[Report of the status and presentation of knowledge sources. Infections in pregnant women, fetuses and newborn infants].
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This report examines the semantic structure of Terminologia Anatomica, taking one page as an example. The focus of analysis is the meaning imparted to an anatomical term by virtue of its location within the structured list. Terminologia's structure, expressed through hierarchies of headings, varied typographical styles, indentations, and an alphanumeric code, implies specific relationships among the terms embedded in the list. Together, terms and relationships can potentially capture essential elements of anatomical knowledge. The analysis focuses on these knowledge elements and evaluates the consistency and logic in their representation. Most critical of these elements are class inclusion and part-whole relationships. Since these are implied, rather than explicitly modeled, by Terminologia, the use of the term list is limited to those who have some knowledge of anatomy; computer programs are excluded from navigating through the terminology. Assuring consistency in the explicit representation of anatomical relationships would facilitate adoption of Terminologia as the anatomical standard by the various controlled medical terminology (CMT) projects. These projects are motivated by the need to computerize the patient record, and their aim is to generate machine-understandable representations of biomedical concepts, including anatomy. Because of the lack of a consistent and explicit representation of anatomy, each of these CMTs has generated its own anatomy model. None of these models is compatible with any other, yet each is consistent with textbook descriptions of anatomy. The analysis of the semantic structure of Terminologia Anatomica leads to some suggestions for enhancing the term list in ways that would facilitate its adoption as the standard for anatomical knowledge representation in biomedical informatics.
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Amylin is the major component of the amyloid found in the pancreases of noninsulin-dependent diabetics (type 2 diabetes). It is a 37 amino acid polypeptide and has been shown to have 46% sequence identity with the neuropeptide alpha-calcitonin gene-related peptide (alpha-CGRP). Both amylin and alpha-CGRP are known to be potent inhibitors of glycogen synthesis in stripped rat soleus muscle. Secondary structure prediction and tertiary structure model-building show the two polypeptides to have an alpha-helix/beta-strand motif similar to that observed in the insulin B-chain. The results have been supported by CD spectroscopy, although there is no sequence similarity between insulin and amylin/alpha-CGRP. Aggregation states have been predicted based on the dimeric and hexameric arrangements seen in porcine insulin. Rat and hamster amylin have a changed sequence motif in the beta-strand which results in lack of amyloid formation and type 2 diabetes. This, we propose, is caused by disruption of hydrogen bonding which prevents the formation of the dimer.
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Domain parsing, or the detection of signals of protein structural domains from sequence data, is a complex and difficult problem. If carried out reliably it would be a powerful interpretive and predictive tool for genomic and proteomic studies. We report on a novel approach to domain parsing using consensus techniques based on Hidden Markov Models (HMMs) and BLAST searches built from a training set of 1471 continuous structural domains from the Dali Domain Dictionary (DDD). Validation on an independent test sample of family-matched structural domain sequences from the Scop database yields a consensus prediction performance rate of 75.5%, well above the 58% obtained by simple agreement of methods.
Although anatomical terminology forms a part of biomedical structured vocabularies, available sources lack the requisite granularity, semantic types and relationships for comprehensively and consistently representing anatomical concepts in machine readable form. Thoracic angiology was selected as a proof of concept experiment for in depth representation of symbolic information in gross anatomy through the enhancement of semantic types, concepts and relationships in UMLS. Provided the representation of concepts is comprehensive, hierarchies generated with four types of simple relationships are capable of displaying anatomical information from the systemic view point with sufficient detail to meet the needs of applications in basic science education and in the practice of surgical subspecialties.
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This article will present a description of the semi-implicit semantic properties of the Systematized Nomenclature of Human and Veterinary Medicine, also called SNOMED International. It will focus on the formalism of SNOMED and its computational properties using the disease definition as an example. Additional information will be provided in order to convert semi-implicit links found between SNOMED concepts into explicit computational semantic links.
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Source monitoring refers to mental processes leading to attributions regarding the origin of information. We tested Johnson, Hashtroudi, and Lindsay's (1993) assumption that prior source-relevant knowledge is used in some source-monitoring tasks. In two experiments using different domains of schematic knowledge, two sources presented information that was expected for one source and somewhat unexpected for the other. In a later source-monitoring test, participants decided whether items had been presented by Source A, by Source B, or were new. The results of both experiments show that source identification is better for expected items than for somewhat unexpected items. Multinomial modeling analyses revealed that when participants do not remember the source of information, they guess that it was presented by the expected source. These results provide evidence for the claim that source monitoring can be based on prior knowledge and support a guessing hypothesis.
A stepwise and interactive identification procedure for foodborne microbial hazards has been developed in which use is made of several levels of detail ranging from rough hazard identification to comprehensive hazard identification. This approach allows one to tackle the most obvious hazards first, before focusing on less obvious hazards. The interactive character of the identification procedure is based on the use of several knowledge sources. Combination of knowledge sources, expressed in the use of knowledge rules, supports the user in systematically selecting hazards which may pose a real risk to the consumer. Due to the structured method and the clear definitions of the knowledge rules, the procedure is transparent and may be changed if necessary. The hazard identification procedure has been implemented as a computer program, resulting in a decision-supporting identification system. It provides a way to efficiently assess those hazards which may cause harm if not brought under control during processing. The procedure forms a basis for quantitative risk assessments.
