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PubMed2000

Using bioinformatics in gene and drug discovery.

Bioinformatics has, out of necessity, become a key aspect of drug discovery in the genomic revolution, contributing to both target discovery and target validation. The author describes the role that bioinformatics has played and will continue to play in response to the waves of genome-wide data sources that have become available to the industry, including expressed sequence tags, microbial genome sequences, model organism sequences, polymorphisms, gene expression data and proteomics. However, these knowledge sources must be intelligently integrated.

Journal Article↗

PubMed2001

Integrating local and scientific knowledge: an example in fisheries science.

Attempting to predict the spatial dynamics fish stocks, as required for management, is an ominous task given our incomplete understanding of biological and ecological mechanisms underpinning behavioral responses of fish. Large gaps still exist in our basic scientific knowledge. Nonetheless, the knowledge of fishers and fishery managers is not incorporated into our scientific analyses, even though such information is rich in observation since knowledge of fish behavior and distribution is a prerequisite for their profession. Combining such observations with more conventional scientific studies and theoretical interpretations provides a means by which we may bridge some gaps in our knowledge. Presented here is an example of how both local and scientific knowledge can be integrated in a heuristic model. The model, CLUPEX, is developed in the framework of a fuzzy logic expert system and uses linguistic statements written in natural language to capture and combine knowledge sources in the form of IF... THEN rules. The rules are inferred from interviews with experts and fishery professionals including fishers, fishery managers, scientists, and First Nations people. The knowledge base, comprised of the set of rules, is flexible in the sense that it can easily be modified to add additional information or change current information. Using input pertaining to biotic and abiotic environmental conditions, CLUPEX uses the rules to provide quantitative and qualitative predictions on the structure, dynamics and mesoscale distribution of shoals of migratory adult herring during different life stages of their annual life cycle.

Animals↗

PubMed2000

Comparison of two knowledge bases on the detection of drug-drug interactions.

This paper describes a drug ordering decision support system that helps with the prevention of adverse drug events by detecting drug-drug interactions in drug orders. The architecture of the system was devised in order to facilitate its use attached to physician order entry systems. The described model focuses in issues related to knowledge base maintenance and integration with external systems. Finally, a retrospective study was performed. Two knowledge bases, developed by different academic centers, were used to detect drug-drug interactions in a dataset with 37,237 drug prescriptions. The study concludes that the proposed knowledge base architecture enables content from other knowledge sources to be easily transferred and adapted to its structure. The study also suggests a method that can be used on the evaluation and refinement of the content of drug knowledge bases.

Artificial Intelligence↗

PubMed2001

Long-term working memory in text production.

In reading and other high-level cognitive tasks, Ericsson and Kintsch (1995) proposed that the limited capacity of short-term working memory (STWM) is supplemented by long- term working memory (LTWM) for individuals with a high degree of domain-specific knowledge. In Experiment 1, college students (N = 80) wrote persuasive and narrative texts concerning baseball; domain-specific knowledge about baseball and verbal ability was assessed. The results showed that verbal ability and domain-specific knowledge independently affected writing skill, supporting the view that literacy depends on both knowledge sources and refuting one argument raised in support of the LTWM hypothesis. Experiment 2 (N = 42) replicated this outcome and tested the prediction that a high degree of domain-specific knowledge would lessen interference on a secondary task. The data supported the interference prediction, offering evidence that LTWM plays a role in the production of text.

Adult↗

PubMed2001

Standardized terminological services enabling semantic interoperability between distributed and heterogeneous systems.

The interconnection of heterogeneous computer applications in medicine raises the issue of semantic interoperability, going beyond traditional approaches of terminological standardization in basically three aspects. First, the variety of medical vocabularies that currently coexist in different domains is a major barrier for the integration of autonomously developed applications. Fortunately, with the Unified Medical Language System (UMLS) there are machine-readable terminological sources that cover and integrate most of the existing medical vocabularies. Second, the exchanged data need to be processed by a machine for different purposes like patient data integration, access to literature and knowledge bases as well as clinical audit and research. Medical vocabularies provided as passive dictionaries are no longer sufficient. Software system developers should take advantage of terminological services for refining user queries, for mapping the user's terms to appropriate medical vocabularies etc. Third, the services should be accessible uniformly and transparently. In the CORBAmed initiative a proposal for a standardized interface for querying and accessing computerized medical terminology resources was created. Based on the mentioned principles the MUSTANG system (Medical UMLS based Terminology Server for Authoring, Navigating and Guiding the Retrieval to Heterogeneous Knowledge Sources) has been developed. It is implemented on a Windows NT platform using the ORACLE database management and development software. The terminological services are accessible via multiple interfaces. The MUSTANG-System and the experiences with using terminological services in practice are described. Opposed to other levels of standardization like syntactical message standards there is much more a hesitation in the use of standardized terminology.

