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Health-2000: an integrated large-scale expert system for the hospital of the future.

Decision making and management are problems which plague health systems in developing countries, particularly in Sub-Saharan Africa where there is significant waste of resources. The need goes beyond national health management information systems, to tools required in daily micro-management of various components of the health system. This paper describes an integrated expert system, Health-2000, an information-oriented tool for acquiring, processing and disseminating medical knowledge, data and decisions in the hospital of the future. It integrates six essential features of the medical care environment: personnel management, patient management, medical diagnosis, laboratory management, propharmacy, and equipment management. Disease conditions covered are the major tropical diseases. An intelligent tutoring feature completes the package. Emphasis is placed on the graphical user interface to facilitate interactions between the user and the system, which is developed for PCs using Pascal, C, Clipper and Prolog.

Expert Systems↗

Recognizing spoken words: the neighborhood activation model.

OBJECTIVE: A fundamental problem in the study of human spoken word recognition concerns the structural relations among the sound patterns of words in memory and the effects these relations have on spoken word recognition. In the present investigation, computational and experimental methods were employed to address a number of fundamental issues related to the representation and structural organization of spoken words in the mental lexicon and to lay the groundwork for a model of spoken word recognition. DESIGN: Using a computerized lexicon consisting of transcriptions of 20,000 words, similarity neighborhoods for each of the transcriptions were computed. Among the variables of interest in the computation of the similarity neighborhoods were: 1) the number of words occurring in a neighborhood, 2) the degree of phonetic similarity among the words, and 3) the frequencies of occurrence of the words in the language. The effects of these variables on auditory word recognition were examined in a series of behavioral experiments employing three experimental paradigms: perceptual identification of words in noise, auditory lexical decision, and auditory word naming. RESULTS: The results of each of these experiments demonstrated that the number and nature of words in a similarity neighborhood affect the speed and accuracy of word recognition. A neighborhood probability rule was developed that adequately predicted identification performance. This rule, based on Luce's (1959) choice rule, combines stimulus word intelligibility, neighborhood confusability, and frequency into a single expression. Based on this rule, a model of auditory word recognition, the neighborhood activation model, was proposed. This model describes the effects of similarity neighborhood structure on the process of discriminating among the acoustic-phonetic representations of words in memory. The results of these experiments have important implications for current conceptions of auditory word recognition in normal and hearing impaired populations of children and adults.

Adult↗

ICOHR: intelligent computer based oral health record.

The majority of work on computer use in the dental field has focused on non-clinical practice management information needs. Very few computer-based dental information systems provide management support of the clinical care process, particularly with respect to quality management. Traditional quality assurance methods rely on the paper record and provide only retrospective analysis. Today, proactive quality management initiatives are on the rise. Computer-based dental information systems are being integrated into the care environment, actively providing decision support as patient care is being delivered. These new systems emphasize assessment and improvement of patient care at the time of treatment, thus building internal quality management into the caregiving process. The integration of real time quality management and patient care will be expedited by the introduction of an information system architecture that emulates the gathering and storage of clinical care data currently provided by the paper record. As a proposed solution to the problems associated with existing dental record systems, the computer-based patient record has emerged as a possible alternative to the paper dental record. The Institute of Medicine (IOM) recently conducted a study on improving the efficiency and accuracy of patient record keeping. As a result of this study, the IOM advocates the development and implementation of computer-based patient records as the standard for all patient care records. This project represents the ongoing efforts of The University of Iowa College of Dentistry's collaboration with the University of Uppsala Data Center, Uppsala, Sweden, on a computer-based patient dental record model. ICOHR (Intelligent Computer Based Oral Health Record) is an information system which brings together five important parts of the patient's dental record: medical and dental history; oral status; treatment planning; progress notes; and a Patient Care Database, generated from their clinical care information (the database is also stored in the ICOHR). ICOHR is designed to be integrated into a traditional practice management system. The components of the ICOHR system support the use of various types of clinical care quality management tools, including medical alerts, clinical care guidelines, care modifiers, and diagnostic decision support. Data input is multimodal, so the user may use both voice recognition and direct input with a digitizer board to enter information into the database. ICOHR is designed to be integrated into the clinical environment in an ergonomic fashion in order to facilitate the unobtrusive and efficient acquisition of patient information. ICOHR is currently under clinical evaluation in both private practice and institutional environments. The private practice is a large general dentistry practice with over twenty sites scattered throughout a large metropolitan area. The institutional settings are a College of Dentistry and a Hospital Dentistry program. The evaluations have started in two of the sites and the other site will be phased in during the next six months. Our demonstration of the system will include both prepared presentations of the system's various functions and provide an opportunity for hands-on use of the system for interested attendees.

