements. Priority need statements--those with a high need score which were not being met--are related to the decision to parent, careers and work, marriage and parenthood, decision making and goal setting, and resource management. Six clusters or groups of family life education needs were identified: Basic Nutrition, Teenage Pregnancy, Sex Education, Developmental Tasks of Adolescents, Marriage and Parenthood, and Planning and Decision Making. Females reported significantly greater need for information on nutrition, teenage pregnancy, and marriage and parenthood.

Adolescent↗

Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability.

At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline and the presence of silent or sinusoidal pattern (87-94% on an arbitrary 0-100% scale), and low regarding the assessment of variability and type of deceleration (50-72%). The degree of agreement in interpreting heart rate patterns was 59% (on an arbitrary 0-100% scale). Senior residents generally interpreted the changes as indicative of less serious fetal stress than did their junior colleagues, explaining why junior residents 30% more frequently than their older colleagues found an indication for Cesarean section. Relatively low regional inter-observer agreement scores were primarily due to low agreement between departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising prospect.

Cesarean Section↗

AutoNR: an automated system that measures ECAP thresholds with the Nucleus Freedom cochlear implant via machine intelligence.

OBJECTIVE: AutoNRT is an automated system that measures electrically evoked compound action potential (ECAP) thresholds from the auditory nerve with the Nucleus Freedom cochlear implant. ECAP thresholds along the electrode array are useful in objectively fitting cochlear implant systems for individual use. This paper provides the first detailed description of the AutoNRT algorithm and its expert systems, and reports the clinical success of AutoNRT to date. METHODS: AutoNRT determines thresholds by visual detection, using two decision tree expert systems that automatically recognise ECAPs. The expert systems are guided by a dataset of 5393 neural response measurements. The algorithm approaches threshold from lower stimulus levels, ensuring recipient safety during postoperative measurements. Intraoperative measurements use the same algorithm but proceed faster by beginning at stimulus levels much closer to threshold. When searching for ECAPs, AutoNRT uses a highly specific expert system (specificity of 99% during training, 96% during testing; sensitivity of 91% during training, 89% during testing). Once ECAPs are established, AutoNRT uses an unbiased expert system to determine an accurate threshold. Throughout the execution of the algorithm, recording parameters (such as implant amplifier gain) are automatically optimised when needed. RESULTS: In a study that included 29 intraoperative and 29 postoperative subjects (a total of 418 electrodes), AutoNRT determined a threshold in 93% of cases where a human expert also determined a threshold. When compared to the median threshold of multiple human observers on 77 randomly selected electrodes, AutoNRT performed as accurately as the 'average' clinician. CONCLUSIONS: AutoNRT has demonstrated a high success rate and a level of performance that is comparable with human experts. It has been used in many clinics worldwide throughout the clinical trial and commercial launch of Nucleus Custom Sound Suite, significantly streamlining the clinical procedures associated with cochlear implant use.

Algorithms↗

An interim determination of health gain from oral cancer and precancer screening: 3. Preselecting high risk individuals.

OBJECTIVE: To perform a sensitivity analysis using a decision model for simulating opportunistic screening for oral cancer and precancer in order to obtain an estimate of health gain from screening high risk dental patients, identified with the aid of artificial intelligence. DESIGN: A hypothetical opportunistic screening programme based on preselection of high risk patients was compared with screening all eligible patients and with a 'do nothing' scenario. The basic assumptions and data used in the model have been described previously. SETTING: Screening would be carried out in dental practices. PARTICIPANTS: A notional population of 100,000 adults of average age 55 years and 20 years life expectancy. INTERVENTIONS: Systematic clinical examination of the oral mucosa of high risk individuals identified by artificial intelligence on the basis of personal characteristics and life style. OUTCOME MEASURES: QALYs and equivalent lives saved RESULTS: The following estimates of health gain were obtained: the preselected screened group (n = 25,000) would achieve 1,993,294 QALYs. Without preselection, screening an unselected population of 100,000 eligible adults would result in 1,993,094 QALYs. Under the 'do nothing' scenario, 100,000 unscreened individuals would achieve 1,992,982 QALYs. Selective screening could avoid the equivalent of 15 deaths per 100,000 subjects examined. Screening preselected subjects at heightened risk would save the equivalent of two to three times the number of healthy lives compared with non-selective screening. Only one quarter of the population would need to be examined. CONCLUSIONS: Opportunistic screening of preselected dental patients for oral cancer and precancer appears to be a promising health promotion strategy and should be subject to formal economic appraisal.