Humans↗

PubMedDate not supplied

A blackboard architecture for automating cephalometric analysis.

This paper describes a principled attempt to use artificial intelligence methodologies for interpretation of lateral skull X-ray images. Lateral skull X-ray images are routinely used in cephalometric analysis to provide quantitative measurements useful to clinical orthodontists. Manual and interactive methods of analysis are known to be error-prone, and time-consuming. Previous attempts have been made to automate this analysis, using conventional algorithmic approaches. Unfortunately such systems typically fail to capture the expertise and adaptability required to cope with the variability in biological structure and X-ray image quality found in cephalograms. The present system makes use of a blackboard architecture and multiple knowledge sources within an integrated model-based system. A data-gathering system allows models of feature appearance and location to be built from examples. Blackboard and task control modules allow specific knowledge-based modules to act on information available to the blackboard. Knowledge-based modules include location hypothesis, intelligent segmentation, and constraint propagation systems. Results from a working experimental system are given, and compare favourably with previous algorithmic solutions.

Artificial Intelligence↗

PubMed1998

Rural youth: HIV/STD knowledge levels and sources of information.

Though it is recognised that a sound knowledge of HIV/STD transmission is insufficient on its own to ensure that young people practise safer sex, knowledge of this sort is a necessary prerequisite to safe sex behaviours. Research on the HIV/STD knowledge levels of young people has shown that, while they have high levels of HIV knowledge, they generally have little idea about the transmission of other STDs. Moreover, most of this research has been conducted with more accessible youth in large urban centres. The research reported in this paper focused on HIV/STD knowledge levels, awareness of safe and unsafe sexual practices, and the information sources accessed by 1168 young people living in small rural towns in Queensland, Tasmania and Victoria. As with mainstream youth, the participants in this study had high levels of HIV knowledge and very low levels of knowledge about the transmission of other STDs, their names and symptoms. Practical knowledge of the safety of sexual practices was good, although a number of students confused high risk practices with high risk groups. Students mainly accessed informal information sources such as parents, peers and magazines and took little advantage of more formal sources even when they were available in their towns. There were few gender differences in levels of knowledge; however, girls accessed more information sources and knew more names of STDs. The implications of these findings are discussed in relation to young people developing critical attitudes towards more informal sources, and the better use of more formal sources.

Adolescent↗

PubMed1999

Re-engineering the process of surgical informed consent.

We have created a clinical performance support system that transforms surgical informed consent into an interactive process capable of evolving in response to institution-specified, provider-specified and patient-specified needs. The system functions in several capacities, including: (1) a source of standardized and comprehensive content and format the transmission of procedure-related risk and complications; (2) as expert critique, providing cues in an effort to reduce the effects of biased risk appraisal; (3) captures and archives clinician behavior relating to use, modification and disclosure of standardized knowledge sources; (4) provides just-in-time access to procedural descriptions information relating to risks and complications; (5) captures, archives and makes available to the clinician patient use of procedure-related knowledge resources. By design, the system will be used to assess the relationship between clinician perception and heuristics surrounding risk appraisal and disclosure and patient perceptions based on response to the disclosure process. The system prototype is currently being deployed in a breast surgery unit at the Beth Israel Deaconess Medical Center.

Computer Systems↗

PubMed1999

[Effective use of medical-scientific internet resources].

PROBLEM: The Internet is not structured hierarchically and therefore it distinguishes from today's common knowledge sources. The rapidly growing number of medical websites offers comprehensive but not easy to find information resources and continuing education opportunities for ophthalmologists. METHODS AND RESULTS: The efficiency of an Internet search is related to knowledge about existing search strategies. Several search systems are described (search engines, catalogs, databases, indices, etc.). Additional advice about efficient usage (Meta-Search, use of Boolean operators, phrase search, etc.) is provided. The suggested search strategies are evaluated regarding their specific results, update status, and the usability of search engines used. New applications such as SemioMap and Intelligent Agents are described. CONCLUSION: Today the Internet provides practitioners and scientists who are able to use efficient search strategies with easy and fast to use information resources. The total number of scientific-medical documents on the Web is growing very quickly. More and more, their content is related to current problems in patient treatment and future trends in clinical research.

Education, Medical, Continuing↗

PubMed1993

The UMLS Metathesaurus: representing different views of biomedical concepts.

The UMLS Metathesaurus is a compilation of names, relationships, and associated information from a variety of biomedical naming systems representing different views of biomedical practice or research. The Metathesaurus is organized by meaning, and the fundamental unit in the Metathesaurus is the concept. Differing names for a biomedical meaning are linked in a single Metathesaurus concept. Extensive additional information describing semantic characteristics, occurrence in machine-readable information sources, and how concepts co-occur in these sources is also provided, enabling a greater comprehension of the concept in its various contexts. The Metathesaurus is not a standardized vocabulary; it is a tool for maximizing the usefulness of existing vocabularies. It serves as a knowledge source for developers of biomedical information applications and as a powerful resource for biomedical information specialists.

