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Machine learning for an expert system to predict preterm birth risk.

OBJECTIVE: Develop a prototype expert system for preterm birth risk assessment of pregnant women. Normal gestation involves a term of 40 weeks, but because 8-12% of the newborns in the United States are delivered prior to 37 weeks' gestation, problems associated with prematurity continue to plague individuals, families, and the health care system. DESIGN: A knowledge-base development methodology used machine learning, statistical analysis, and validation techniques to analyze three large datasets (18,890 subjects and 214 variables). The dependent (i.e., decision) variable studied was weeks of gestation at delivery, with dichotomous coding of preterm delivery (prior to 37 weeks) and full-term delivery (37+ weeks). RESULTS: Machine learning with a program named Learning from Examples using Rough Sets (LERS) induced 520 usable rules that were entered into a prototype expert system. The prototype expert system was 53-88% accurate in predicting preterm delivery for 9,419 patients. CONCLUSION: The prototype expert system was more accurate than traditional manual techniques in predicting preterm birth.

Adult↗

Geriatric patient simulations for dental hygiene.

The rapidly increasing number of this country's elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.

Aged↗

Information systems for the community health services.

This paper is concerned with the design and implementation of an information system which fulfils some of the local needs of fourteen nursing and para-medical professions working in the community in a district health authority, whilst satisfying the statutory requirements of the NHS Körner steering group for those professions. The implementation of the computer information system was achieved through the participation of those professionals who would eventually use the system. A prototype system, which has now been extended, has been operational for some time covering the chiropody and school nursing staff groups. An evaluation of this system has shown that a significant number of the problems and objectives of those groups have been successfully addressed, the value of community health information has been increased, and information has been fed back to staff and better utilized.

Ambulatory Care Information Systems↗

Microsoft Excel Program for creating attractive survival curves.

This paper describes the design of a Microsoft Excel Program which interactively creates attractive and outstanding survival curves. This program enables medical researchers to easily create quality presentation graphs of survival curves and obtain high quality slides and prints, which can be inserted in papers or used directly at medical meetings. Through the use of vertical bars, this program can display the exact points where censored cases occur on survival curves, making it possible to monitor censoring patterns between groups. Furthermore, this program can also create survival curves based on the proportional hazards model for specific patterns of covariate values, given estimated regression coefficients and baseline survival function. This program may be a most useful and effective tool in creating medical research papers containing survival analysis.

Age Factors↗

Guided self diagnosis: an innovative approach to triage for emergency dental care.

BACKGROUND: The basic model of triage, developed more than 200 years ago by the French, is based on categorization of patient needs and thus the urgency and time required for care. This model in various forms is used in most hospitals throughout the world. METHODS: In this study, a fully computerized guided self-diagnosis system (based on a neural network design) was designed, prototyped, developed and trialled by front line non-clinically trained personnel in emergency dentistry. RESULTS: A total of 699 patients were seen as a result of the triage assessment within 14 days of their initial phone call and/or first contact. Patients categorized as requiring care on the day (Category 1) were provided more items of care (50 per cent of all items) and the greatest number of extractions (76 per cent) and endodontic treatments (78 per cent). Other categories were found to require less urgent care. CONCLUSIONS: The triage system developed in this study clearly holds significant promise in reducing the impact of emergency dental patients on dental health care systems. However, it is recognized that the system still requires some adjustment to ensure all Category 1 patients are examined before less urgent categories.

Dental Care↗

Design and evaluation of tiled parallel coordinate visualization of multichannel EEG data.

The field of visualization assists data interpretation in many areas, but does not manage all types of data equally well. This holds, in particular, for time-varying multichannel EEG data. No existing method can successfully visualize simultaneous information from all channels in use at all time steps. To address this problem, a new visualization method is presented based on the parallel coordinate method and making use of a tiled organization. This tiled organization employs a two-dimensional row-column representation, rather than a one-dimensional arrangement in columns as used for classical parallel coordinates. The usefulness of the new method, referred to as tiled parallel coordinates (TPC), is demonstrated by a particular type of EEG data. It can be applied to an arbitrary number of time steps, handling the maximum number of channels currently in use. An extensive user evaluation shows that, for a typical EEG assessment task, data evaluation by the TPC method is faster than by an existing clinical EEG visualization method, without loss of information. The generality of the TPC method makes it widely applicable to other time-varying multivariate data types.

Computer Graphics↗

Predicting length of stay for psychiatric diagnosis-related groups using neural networks.