African American women have a disproportionate risk of diabetes-related morbidity and mortality. Despite this risk, evidence indicates that educational interventions are not aimed at this population. We also currently lack basic information about the source of diabetes information for African American women and how such sources might affect their knowledge of the disease. We interviewed 51 women with diabetes to address such deficits in our understanding and, conceivably, to contribute culturally sensitive recommendations to enhance glucose control. To detect ethnic variations in knowledge and information source, half of our selected sample was African American and half was white. Results indicate that African American respondents achieved lower scores on the Diabetes Knowledge Test than their white counterparts. However, few differences were noted in the source of diabetes information, with both groups receiving their information from a wide variety of sources. Implications for health providers and educators are discussed.
The dental health knowledge and sources of health information of 848 elementary schoolchildren (aged 9-12) in southwestern Michigan were assessed. Demographic parameters (education level, percent below poverty level, median income level) of the area were similar to state and national averages. The children were found to have some knowledge of caries and periodontal disease prevention, yet basic misconceptions were evident. More than one-third of the children thought that plaque should only be removed by a dentist. While 75 percent of the subjects knew that fluoride protected teeth from decay, only 4 percent of the children identified fluoridated water as the best source of this preventive agent. Knowledge of pit and fissure sealants was limited. Extent of correct dental knowledge was not related to age, sex, or mean DMFS scores. Children who answered the most questions correctly named parents and family as their source of information; dentist's office was the second most frequently mentioned source. Findings suggest a need to correct basic misinformation about dental health and to inform children about current efficacious preventive agents.
Conceptual connections between users and information sources depend on an accurate representation of the content of available information sources, an accurate representation of specific user information needs, and the ability to match the two. Establishing such connections is a principal function of medical librarians. The goal of the National Library of Medicine's Unified Medical Language System (UMLS) project is to facilitate the development of conceptual connections between users and relevant machine-readable information. The UMLS model involves a combination of three centrally developed Knowledge Sources (a Metathesaurus, a Semantic Network, and an Information Sources Map) and a variety of smart interface programs that make use of these Knowledge Sources to help users in different environments find machine-readable information relevant to their particular practice or research problems. The third experimental edition of the UMLS Knowledge Sources was issued in the fall of 1992. Current priorities for the UMLS project include developing applications that make use of the Knowledge Sources and using feedback from these applications to guide ongoing enhancement and expansion of the Knowledge Sources. Medical librarians are involved heavily in the direction of the UMLS project, in the development of the Knowledge Sources, and in their experimental application. The involvement of librarians in reviewing, testing, and providing feedback on UMLS products will increase the likelihood that the UMLS project will achieve its goal of improving access to machine-readable biomedical information.
In the experiments reported here, children chose either to maintain their initial belief about an object's identity or to accept the experimenter's contradicting suggestion. Both 3- to 4-year-olds and 4- to 5-year-olds were good at accepting the suggestion only when the experimenter was better informed than they were (implicit source monitoring). They were less accurate at recalling both their own and the experimenter's information access (explicit recall of experience), though they performed well above chance. Children were least accurate at reporting whether their final belief was based on what they were told or on what they experienced directly (explicit source monitoring). Contrasting results emerged when children decided between contradictory suggestions from two differentially informed adults: Three- to 4-year-olds were more accurate at reporting the knowledge source of the adult they believed than at deciding which suggestion was reliable. Decision making in this observation task may require reflective understanding akin to that required for explicit source judgments when the child participates in the task.
Most care-giver "knowledge" needs arise at the point of care and are "patient-centered." Many of these knowledge needs can be met using existing on-line knowledge sources, but the process is too time-consuming, currently, for even the computer-proficient. We are developing a set of public domain standards aimed at bringing potentially relevant knowledge to the point of care in a straight-forward and timely fashion. The standards will a) make use of selected items from a Computer-based Patient Record (CPR), e.g., a diagnosis and measure of severity, b) anticipate certain care-giver knowledge needs, e.g., "therapy," "protocols," "complications," and c) try to satisfy those needs from available knowledge sources, e.g., knowledge-bases, citation databases, practice guidelines, and on-line textbooks. The standards will use templates, i.e., fill-in-the-blank structures, to anticipate knowledge needs and UMLS Metathesaurus enhancements to represent the content of knowledge sources. Together, the standards will form the specification for a "Knowledge-Server" (KS) designed to be accessed from any CPR system. Plans are in place to test an interim version of this specification in the context of medical oncology. We are accumulating anecdotal evidence that a KS operating in conjunction with a CPR is much more compelling to users than either a CPR or a KS operating alone.