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Medical expert systems based on causal probabilistic networks.

Causal probabilistic networks (CPNs) offer new methods by which you can build medical expert systems that can handle all types of medical reasoning within a uniform conceptual framework. Based on the experience from a commercially available system and a couple of large prototype systems, it appears that CPNs are now an attractive alternative to other methods. A CPN is an intensional model of a domain, and it is therefore conceptually much closer to qualitative reasoning systems and to simulation systems than to rule-based or logic-based systems. Recent progress in Bayesian inference in networks has yielded computationally efficient methods. The inference method used follows the fundamental axioms of probability theory, and gives a sound framework for causal and diagnostic (deductive and abductive) reasoning under uncertainty. Experience with the prototypes indicates that it may be possible to use decision theory as a rational approach to test planning and therapy planning. The way in which knowledge is acquired and represented in CPNs makes it easy to express 'deep knowledge' for example in the form of physiological models, and the facilities for learning make it possible to make a smooth transition from expert opinion to statistics based on empirical data.

Artificial Intelligence↗

Causal relationship between occlusive lesions of the coronary artery and myocardial fibrosis in arteriosclerotic rabbits--differences between cholesterol-fed and heritable hyperlipidemic rabbits.

To investigate the causal relationship between lesions of either the proximal large or the distal small coronary arteries and myocardial fibrosis, the hearts and the aortas of 99 cholesterol-fed rabbits with either intermittent or continuous hyperlipidemia for 8 months or more, 44 Watanabe-heritable hyperlipidemic (WHHL) rabbits and 20 normal rabbits were studied histologically. The size and location of the myocardial fibrosis correlated closely with the almost completely occlusive distal small coronary artery which mainly consisted of macrophages, necrosis and calcification but did not correlate with the maximum % stenosis of the large proximal subepicardial coronary arteries in the cholesterol-fed-rabbits. Myocardial fibrosis and almost completely occlusive lesions of the distal small coronary arteries were very rare in the WHHL rabbits, and the maximum % stenosis of the proximal coronary artery and aortic lesions in the WHHL rabbits tended to be greater than those in the cholesterol-fed rabbits. Thus, we are still not certain as to whether or not, the organic stenosis of the subepicardial coronary artery is responsible for myocardial fibrosis in WHHL-rabbits. In conclusion, a causal relationship was observed between myocardial fibrosis and the occlusive lesions of the distal small coronary arteries in cholesterol-fed rabbits, while the arteriosclerotic lesions of the small coronary artery in cholesterol-fed rabbits completely differed from those observed in WHHL-rabbit.

Animals↗

The surgeon general's "epidemiologic criteria for causality". Reply to Lilienfeld.

I argued in my Critique [6] that the Surgeon General's five epidemiologic criteria for causality are not given adequate definition, and that, unless they are so lax as to be meaningless, not even one of them is indisputably satisfied by the evidence relating to smoking and lung cancer. Lilienfeld concedes that "It is tactically unfortunate that the 1982 Report used the same criteria that were adopted in the original 1964 Report" [4], but he is unable to demonstrate that the available evidence, interpreted according to the accepted canons of scientific inference, is consistent either with the original or the "more detailed criteria". He makes no acknowledgement of the principle that valid inferences about cause cannot be drawn from epidemiologic comparisons between selected, non-randomized groups; he actually violates that principle in his defence of the Report by deploying conclusions from such evidence. As to the vexed 85% of lung cancer cases and the 30% of all cancer deaths in the U.S. attributed to smoking [5], no justification is offered for assigning the entire "relative risk" to a (smoking) causal relation; indeed at one point, and perhaps inadvertently, Lilienfeld repudiates that practice. I know of no valid arguments from reliable evidence that justify such precise estimates of attributable risk and if Lilienfeld cannot supply them who can? If specific claims about the hazards of any agent cannot be sustained by scientifically rigorous methods they should never be made publicly in the first place but, once having been made and exposed, they should then be retracted with as much grace and dignity as possible.

Animals↗

Intention and outcome: key components of causal structure facilitating mapping in children's analogical transfer.

The consequences of two key features of causal structure in source stories, intention and positive outcome, for analogical transfer were examined in kindergarten and second graders. In Experiment 1, children received either structure-complete, structure-incomplete, or irrelevant source stories. Structure-incomplete stories lacked either the intention to solve a problem (a goal-directed component), evidence of a successful consequence (an outcome-related component), or both as part of the solution activity described in source stories. Evidence for transfer was obtained for second graders when a goal-directed component, and to a lesser extent, an outcome-related component were connected to the solution action in source stories. Differences among conditions for kindergartners were less evident, although they revealed a pattern of performance similar to the second graders. A second experiment was conducted to determine whether memory and an orientation to use the source story information might account for these findings. Efforts to ensure memory for and hints to use information in the source stories, however, did not benefit solution transfer when intention and positive outcome were absent. These results suggest that a complete causal structure, including goal and outcome, in source stories augments transfer in young children by promoting mapping of the analogical relationship between source stories and the target problem.