Artificial Intelligence↗

Insect walking is based on a decentralized architecture revealing a simple and robust controller.

Control of walking in rugged terrain requires one to incorporate different issues, such as the mechanical properties of legs and muscles, the neuronal control structures for the single leg, the mechanics and neuronal control structures for the coordination between legs, as well as central decisions that are based on external information and on internal states. Walking in predictable environments and fast running, to a large degree, rely on muscle mechanics. Conversely, slow walking in unpredictable terrain, e.g. climbing in rugged structures, has to rely on neuronal systems that monitor and intelligently react to specific properties of the environment. An arthropod model system that shows the latter abilities is the stick insect, based on which this review will be focused. An insect, when moving its six legs, has to control 18 joints, three per leg, and therefore has to control 18 degrees of freedom (d.f.). As the body position in space is determined by 6 d.f. only, there are 12 d.f. open to be selected. Therefore, a fundamental problem is as to how these extra d.f. are controlled. Based mainly on behavioural experiments and simulation studies, but also including neurophysiological results, the following control structures have been revealed. Legs act as basically independent systems. The quasi-rhythmic movement of the individual leg can be described to result from a structure that exploits mechanical coupling of the legs via the ground and the body. Furthermore, neuronally mediated influences act locally between neighbouring legs, leading to the emergence of insect-type gaits. The underlying controller can be described as a free gait controller. Cooperation of the legs being in stance mode is assumed to be based on mechanical coupling plus local positive feedback controllers. These controllers, acting on individual leg joints, transform a passive displacement of a joint into an active movement, generating synergistic assistance reflexes in all mechanically coupled joints. This architecture is summarized in the form of the artificial neural network, Walknet, that is heavily dependent on sensory feedback at the proprioceptive level. Exteroceptive feedback is exploited for global decisions, such as the walking direction and velocity.

Animals↗

Image mining for investigative pathology using optimized feature extraction and data fusion.

In many subspecialties of pathology, the intrinsic complexity of rendering accurate diagnostic decisions is compounded by a lack of definitive criteria for detecting and characterizing diseases and their corresponding histological features. In some cases, there exists a striking disparity between the diagnoses rendered by recognized authorities and those provided by non-experts. We previously reported the development of an Image Guided Decision Support (IGDS) system, which was shown to reliably discriminate among malignant lymphomas and leukemia that are sometimes confused with one another during routine microscopic evaluation. As an extension of those efforts, we report here a web-based intelligent archiving subsystem that can automatically detect, image, and index new cells into distributed ground-truth databases. Systematic experiments showed that through the use of robust texture descriptors and density estimation based fusion the reliability and performance of the governing classifications of the system were improved significantly while simultaneously reducing the dimensionality of the feature space.

Diagnosis, Differential↗

Automated treatment planning engine for prostate seed implant brachytherapy.

PURPOSE: To develop a computer-intelligent planning engine for automated treatment planning and optimization of ultrasound- and template-guided prostate seed implants. METHODS AND MATERIALS: The genetic algorithm was modified to reflect the 2D nature of the implantation template. A multi-objective decision scheme was used to rank competing solutions, taking into account dose uniformity and conformity to the planning target volume (PTV), dose-sparing of the urethra and the rectum, and the sensitivity of the resulting dosimetry to seed misplacement. Optimized treatment plans were evaluated using selected dosimetric quantifiers, dose-volume histogram (DVH), and sensitivity analysis based on simulated seed placement errors. These dosimetric planning components were integrated into the Prostate Implant Planning Engine for Radiotherapy (PIPER). RESULTS: PIPER has been used to produce a variety of plans for prostate seed implants. In general, maximization of the minimum peripheral dose (mPD) for given implanted total source strength tended to produce peripherally weighted seed patterns. Minimization of the urethral dose further reduced the loading in the central region of the PTV. Isodose conformity to the PTV was achieved when the set of objectives did not reflect seed positioning uncertainties; the corresponding optimal plan generally required fewer seeds and higher source strength per seed compared to the manual planning experience. When seed placement uncertainties were introduced into the set of treatment planning objectives, the optimal plan tended to reach a compromise between the preplanned outcome and the likelihood of retaining the preferred outcome after implantation. The reduction in the volatility of such seed configurations optimized under uncertainty was verified by sensitivity studies. CONCLUSION: An automated treatment planning engine incorporating real-time sensitivity analysis was found to be a useful tool in dosimetric planning for prostate brachytherapy.