OBJECTIVE: To test the effect of diagnosis on training an artificial neural network (ANN) to predict length of stay (LOS) for psychiatric patients involuntarily admitted to a state hospital. DESIGN: A series of ANNs were trained representing schizophrenia, affective disorders, and diagnosis-related group (DRG) 430. In addition to diagnosis, variables used in training included demographics, severity of illness, and others identified to be significant in predicting LOS. RESULTS: Depending on diagnosis, ANN-predictions compared with actual LOS indicated accuracy rates ranging from 35% to 70%. The validity of ANN predictions was determined by comparing LOS estimates with the treatment team's predictions at 72 hours following admission, with the ANN predicting as well as or better than did the treatment team in all cases. CONCLUSIONS: One problem in traditional approaches to predicting LOS is the inability of a derived predictive model to maintain accuracy in other independently derived samples. The ANN reported here was capable of maintaining the same predictive efficiency in an independently derived cross-validation sample. The results of ANNs in a cross-validation sample are discussed and the application of this tool in augmenting clinical decision is presented.

Adult↗

A computer program designed for the analysis of data from rat caries studies.

The Keyes method for scoring dental caries in the rat animal model has been used as the basis for a computer-assisted scoring system on the Apple Macintosh personal computer that is described here. The program provides the ability to draw on diagrams of the rat molar dentition and to enter enamel lesion scores (L, E) and dentinal lesion scores (Ds, Dm, and Dx) for all aspects of the molars. The scores and drawings may be changed at any time. Total carious teeth and totals of L, E, Ds, Dm, and Dx are automatically calculated and presented upon user command. Error trapping for typographical errors is provided. In addition, the program provides automatic storage of the collected information, searching and sorting on any of the experimental parameters and on-disk help files that can be accessed from any place within the program. The capacity to obtain printed copy of any or all of the stored information is provided in the program. The program also enables the creation of external data files containing totals for carious teeth, in addition to L, E, Ds, Dm, and Dx totals for each animal of each group represented in the data base. These files are suitable for the transfer of data to commercially available programs for graphical and statistical analyses. The programming technique we describe could be extended to other model systems with standardized scoring for oral disease.

Animals↗

A surface-marker imaging system to measure a moving knee's rotational axis pathway in the sagittal plane.

This paper describes a new surface-marker imaging system designed to measure the rotational axis pathway (RAP) of a moving knee in the sagittal plane. Measurement of this parameter can provide important information about a knee's slipping and rolling action that can aid clinical assessment. Seated subjects are video recorded as they actively extend their legs. A series of stills is then captured and analyzed to extract the coordinates of markers placed on the subjects upper and lower legs. These coordinates are then processed to deduce an instant center of rotation (ICR) for each still. These ICRs are then plotted to derive the joint's RAP. The system has been validated with a mechanical model and tested in a clinical study of ten patients with unilateral anterior cruciate ligament (ACL) ruptures. The study found that the system could consistently measure differences between a patients normal and injured knees. Leg extension caused the normal knees ICRs to displace anteriorly with a mean value of 17.4 mm, whereas the injured knees had a mean displacement of 7.5 mm. This loss of roll in the ACL-deficient knees is consistent with their abnormal biomechanical arrangement.

Adult↗

Materials management information systems.

The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The MMIS Selection Process: Outlines steps to follow and describes factors to consider when selecting an MMIS. Also includes our Materials Management Process Evaluation and Needs Assessment Worksheet (which is also available online through ECRInet(TM)) and a list of suggested interview questions to be used when gathering user experience information for systems under consideration. Section 3A. MMIS Vendor Profiles: Presents information for the evaluated systems in a standardized, easy-to-compare format. Profiles include an Executive Summary describing our findings, a discussion of user comments, a listing of MMIS specifications, and information on the vendor's business background. Section 3B. Discussion of Vendor Profile Conclusions and Ratings: Presents our ratings and summarizes our rationale for all evaluated systems. Also includes a blank Vendor Profile Template to be used when gathering information on other vendors and systems. We found that, in general, all of the evaluated systems are able to meet most of the functional needs of a materials management department. However, we did uncover significant differences in the quality of service and support provided by each vendor, and our ratings reflect these differences: we rated two of the systems Acceptable--Preferred and four of the systems Acceptable. We have not yet rated the seventh system because our user experience information may not reflect the vendor's new ownership and management. When this vendor provides the references we requested, we will interview users and supply a rating. We caution readers against basing purchasing decisions solely on our ratings. Each hospital must consider the unique needs of its users and its overall strategic plans--a process that can be aided by using our Process Evaluation and Needs Assessment Worksheet. Our conclusions can then be used to narrow down the number of vendors under consideration...

Computer Security↗

A transcript finishing initiative for closing gaps in the human transcriptome.