Achievement↗

Causal attribution and adaptation among lung cancer patients.

The aim of the present study was to describe lung cancer patients' causal attributions and examine their associations with adaptation. Methods were based on semi-structured interview, content analysis, self-reports, interviewer ratings and standardized questionnaires. 'Smoking cigarettes' and 'toxins in the work place' were the most commonly mentioned possible causes. Patients who made a psychosocial causal attribution suffered greater emotional distress, were more depressed, and less hopeful than other patients. They were also more likely to be rated as showing a maladaptive way of coping with illness. The implications of these findings for psychosocial care are discussed.

Adaptation, Psychological↗

Scrotal size of yearling sires and early calving in beef herds: epidemiological investigation of possible causal pathways.

Scrotal circumference has been recommended as a clinical test for predicting the fertility potential of yearling bulls. The objectives of this study were to determine if scrotal size of yearling bulls influences herd fertility and to investigate specific causal pathways. Calving records from 44 herds enrolled in the Beef Herd Improvement Plan were selected from the data base for 1984 to 1989. Logistic regression was used to model the event of calving within the first 3 wk of the calving season as a function of scrotal circumference, herd size, age and the interactions of scrotal circumference with age, scrotal circumference with herd size, and herd size with age and the random effects of herd. The odds of cows calving in the first 3 weeks of the calving season were lower in large herds (>30 vs 20 to 30 calves born per season) and with younger yearling bulls (12 to 15 vs. 16 to 18 months of age). Early calving was not associated with scrotal circumference, or the interactions scrotal circumference with herd size and scrotal circumference with age (p > 0.15). It was concluded that the female:male ratio and age of bull both affected the odds of a cow calving early, but neither of the associations was altered by selection for bulls with a larger scrotal circumference, and therefore scrotal circumference is not included in either of the 2 causal pathways.

Journal Article↗

Stressful life events, social rhythms, and depressive symptoms among the elderly: an examination of hypothesized causal linkages.

This study sought to determine possible causal linkages among stressful life events, social rhythms, and levels of depressive symptomatology for 81 elderly subjects (51 recently widowed, 30 healthy controls). We examined the associations among stressful life events (i.e., bereavement status at baseline or a severely threatening event occurring between baseline and followup), social rhythm stability, and the level of depressive symptoms. Results indicated that while stressful life events were not associated with significant changes in social rhythm stability, social rhythm stability was a significant negative correlate of both baseline and followup levels of depressive symptomatology; that is, lower levels of social rhythm stability at baseline were associated with high levels of depressive symptoms at baseline (rho = -0.33, n = 81, p < 0.001) and at followup (rho = -0.23, n = 81, p < 0.05). Bereavement was also a significant positive correlate of depressive symptomatology both at baseline (rho = 0.79, n = 81), p < 0.0001) and at followup (rho = 0.55, n = 81, p < 0.0001). It is likely that future research will benefit from social rhythm assessment obtained temporally closer to major life events and from the use of structured interviews to ascertain the presence of syndromal major depression at followup as well as the inclusion of subjects with a wider range of functional impairments. Nevertheless, these results represent a first step in disentangling possible causal connections among stressful life events, social rhythms, and depressive symptomatology.

Aged↗

A diagnostic method that uses causal knowledge and linear programming in the application of Bayes' formula.

Bayes' formula has been applied extensively in computer-based medical diagnostic systems. One assumption that is often made in the application of the formula is that the findings in a case are conditionally independent. This assumption is often invalid and leads to inaccurate posterior probability assignments to the diagnostic hypotheses. This paper discusses a method for using causal knowledge to structure findings according to their probabilistic dependencies. An inference procedure is discussed which propagates probabilities within a network of causally related findings in order to calculate posterior probabilities of diagnostic hypotheses. A linear programming technique is described that bounds the values of the propagated probabilities subject to known probabilistic constraints.

Bayes Theorem↗

The effect of social change on causal beliefs of mental disorders and treatment preferences in Ghana.