Algorithms↗

An association rule mining-based methodology for automated detection of ischemic ECG beats.

Currently, an automated methodology based on association rules is presented for the detection of ischemic beats in long duration electrocardiographic (ECG) recordings. The proposed approach consists of three stages. 1) Preprocessing: Noise is removed and all the necessary ECG features are extracted. 2) Discretization: The continuous valued features are transformed to categorical. 3) CLASSIFICATION: An association rule extraction algorithm is utilized and a rule-based classification model is created. According to the proposed methodology, electrocardiogram (ECG) features extracted from the ST segment and the T-wave, as well as the patient's age, were used as inputs. The output was the classification of the beat as ischemic or not. Various algorithms were tested both for discretization and for classification using association rules. To evaluate the methodology, a cardiac beat dataset was constructed using several recordings of the European Society of Cardiology ST-T database. The obtained sensitivity (Se) and specificity (Sp) was 87% and 93%, respectively. The proposed methodology combines high accuracy with the ability to provide interpretation for the decisions made, since it is based on a set of association rules.

Arrhythmias, Cardiac↗

Activity classification using realistic data from wearable sensors.

Automatic classification of everyday activities can be used for promotion of health-enhancing physical activities and a healthier lifestyle. In this paper, methods used for classification of everyday activities like walking, running, and cycling are described. The aim of the study was to find out how to recognize activities, which sensors are useful and what kind of signal processing and classification is required. A large and realistic data library of sensor data was collected. Sixteen test persons took part in the data collection, resulting in approximately 31 h of annotated, 35-channel data recorded in an everyday environment. The test persons carried a set of wearable sensors while performing several activities during the 2-h measurement session. Classification results of three classifiers are shown: custom decision tree, automatically generated decision tree, and artificial neural network. The classification accuracies using leave-one-subject-out cross validation range from 58 to 97% for custom decision tree classifier, from 56 to 97% for automatically generated decision tree, and from 22 to 96% for artificial neural network. Total classification accuracy is 82 % for custom decision tree classifier, 86% for automatically generated decision tree, and 82% for artificial neural network.

Activities of Daily Living↗

Down's syndrome: intellectual and behavioural functioning during adulthood.

Previous cross-sectional studies of Down's syndrome have suggested that deficits in cognitive and neurological functioning after the age of 35 years are symptomatic of Alzheimer's disease. It has been claimed that this pattern corresponds to post-mortem neuropathological findings of Alzheimer's disease in all Down's syndrome patients who die aged over 35 years. In the present study of Down's syndrome patients aged between 19 and 49 years, results showed that, for those over 35 years, intellectual deterioration had occurred in less than a third. No relationship was found between chronological age and the level of self care skills or the presence of disturbed behaviour. Results are discussed in terms of the interpretation of the existing neuropathological literature, the methodology of future studies and clinical decisions regarding hospitalized patients with Down's syndrome.

Activities of Daily Living↗

Early epidemiologic and genomic insights from Sierra Leone's first mpox cases, 2025.