MEDLINE↗

PubMed2000

Validity of adolescent and young adult self-report of Papanicolaou smear results.

OBJECTIVE: To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting. METHODS: We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting. RESULTS: Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (kappa) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0). CONCLUSION: The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.

Adolescent↗

PubMed1998

The decision support system for telemedicine based on multiple expertise.

This paper discusses the application of artificial intelligence in telemedicine and some of our research results in this area. The main goal of our research is to develop methods and systems to collect, analyse, distribute and use medical diagnostics knowledge from multiple knowledge sources and areas of expertise. Use of modern communication tools enable a physician to collect and analyse information obtained from experts worldwide with the help of a decision support medical system. In this paper we discuss a multilevel representation and processing of medical data using a system which evaluates and exploits knowledge about the behaviour of statistical diagnostics methods. The presented technique is able to acquire semantically-essential information from the complex dynamics of quasi-periodical medical signals by applying recursively-ordinary statistical tools. A method and an algorithm are elaborated to select automatically the most appropriate diagnostics method for each case under consideration. We suggest the use of a voting-type technique to search for consensus among the different opinions of medical experts. Research results can be applied in the development of a telediagnostics expert medical system and medical teleconsulting support system.

Algorithms↗

PubMed1995

Cognitive design for sharing medical knowledge models.

By building a medical conceptual model inside the galen project, a methodology has been defined to deal with both operative goals and deep and unsolved problems about knowledge. This knowledge sharing oriented approach exploits existing medical coding systems such as knowledge sources and enables us to represent their concepts in a wider cognitive context referring to ontological theories. The tasks of cognitive ergonomy, quasi-naturalness of language, versatility, and flexibility seem to be supported through some functions, such as viewpoint, context, and sign, which act as spin-off points to knowledge or information which is not modeled.

Artificial Intelligence↗

PubMed1995

Sexual knowledge, behavior and sources of information among deaf and hard of hearing college students.

A sexual health knowledge, behavior and sources of sexual health information survey was administered to 134 deaf and hard of hearing college students. Results indicated the students in this sample were not particularly well informed about sexual health and sexuality issues, were engaging in high risk sexual behaviors and relied primarily on peers for sexual health information. The need for the development of psychometrically sound measurement instruments for use with deaf populations as well as areas for future sexual health research are discussed.

Adult↗

PubMed1995

Managed care organizations: the new research partners.

The current "accountability movement" in managed care demands many of the same components as good research methodology: both issues depend on comprehensive data sources, knowledgeable data manipulation, and credible reporting of the results. As a result, some plans that have earmarked resources and institutional support to good accounting practices are also forming centers of research. The following is an overview of these managed care organizations and their studies, which investigate questions most relevant to their populations and data sources. This article summarizes this expanding area of health services research and identifies the key institutional components of the plans that support this work.

Decision Making, Organizational↗

PubMed2001

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.

PROBLEM: Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data. METHODS: An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library. RESULTS: Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.

Abdominal Pain↗

PubMedDate not supplied

The content and sources of maternal knowledge about the infant.

The author's purpose was to explore the knowledge that a primiparous mother acquires during the first 14 days postpartum about caretaking and personal characteristics of the infant. The study also examined the sources of this knowledge. The convenience sample consisted of 33 healthy, married, middle-class women. For caretaking knowledge, on postpartum days 1-6, mothers learned most about feeding, and on days 7-13 about administering daily care. For personal knowledge, on day 1 mothers learned most about infant physical characteristics and on days 2-13 about infant activity. Mothers acquired significantly more personal knowledge about their infant than caretaking knowledge, both daily and across the 2 weeks. Knowledge acquisition was highest during hospitalization. Maternal use of self was the dominant source for learning; however, nurses were the primary source for caretaking knowledge during hospitalization.

Adult↗

PubMed2001

HIV/AIDS knowledge and information sources among deaf and hearing college students.

A sample of 34 deaf undergraduate college students at Gallaudet University and 46 hearing undergraduate college students at the University of Maryland Baltimore County completed a questionnaire that asked about their knowledge and sources of information concerning the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). The deaf students had significantly lower scores on an "HIV/AIDS Knowledge Index" than the hearing students. This difference could not be explained by the deaf students' gender, class standing, family structure, or father's or mother's education level. The deaf students obtained more of their information about HIV/AIDS from family and friends than the hearing students, who relied to a greater extent on teachers, television, and reading material. The interpersonal sources used by the deaf students are more prone to factual errors than formal sources. Deaf students need methods of educating themselves about HIV/AIDS that are more accurate and that recognize the importance of sources as well as the content of information.

Acquired Immunodeficiency Syndrome↗