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Basic principles of aesthetics and function important for successful facial cutaneous reconstructive surgery with local flaps include the use of appropriate tissue donor sources, knowledge of the mechanisms, dynamics, and effects of tissue movement, and techniques for scar camouflage. Useful flaps for defects in each of the facial cosmetic units are reviewed with these principles used as guidelines.
As part of a plan to promote semi-automatic knowledge acquisition for the medical consultant system CADIAG-II/RHEUMA, this study sought to explore and cope with the variability of results that may be anticipated when performing knowledge acquisition with patient data from different patient settings. Patient data were drawn both from a published study for the classification of rheumatoid arthritis (RA) and from a large database of rheumatological patient charts developed for the CADIAG-II/RHEUMA system. An analysis of the relationships between RA and selected CADIAG-II/RHEUMA symptoms was done using two models. In one of them, we controlled for the differences in baseline frequencies of symptoms and diseases in the two study populations as an important factor influencing the results of the calculations. Other factors that were identified included inconsistent definitions of symptoms and diseases, and the different composition of study groups in the two study populations. By eliminating differences in baseline frequencies as the most important bias, the results obtained from the two different knowledge sources became more consistent. All remaining inconsistencies and uncertainties about the contribution and relative importance of the factors were formalized using fuzzy intervals.
In vitro fertilization (IVF) is a medically-assisted reproduction technique, enabling infertile couples to achieve successful pregnancy. Given the unpredictability of the task, we propose to use a case-based reasoning system that exploits past experiences to suggest possible modifications to an IVF treatment plan in order to improve overall success rates. Once the system's knowledge base is populated with a sufficient number of past cases, it can be used to explore and discover interesting relationships among data, thereby achieving a form of knowledge mining. The article describes the TA3IVF system--a case-based reasoning system which relies on context-based relevance assessment to assist in knowledge visualization, interactive data exploration and discovery in this domain. The system can be used as an advisor to the physician during clinical work and during research to help determine what knowledge sources are relevant for a treatment plan.
We describe a semi-automatic knowledge engineering approach for converting the human anatomy and pathology portion of the UMLS metathesaurus into a terminological knowledge base. Particular attention is paid to the proper representation of part-whole hierarchies, which complement taxonomic ones as a major hierarchy-forming principle for anatomical knowledge. Our approach consists of four steps. First, concept definitions are automatically generated from the metathesaurus, with LOOM as the target language. Second, integrity checking of the emerging taxonomic and partonomic hierarchies is automatically carried out by the terminological classifier. Third, terminological cycles and inconsistencies are manually eliminated and, in the last step, the knowledge base built this way is incrementally refined by a medical expert. Our experiments were run on a terminological knowledge base which is composed of 164,000 concepts and 76,000 relations. Empirical evidence for the lack of logical consistency, adequacy and improper granularity of the UMLS knowledge source is given, and finally, assessments of what kind of efforts are needed to render the formal target representation structures complete and empirically adequate.
Combinatorial terminological systems are appearing, to solve the issues related to flexibility and precision of representation requested by modern healthcare information systems and in particular by messaging standards. The development of a robust system of descriptors ('cross-thesaurus') is a crucial activity in the production of combinatorial terminological systems. We developed a tool (I-BROWSE) to produce a cross-thesaurus by analysing existing terminological corpora. To facilitate the work of experts and to produce re-usable results, our application interacts via the Internet with the UMLS Knowledge Sources Server. We applied our tool on 6372 dissections on surgical procedures produced in the project GALEN-IN-USE, as a part of the internal Quality Assurance Program. Support from UMLS seems mostly promising about descriptors on , , and . Additional assistance can be given to domain experts on less frequent descriptors on pervasive modifiers. We plan to apply our tool also to production of terminological standards in CEN, as a part of a world-wide process of gradual convergence and transformation of coding systems into second-generation systems and terminological services.
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The purpose of anatomy education is to develop the skills for anatomical reasoning, which is a requirement for performing a number of clinical tasks. Anatomical reasoning integrates an understanding of the three-dimensional (3-D) geometry of the body and its parts (the spatial domain of anatomical information) with an understanding of functional, developmental, pathological, and other relationships among anatomic entities (the symbolic domain of anatomical information). Traditional methods in anatomy have substantial shortcomings for representing and integrating these two information domains. Computer-based methods of knowledge representation have a great potential for overcoming the shortcomings and for promoting anatomical reasoning. To realize this potential, there is a need for (1) establishing 3-D electronic atlases of the human body; (2) generating models of symbolic anatomical information, and (3) developing computer programs (user interfaces) that integrate these knowledge sources and serve the needs of trainees and practitioners in different fields of the health sciences. The Digital Anatomist Program at the University of Washington has begun to build such a client-server framework for anatomical information, and its application for biomedical education is being evaluated.