The present study investigated the associations between social change, personality, causal beliefs and treatment style and goal preferences of 375 Ghanaian teachers. The index of social change (ISC) was conceptualized as the average percentile rank of a person's income, education and acculturation. The self-report measures (greatly modified after two pilot studies) were subscales of the SuinnLew Acculturation Scale, the Depressive Experiences Questionnaire (dependency), the Sociotropy-Autonomy Scale (autonomy), the Symptom Checklist '90 (paranoid ideation), the Spheres of Control Scale, and the Cognitive Somatic Anxiety Questionnaire. Respondents also completed a questionnaire on causal beliefs and treatment preferences pertaining to mental disorders. Results indicated that beliefs and treatment preferences were affected by the index of social change (ISC) and were specific to type of disorder. High ISC teachers endorsed significantly higher ratings on belief in an internal cause for Depression and Dependent Personality Disorder, and indicated greater preference for participation in treatment than lower ISC teachers. Contrary to prediction, lower ISC teachers indicated a greater preference for greater individual goals in treatment for depression and schizophrenia. High ISC teachers also reported greater perception of interpersonal control and emotional support, less dependency and less interpersonal sensitivity than lower ISC teachers. Little support was found for the commonly observed somatization of distress among non-Western peoples.

Acculturation↗

Children's understanding of the causality of pain.

The ideas of 680 Irish schoolchildren aged 5-14 years about the causality of pain were studied as part of a wider investigation of children's understanding of pain. The results indicated an association between pain and 'transgression' consonant with the literature on children's beliefs about the causality of illness, but not reported in previous studies of children's ideas about pain. Developmental patterns were also noted in the data and one significant sex difference consistent with a previously reported trend.

Adolescent↗

Methadone-maintained males' reactions to success and failure: causal attributions, self-efficacy, and attitudes toward heroin.

This exploratory study investigated several components of Marlatt's [1,2] cognitive-behavioral model of relapse to substance abuse. The components were outcome expectancies for the abused substance, self-efficacy, and causal responsibility for success and failure. Also, Hispanic and white ethnic differences in causal attributions were analyzed. Some support was found for Marlatt's model. Both groups exhibited more favorable attitudes toward heroin following success and failure. However, the success group evaluated heroin most favorably. This finding may have been due to both groups responding more to task-performance anxiety than to success and failure. Hispanic subjects attributed success most to the internal cause of high effort and white subjects exhibited lowered self-efficacy by attributing failure most to low ability. Nonsupport for Marlatt's model was found. Success was found not to enhance self-efficacy. White subjects did not take personal responsibility for success. They attributed success most to easy task. A self-protective bias was evident in the Hispanic subjects attributing failure most to hard task. The meaning and implications of these findings, as well as suggestions for further research, are discussed.

Achievement↗

Assessing methods for causality assessment of suspected adverse drug reactions.

Reproducibility and validity as currently defined are inappropriate criteria for the evaluation of methods for causality assessment. Reproducibility leads to suppression rather than resolution of real disagreements and the method used to establish validity relies on the tarnished gold standard of expert opinion. We describe six alternative criteria that attempt to address a potential user's main concerns--the need to know whether to believe the results in general and in a particular case. These criteria focus on the internal structure of a method rather than its output. When we assessed the published methods by these criteria most of the methods failed most of the criteria. We believe that the problem and its solution lie at a fundamental level--real understanding of the true nature of causality assessment, which we suggest is an inherently subjective evaluation based on the multiple uncertainties that an assessor has about a case and not an objective attribute of the drug-event connection that can be determined from unambiguous evidence elicited in response to "operational questions".

Drug-Related Side Effects and Adverse Reactions↗

Specification of models in large expert systems based on causal probabilistic networks.

Problems involved in the specification of large expert systems are discussed. In the specification of causal probabilistic networks conditional probability tables for all nodes have to be provided. These conditional probability tables can often be described by models that specify the nature of interaction between nodes. Various types of models are described and a program that handles such models is presented. Large causal probabilistic networks often contain several copies of identical tables or structures. A header facility that provides common definitions of such repeated elements is proposed. This facility makes specifications much shorter and easier to construct and maintain.

Expert Systems↗

The causal ordering of mathematics anxiety and mathematics achievement: a longitudinal panel analysis.

Using data from the Longitudinal Study of American Youth (LSAY), we aimed to determine the causal ordering between mathematics anxiety and mathematics achievement. Results of structural equation modelling showed that, across the entire junior and senior high school, prior low mathematics achievement significantly related to later high mathematics anxiety, but prior high mathematics anxiety hardly related to later low mathematics achievement. Mathematics achievement was more reliably stable from year to year than mathematics anxiety. There were statistically significant gender differences in the causal ordering between mathematics anxiety and mathematics achievement. Prior low mathematics achievement significantly related to later high mathematics anxiety for boys across the entire junior and senior high school but for girls at critical transition points only. Mathematics anxiety was more reliably stable from year to year among girls than among boys.