INTRODUCTION: early characterization of outbreak cases supports rapid decisions. We conducted real-time analysis during the initial outbreak phase in mid-March 2025 of Sierra Leone's first 44 laboratory-confirmed Mpox cases (10th January to 5th March 2025) to generate epidemiologic and genomic intelligence for response. METHODS: we summarized surveillance data and sequenced 18 early cases with Oxford Nanopore. Firth-penalized logistic regression was employed to explore risk factors for severe disease. RESULTS: median age was 27 years (interquartile range 22 to 35); 68.2% were male. Most cases reported no recent international travel (95.5%). All cases presented with rash; fever occurred in 72.7%. Six cases (13.6%) met severe criteria; no deaths occurred (0 of 44; 95% confidence interval 0 to 8.0). Household secondary attack rate was 7.3% during the study window and 8.2% after completion of follow-up. Sequencing identified two co-circulating sub-lineages consistent with A.2.2 and B.1.6 and a strong APOBEC3 pattern (142 of 212 guanine-to-adenine in thymine-cytosine versus 70 of 212 cytosine-to-thymine in guanine-adenine; exact binomial p approximately 8.6x10-7; X2= 24.5, df = 1, p≈ 7.6x10-7). Root-to-tip analysis showed weak temporal signal (R2=0.31; date randomization p= 0.18), so we did not interpret clock estimates. CONCLUSION: real-time analysis during the initial outbreak phase showed community transmission, quantified household spread, documented two sub-lineages with an APOBEC3 signature, and generated severity hypotheses that immediately informed surveillance and vaccine prioritization. Findings require validation in larger cohorts.

Adult↗

The Edinburgh cohort of HIV-positive drug users: pattern of cognitive impairment in relation to progression of disease.

To examine the neuropsychiatric effects of infection with HIV, 220 drug users (27 HIV negative, 193 HIV positive) completed tests evaluating premorbid intelligence, memory, non-verbal performance, information processing speed, and mood. When these measures were compared cross-sectionally by the severity of HIV illness, symptomatic patients (in CDC stage IV) were impaired on Trails B, two-choice decision time, delayed recall of the Wechsler Logical Memory Test and most components of the Auditory Verbal Learning Test. These findings imply reduced capacity for concentration, speed of thought and memory. When 101 patients were retested a mean of 16 months after their initial assessment, performance on Trails A and B, Block Design and delayed recall of the Wechsler Logical Memory Test deteriorated more for patients at, or progressing within, CDC stage IV, than performance of patients at stage III. The results broadly correspond to the cross-sectional findings. However, there was a decline in all tests of memory function for the sample independent of clinical staging. This may be evidence of brain involvement before the appearance of other symptoms. Self-rated measures of mood did not change cross-sectionally, progressively, or interactively with time and stage of HIV illness, and cannot account for the changes in cognitive function observed. Change in drug use, similarly, does not account for the cognitive findings. Four (5%) of the retested subjects developed AIDS dementia complex, but most of the performance and memory impairments seen were subclinical despite the destructive neuropathology presumed to underlie intellectual decline in patients with HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS Dementia Complex↗

How do experts recognize schizophrenia: the role of the disorganization symptom.

OBJECTIVE: Research on clinical reasoning has been useful in developing expert systems. These tools are based on Artificial Intelligence techniques which assist the physician in the diagnosis of complex diseases. The development of these systems is based on a cognitive model extracted through the identification of the clinical reasoning patterns applied by experts within the clinical decision-making context. This study describes the method of knowledge acquisition for the identification of the triggering symptoms used in the reasoning of three experts for the diagnosis of schizophrenia. METHOD: Three experts on schizophrenia, from two University centers in Sao Paulo, were interviewed and asked to identify and to represent the triggering symptoms for the diagnosis of schizophrenia according to the graph methodology. RESULTS: Graph methodology showed a remarkable disagreement on how the three experts established their diagnosis of schizophrenia. They differed in their choice of triggering-symptoms for the diagnosis of schizophrenia: disorganization, blunted affect and thought disturbances. CONCLUSIONS: The results indicate substantial differences between the experts as to their diagnostic reasoning patterns, probably under the influence of different theoretical tendencies. The disorganization symptom was considered to be the more appropriate to represent the heterogeneity of schizophrenia and also, to further develop an expert system for the diagnosis of schizophrenia.

Decision Support Systems, Clinical↗

[Expert systems in pulmonology].

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advices to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process++ etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, education, managing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. In this paper we presented several expert systems which are actually used in practice, especially in internal disciplines: Internist, Mycin, Onkocyn, DXplain.