Cost-Benefit Analysis↗

Nontracheoesphageal speech rehabilitation.

Numerous noninvasive methods exist for successful voice rehabilitation following total laryngectomy. In addition to surgical voice restoration, practitioners caring for laryngectomee patients should understand the esophageal speech methods and the available electronic devices, so informed decisions can be made on individualized needs and abilities.

Articulation Disorders↗

Distance based algorithms for small biomolecule classification and structural similarity search.

MOTIVATION: Structural similarity search among small molecules is a standard tool used in molecular classification and in-silico drug discovery. The effectiveness of this general approach depends on how well the following problems are addressed. The notion of similarity should be chosen for providing the highest level of discrimination of compounds wrt the bioactivity of interest. The data structure for performing search should be very efficient as the molecular databases of interest include several millions of compounds. RESULTS: In this paper we focus on the k-nearest-neighbor search method, which, until recently was not considered for small molecule classification. The few recent applications of k-nn to compound classification focus on selecting the most relevant set of chemical descriptors which are then compared under standard Minkowski distance L(p). Here we show how to computationally design the optimal weighted Minkowski distance wL(p) for maximizing the discrimination between active and inactive compounds wrt bioactivities of interest. We then show how to construct pruning based k-nn search data structures for any wL(p) distance that minimizes similarity search time. The accuracy achieved by our classifier is better than the alternative LDA and MLR approaches and is comparable to the ANN methods. In terms of running time, our classifier is considerably faster than the ANN approach especially when large data sets are used. Furthermore, our classifier quantifies the level of bioactivity rather than returning a binary decision and thus is more informative than the ANN approach.

Algorithms↗

Automatically identifying health outcome information in MEDLINE records.

OBJECTIVE: Understanding the effect of a given intervention on the patient's health outcome is one of the key elements in providing optimal patient care. This study presents a methodology for automatic identification of outcomes-related information in medical text and evaluates its potential in satisfying clinical information needs related to health care outcomes. DESIGN: An annotation scheme based on an evidence-based medicine model for critical appraisal of evidence was developed and used to annotate 633 MEDLINE citations. Textual, structural, and meta-information features essential to outcome identification were learned from the created collection and used to develop an automatic system. Accuracy of automatic outcome identification was assessed in an intrinsic evaluation and in an extrinsic evaluation, in which ranking of MEDLINE search results obtained using PubMed Clinical Queries relied on identified outcome statements. MEASUREMENTS: The accuracy and positive predictive value of outcome identification were calculated. Effectiveness of the outcome-based ranking was measured using mean average precision and precision at rank 10. RESULTS: Automatic outcome identification achieved 88% to 93% accuracy. The positive predictive value of individual sentences identified as outcomes ranged from 30% to 37%. Outcome-based ranking improved retrieval accuracy, tripling mean average precision and achieving 389% improvement in precision at rank 10. CONCLUSION: Preliminary results in outcome-based document ranking show potential validity of the evidence-based medicine-model approach in timely delivery of information critical to clinical decision support at the point of service.

Artificial Intelligence↗

A framework for intelligent visualization of multiple time-oriented medical records.

Management of patients, especially chronic patients, requires presentation and processing of very large amounts of time-oriented clinical data. Using regular means such as text or tables is often ineffective, thus we propose to use the visual presentation of the information in decision support, especially in the medical domain. Displaying only raw data is not sufficient, because it still requires the user to derive meaningful conclusions from large amount of data. In order to support the computation process, we provide automated mechanisms for temporal abstraction. These mechanisms perform derivation of context-specific, interval-based abstract concepts from raw time-stamped clinical data, by using a domain-specific knowledge base. Then, these abstractions can be visualized and explored. In addition, in many cases (e.g. when comparing the effect of new drugs on various groups of patients) a view of multiple records is more effective than a view of each indi-vidual record separately. We have designed and implemented a system called VISITORS (VisualizatIon of Time-Oriented RecordS) which includes several tools for intelligent visualization and exploration of raw data and abstracted concepts for multiple patient records.

Abstracting and Indexing↗