We report the results of a transcript finishing initiative, undertaken for the purpose of identifying and characterizing novel human transcripts, in which RT-PCR was used to bridge gaps between paired EST clusters, mapped against the genomic sequence. Each pair of EST clusters selected for experimental validation was designated a transcript finishing unit (TFU). A total of 489 TFUs were selected for validation, and an overall efficiency of 43.1% was achieved. We generated a total of 59,975 bp of transcribed sequences organized into 432 exons, contributing to the definition of the structure of 211 human transcripts. The structure of several transcripts reported here was confirmed during the course of this project, through the generation of their corresponding full-length cDNA sequences. Nevertheless, for 21% of the validated TFUs, a full-length cDNA sequence is not yet available in public databases, and the structure of 69.2% of these TFUs was not correctly predicted by computer programs. The TF strategy provides a significant contribution to the definition of the complete catalog of human genes and transcripts, because it appears to be particularly useful for identification of low abundance transcripts expressed in a restricted set of tissues as well as for the delineation of gene boundaries and alternatively spliced isoforms.

Alternative Splicing↗

An object-oriented framework for medical image registration, fusion, and visualization.

An object-oriented framework for image registration, fusion, and visualization was developed based on the classic model-view-controller paradigm. The framework employs many design patterns to facilitate legacy code reuse, manage software complexity, and enhance the maintainability and portability of the framework. Three sample applications built a-top of this framework are illustrated to show the effectiveness of this framework: the first one is for volume image grouping and re-sampling, the second one is for 2D registration and fusion, and the last one is for visualization of single images as well as registered volume images.

Algorithms↗

Decision support for acute problems: the role of the standardized patient in usability testing.

For applications that require clinician use while interacting with patients, usability testing with standardized patients has the potential to approximate actual patient care in a controlled setting. We used hypothetical scenarios and a standardized patient to collect quantitative and qualitative results in testing an early prototype of a new application, the Acute Respiratory Infection (ARI) Smart Form. The standardized patient fit well into the usability testing sessions. Clinicians had a positive response to the standardized patients and behaved as they normally would during a clinical encounter. Positive findings of the ARI Smart Form included that users thought it had impressive functionality and the potential to save time. Criticism focused on the visual design, which could be streamlined, and navigation, which was difficult in some areas. Based on these results, we are modifying the ARI Smart Form in preparation for use in actual patient care. Standardized patients should be considered for usability testing, especially if an application is to be used during the patient interview.

Adult↗

Flexibility in system design and implications for aerospace systems.

The purpose of this paper is to review the concept of flexibility as discussed in various fields of investigations, to extract its characteristic features, and to explore its implications in the case of aerospace system design. In order to discuss any subject matter clearly, it is necessary to begin with a clear set of definitions. Indeed much can be gained through careful and consistent definitions of terms alone. Flexibility however is a word rich with ambiguity. While it is being increasingly used in various fields, few attempts have been made to formally define, quantify, and propose ways for achieving flexibility. This paper proposes to fill in part of this gap by synthesizing a clear and consistent definition of flexibility. It will do so by reviewing the usage of the term in various fields of inquiries, and show that it is indeed possible to clearly and unambiguously characterize flexibility, and to disentangle it from closely related concepts.

Aircraft↗

Assessing effectiveness of home care for persons with AIDS: analysis of methodological problems.

The aim of this paper is to assess the methodological problems of an unsuccessful randomized controlled trial (RCT) conducted to evaluate the effectiveness, in terms of survival and quality of life, of the early offer of home care (HC) to persons with AIDS (PWA). The study carried out was an intention-to-treat RCT. Persons in the treatment group (TG) received the offer of HC at the moment of AIDS diagnosis; those in the control group (CG) received it six months from diagnosis. Many problems have hindered the progress of the study: particularly, the low compliance to the offer and the failure to enroll the required sample size have made the results unreliable. Analogous problems have been reported within other trials evaluating HC in different fields. The present study thoroughly evaluates the specific ethical and methodological problems encountered in designing and conducting a RCT on HC for PWA. We conclude that, before designing and conducting a RCT in this field, it is advisable to examine some main issues carefully, such as the acceptability of the offer of treatment, the expected compliance and the required size of the study population. If one or more of these elements prove to be problematic, the results of the trial risk being seriously compromised, and alternative approaches should be considered.

Acquired Immunodeficiency Syndrome↗

The group sequential triangular test for phase II cancer clinical trials.

In cancer, phase II clinical trials are usually noncomparative. Their purpose is to determine whether a new chemotherapy is effective enough to warrant further evaluation in phase III. Therefore, in order to meet ethical requirements, decision-making methods must allow for early termination when inefficacy (or efficacy) is clear. We previously extended the Triangular Test, a group sequential method initially proposed for phase III trials, to phase II trials and demonstrated its advantages (i.e., type I error rate alpha and power close to the nominal values, reduction of the sample size) over other methods. The aim of this paper is to present the Triangular Test from a practical standpoint that will facilitate its application to phase II clinical trials in oncology. After summarizing the minimal theoretical knowledge required to use the method appropriately, we discuss its use in the design and analysis of a phase II cancer trial.

Algorithms↗