Many medical schools today are questioning whether they should implement a problem-based learning (PBL) curriculum. Educators have raised serious questions regarding the efficiency of PBL and therefore recommend learning more about the cognitive processes developed by PBL before implementing it broadly. In addition, it is important to determine whether PBL best matches the human reasoning process. The authors' theoretical discussion examines the relationship between the case-based reasoning (CBR) model and the PBL model. CBR indicates that the knowledge source one uses while solving a new problem includes not only generalized rules or general cases, but often a memory of stored cases recording specific prior episodes. CBR enables the reasoner to recommend solutions to problems quickly and to propose solutions in domains that are not completely understood, such as medicine. The authors' analysis reveals a strong association between the CBR and PBL models, and thus it can be argued that PBL is a successful teaching method that should be encouraged by medical schools.
Approximately 15% of ischemic strokes are the result of an embolism from a cardiac source. Patients with nonvalvular atrial fibrillation, acute myocardial infarction, ventricular aneurysm, rheumatic heart disease, prosthetic heart valves and other less common cardiac disorders are at an increased risk for cardioembolic stroke. Clinicians must distinguish cardioembolic from atherosclerotic strokes to provide unique management for each patient. The nurse plays a dynamic role in diagnosis, education and treatment of patients at risk or who have had a stroke from a cardiac source. Knowledge of the pathophysiologic mechanisms and treatment options is essential for the nurse to adequately manage patient care.
Nowadays, information fusion constitutes a challenging research topic. Our study proposes to achieve the fusion of several knowledge sources. This, in order to detect the esophagus inner wall from ultrasound medical images. After a brief description of information fusion concepts, we propose a system architecture including both model and data fusion. The data fusion is accomplished using fuzzy modeling, which can be seen as a monosensor/multiple sources data fusion system. The model fusion is performed using a full-adapted snake theory, which projects the fuzzy decision into the binary decision space.
After five patients were diagnosed with nosocomial invasive aspergillosis caused by Aspergillus fumigatus and A. flavus, a 14-month surveillance program for pathogenic and nonpathogenic fungal conidia in the air within and outside the University Hospital in Rotterdam (The Netherlands) was begun. A. fumigatus isolates obtained from the Department of Hematology were studied for genetic relatedness by randomly amplified polymorphic DNA (RAPD) analysis. This was repeated with A. fumigatus isolates contaminating culture media in the microbiology laboratory. The density of the conidia of nonpathogenic fungi in the outside air showed a seasonal variation: higher densities were measured during the summer, while lower densities were determined during the fall and winter. Hardly any variation was found in the numbers of Aspergillus conidia. We found decreasing numbers of conidia when comparing air from outside the hospital to that inside the hospital and when comparing open areas within the hospital to the closed department of hematology. The increase in the number of patients with invasive aspergillosis could not be explained by an increase in the number of Aspergillus conidia in the outside air. The short-term presence of A. flavus can only be explained by the presence of a point source, which was probably patient related. Genotyping A. fumigatus isolates from the department of hematology showed that clonally related isolates were persistently present for more than 1 year. Clinical isolates of A. fumigatus obtained during the outbreak period were different from these persistent clones. A. fumigatus isolates contaminating culture media were all genotypically identical, indicating a causative point source. Knowledge of the epidemiology of Aspergillus species is necessary for the development of strategies to prevent invasive aspergillosis. RAPD fingerprinting of Aspergillus isolates can help to determine the cause of an outbreak of invasive aspergillosis.
OBJECTIVE: Development of a general natural-language processor that identifies clinical information in narrative reports and maps that information into a structured representation containing clinical terms. DESIGN: The natural-language processor provides three phases of processing, all of which are driven by different knowledge sources. The first phase performs the parsing. It identifies the structure of the text through use of a grammar that defines semantic patterns and a target form. The second phase, regularization, standardizes the terms in the initial target structure via a compositional mapping of multi-word phrases. The third phase, encoding, maps the terms to a controlled vocabulary. Radiology is the test domain for the processor and the target structure is a formal model for representing clinical information in that domain. MEASUREMENTS: The impression sections of 230 radiology reports were encoded by the processor. Results of an automated query of the resultant database for the occurrences of four diseases were compared with the analysis of a panel of three physicians to determine recall and precision. RESULTS: Without training specific to the four diseases, recall and precision of the system (combined effect of the processor and query generator) were 70% and 87%. Training of the query component increased recall to 85% without changing precision.