Expert Systems↗

[Progress in knowledge-based X-ray fluorescence spectrometry].

The review focuses on the expert systems and knowledge engineering in X-ray fluorescence spectrometry. It includes mainly a knowledge-controlled strategy combining the scan-based method with the fixed channel measurements, a XRF interpretation system of spectra with fuzzy logic and pattern recognition, and an expert system for qualitative interpretation of XRF spectra using a certainty factor. In the review, a series of the studies of exploring the knowledge engineering system in XRF are also included, which consists of four parts, i.e. spectra identification, pattern recognition with decision-making, quantitative determination combined with the theoretical alpha coefficients and neural networks, and XRF analysis without standards.

Algorithms↗

Multiparameter trend monitoring and intelligent displays using wavelet analysis.

An Intelligent Patient Monitoring (IPM) framework is defined for the analysis and display of multiparameter trends from ICU patients. Wavelet analysis was utilized for detection of physiological events and artifacts in long-term trends. A group of 58 patients from the MIMIC database were identified in which the heart rate (HR), arterial blood pressure (ABP), and pulmonary artery pressure (PAP) were monitored. An estimated cardiac output (CO) signal, using HR and ABP, was shown to correlate strongly (r=.67) with actual CO measurements. Using wavelet analysis, automated artifact and physiological event detection algorithms were developed to monitor left ventricular hemodynamic function. Finally, an intelligent display system is presented for presentation of the data in ICU monitors.

Algorithms↗

How reliable is computerized assessment of readability?

To assess the consistency and comparability of readability software programs, four software programs (Corporate Voice, Grammatix IV, Microsoft Word for Windows, and RightWriter) were compared. Standard materials included 28 pieces of printed educational materials on human immunodeficiency virus/acquired immunodeficiency syndrome distributed nationally and the Gettysburg Address. Statistical analyses for the educational materials revealed that each of the three formulas assessed (Flesch-Kincaid, Flesch Reading Ease, and Gunning Fog Index) provided significantly different grade equivalent scores and that the Microsoft Word program provided significantly lower grade levels and was more inconsistent in the scores provided. For the Gettysburg Address, considerable variation was revealed among formulas, with the discrepancy being up to two grade levels. When averaging across formulas, there was a variation of 1.3 grade levels between the four software programs. Given the variation between formulas and programs, implications for decisions based on results of these software programs are provided.

Analysis of Variance↗

[Medical expert systems].

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advice to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, self-education, directing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. Though, expert systems also have certain bad features: primarily, they are not physicians i.e. they can not examine a patient. Furthermore, expert system that is good for one certain area is often not good for another one. There are some cases, when these systems can confuse a physician and make him to make a wrong decision. This occurs very often in two specific cases: when the clinical situation is urgent; and when accuracy of clinical information is not definite.

Expert Systems↗

Computer-assisted diagnosis system in digestive endoscopy.

The purpose of this paper is to present an intelligent atlas of indexed endoscopic lesions that could be used in computer-assisted diagnosis as reference data. The development of such a system requires a mix of medical and engineering skills for analyzing and reproducing the cognitive processes that underlie the medical decision-making process. The analysis of both endoscopists experience and endoscopic terminologies developed by professional associations shows that diagnostic reasoning in digestive endoscopy uses a scene-object approach. The objects correspond to the endoscopic findings and the medical context of examination and the scene to the endoscopic diagnosis. According to expert assessment, the classes of endoscopic findings and diagnoses, their primitive characteristics (or indices), and their relationships have been listed. Each class describes an endoscopic finding or diagnosis in an intensive way. The retrieval method is based on a similarity metric that estimates the membership value of the case under investigation and the prototype of the class. A simulation test with randomized objects demonstrates a good classification of endoscopic findings. The correct class is the unique response in 68% of the tested objects, the first of multiple responses in 28%. Four descriptors are shown to be of major importance in the classification algorithm: anatomic location, shape, color, and relief. At the present time, the application database contains approximately 150 endoscopic images and is accessible via Internet. Experiments are in progress with endoscopists for the validation of the system and for the understanding of the similarity between images. The next step will integrate the system in a learning tool for junior endoscopists.

Algorithms↗