Anxiety↗

Dysphoric adolescents' causal explanations and expectancies for approach and avoidance goals.

Relatively little research has studied emotional disturbance from a motivational perspective. The current study aimed to investigate personal goal systems at different levels of analysis, namely, personal goals, associated causal explanations and goal expectancies, as a function of dysphoria. Dysphoric (n = 28) and non-dysphoric (n = 28) adolescents (16-18-yr-olds) selected from a larger school sample completed tasks that measured number of approach goals and avoidance goals, causal explanations for goals, and perceived likelihood and control estimates for idiographic goals. As predicted dysphoric adolescents, relative to controls, generated a combination of more avoidance goals and fewer approach goals, and thought of more reasons that explain why goals would not be achieved and fewer reasons that explain why goals would be achieved (irrespective of goal type), and considered avoidance goal outcomes as more likely to occur and approach goal outcomes as less likely to occur. In addition, dysphoric adolescents anticipated less personal control in implementing their goals than controls. Overall, the data identified distinct personal goal systems that function differently in dysphoric and non-dysphoric adolescents.

Adolescent↗

Does a causal relation exist between the functional hemispheric asymmetries of visual processing subsystems?

Past research indicates that specific shape recognition and spatial-relations encoding rely on subsystems that exhibit right-hemisphere advantages, whereas abstract shape recognition and spatial-relations encoding rely on subsystems that exhibit left-hemisphere advantages. Given these apparent regularities, we tested whether asymmetries in shape processing are causally related to asymmetries in spatial-relations processing. We examined performance in four tasks using the same stimuli with divided-visual-field presentations. Importantly, the asymmetry observed in any one task did not correlate with the asymmetries observed in the other tasks in ways predicted by extant theories. Asymmetries in shape processing and spatial-relations encoding may not be due to a common causal force influencing multiple subsystems.

Adult↗

Overproduction of collagen and diminished SOCS1 expression are causally linked in fibroblasts from idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and often fatal pulmonary disorder, and its pathology is characterized by parenchymal fibrosis. To investigate the characteristics of fibroblasts in IPF, we obtained eight fibroblast cell lines from lungs with IPF and eight lines from normal lungs. We found that the fibroblasts from IPF spontaneously produced higher amounts of type I collagen and had lower expression levels of SOCS1 than fibroblasts from normal lung. By using mouse fibroblasts, we demonstrated the causal relationship between them: the deficiency of SOCS1 in fibroblasts resulted in increased collagen production, whereas overexpression of SOCS1 suppressed collagen production. IFN-gamma suppressed spontaneous collagen production even in SOCS1-deficient fibroblasts, indicating that IFN-gamma inhibition is SOCS1-independent. In contrast, IFN-gamma suppressed the increase of collagen production induced by IL-4 in wild type fibroblasts but not SOCS1-deficient fibroblasts, suggesting IFN-gamma acted exclusively via SOCS1 in this case. Following IFN-gamma stimulation, the amount of SOCS1 mRNA expressed by IPF fibroblasts was comparable to that of normal fibroblasts. Thus, the extent of SOCS1 increase after stimulation by IFN-gamma was significantly higher in IPF fibroblasts. The extent to which IFN-gamma inhibited collagen production was also larger in IPF fibroblasts than in normal fibroblasts. These results suggest that the exaggerated production of collagen observed in fibroblasts from IPF is causally related to the diminished expression of SOCS1, and IPF fibroblasts are more susceptible to IFN-gamma because of decreased expression of SOCS1.

Animals↗

Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes?

Before assigning full etiologic validity to a psycopathologic disorder, disease theory suggests that a causal dysfunction in a mechanism within the affect individuals must be identified. Existing theories on attention-deficit/hyperactivity disorder (ADHD) suggest such dysfunctions in cognitive, neuropsychological, or motivational processes in the child. To date, researchers have tested these theories by comparing groups with DSM-defined ADHD to children without ADHD. Using executive functioning as an illustration of an issue that exists across all such theories, this article describes substantial overlaps in the group performance data. Thus only a subgroup may have executive deficits. Noted are other supportive data suggesting multiple pathways to ADHD. The article explores implications and recommends that future theory and research give more consideration to the probability that only a subset of behaviorally defined children will have a deficit in a given neurocognitive mechanism believed to contribute to the disorder. Creation of a provisional set of criteria in DSM-V for defining an "executive deficit type" could stimulate research to validate the first etiologic subtype of ADHD and spur the development of more sophisticated causal models, which in the longer term may give clinicians ways to target and tailor treatments.

Attention Deficit Disorder with Hyperactivity↗