The National Library of Medicine (NLM) and the Agency for Health Care Policy and Research (AHCPR) are sponsoring a test to determine the extent to which a combination of existing health-related terminologies covers vocabulary needed in health information systems. The test vocabularies are the 30 that are fully or partially represented in the 1996 edition of the Unified Medical Language System (UMLS) Metathesaurus, plus three planned additions: the portions of SNOMED International not in the 1996 Metathesaurus Read Clinical Classification, and the Logical Observations Identifiers, Names, and Codes (LOINC) system. These vocabularies are available to testers through a special interface to the Internet-based UMLS Knowledge Source Server. The test will determine the ability of the test vocabularies to serve as a source of controlled vocabulary for health data systems and applications. It should provide the basis for realistic resource estimates for developing and maintaining a comprehensive "standard" health vocabulary that is based on existing terminologies.
Emphysematous (gas-forming) infections of the abdomen and pelvis represent potentially life-threatening conditions that require aggressive medical and often surgical management. The initial clinical manifestation of these entities may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. However, when a differential diagnosis remains, or if further localization or confirmation of tentative findings is needed, computed tomography (CT) should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Of equal importance may be the capability of CT to help reliably identify benign sources of gas, because treatment (if any) varies dramatically depending on the source. Knowledge of the pathophysiologic characteristics, common predisposing conditions, and typical imaging features associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will help make early diagnosis and successful treatment possible. In addition, such knowledge will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response.
The status of preventive social work in the United States is reviewed, as are the three knowledge sources used in the teaching and practice of prevention: public health, mental health, and social work. The integration of concepts of prevention in social work curricula and practice are discussed, and new directions for its use are projected.
This study evaluated the effects of peer counseling in a culturally specific adolescent pregnancy prevention program for African American females. A random pretest and multiple posttest experimental and comparison group design was used to obtain data on a sample of 63 female African American adolescents, ages 12 to 16, who lived in four public housing developments. Descriptive data and tests of significance revealed that none of the participants who received peer counseling became pregnant within three months of the intervention. Findings revealed a statistically significant increase in reproductive and other self-related knowledge topics among the experimental group when comparing pretest and eight-week posttest scores. Most participants had not had sexual intercourse; the average age of sexual onset was 12 years in the experimental group and 11 years in the controls. Designing and implementing culturally specific adolescent pregnancy prevention programs for adolescents younger than age 11 and/or before sexually active seems appropriate.
A cryptic fungal endophyte, Neotyphodium coenophialum, infects most tall fescue (Festuca arundinacea) pastures in the United States. Cattle, sheep, and horses that consume the endophyte-infected grass can suffer fescue toxicosis caused by toxic alkaloids in the infected plants. The effects of the endophyte on mammalian herbivores have been well documented, but less is known regarding the quality of the grass (infected vs noninfected) as a food material for soil invertebrates. We conducted 21-d tests with earthworms (Eisenia fetida) to determine the nutritional quality of endophyte-infected and noninfected tall fescue leaf and root tissues. Earthworm survival, growth, and reproduction were measured in each treatment combination of tissue type and infection status. Earthworm survival was 100% in all treatments. Tall fescue tissue type (leaf vs root) and infection status (present or absent) both significantly affected E. fetida growth and reproduction. The earthworms grew and had moderate levels of reproduction in replicates containing tall fescue leaf tissue as the sole food source regardless of the endophyte-infection status, but earthworms lost weight and had less reproduction in replicates where tall fescue root tissue was the sole food source. An unexpected effect of infection status on earthworm growth in the tall fescue leaf-tissue treatments was also evident: mean growth of E. fetida with access to endophyte-infected leaf tissue as the sole food source was 3.6-fold greater than mean growth of E. fetida with access to noninfected leaf tissue as the sole food source. Knowledge regarding the relative effects of endophyte status of tall fescue on soil organisms may allow the development of more effective environmental management strategies at sites where tall fescue is being considered for use in phytoremediation or for vegetative cover. Investigators working with tall fescue should be alert to the possibility of endophyte-mediated effects of tall fescue on other organisms and, at a minimum, should provide information regarding the grass's infection status when reporting the results of studies that involve use of tall fescue.
Professionals working with low vision persons may find themselves in the situation where they are either the first or only contact known to their patient. Because one person is usually not able to fulfill the diverse needs of the visually impaired individual, he may find it necessary to refer patients to other sources. Knowledge of the role of other related professionals and their availability in the community may make the difference between a fragmetned receipt of services or a total approach to vision rehabilitation.