Proposed Rule for Modification of Federal On Board Diagnostic Regulations for: Light Duty Vehicles, Light Duty Trucks, Medium Duty Passenger Vehicles, Complete Heavy Duty Vehicles and Engines Intended for Use in Heavy Duty Vehicles Weighing 14,000 Pounds

EPA Pesticide Factsheets

Following is information for the proposed rule for the Modification of Federal On Board Diagnostic Regulations for Light-Duty Vehicles, Light-Duty Trucks, etc. Includes links to Federal Register and final rule.

Optimizing Diagnostic Imaging in the Emergency Department

PubMed Central

Mills, Angela M.; Raja, Ali S.; Marin, Jennifer R.

2015-01-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging in order to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. PMID:25731864

Optimizing diagnostic imaging in the emergency department.

PubMed

Mills, Angela M; Raja, Ali S; Marin, Jennifer R

2015-05-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. © 2015 by the Society for Academic Emergency Medicine.

Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis.

PubMed

Stefanopoulou, Evgenia; Manoharan, Andiappan; Landau, Sabine; Geddes, John R; Goodwin, Guy; Frangou, Sophia

2009-01-01

There is considerable evidence for cognitive dysfunction in schizophrenia and affective disorders, but the pattern of potential similarities or differences between diagnostic groups remains uncertain. The objective of this study was to conduct a quantitative review of studies on cognitive performance in schizophrenia and affective disorders. Relevant articles were identified through literature search in major databases for the period between January 1980 and December 2005. Meta-analytic treatment of the original studies revealed widespread cognitive deficits in patients with schizophrenia and affective disorders in intellectual ability and speed of information processing, in encoding and retrieval, rule discovery and in response generation and response inhibition. Differences between diagnostic groups were quantitative rather than qualitative.

Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review

PubMed Central

Michaleff, Zoe A.; Maher, Chris G.; Verhagen, Arianne P.; Rebbeck, Trudy; Lin, Chung-Wei Christine

2012-01-01

Background: There is uncertainty about the optimal approach to screen for clinically important cervical spine (C-spine) injury following blunt trauma. We conducted a systematic review to investigate the diagnostic accuracy of the Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria, 2 rules that are available to assist emergency physicians to assess the need for cervical spine imaging. Methods: We identified studies by an electronic search of CINAHL, Embase and MEDLINE. We included articles that reported on a cohort of patients who experienced blunt trauma and for whom clinically important cervical spine injury detectable by diagnostic imaging was the differential diagnosis; evaluated the diagnostic accuracy of the Canadian C-spine rule or NEXUS or both; and used an adequate reference standard. We assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies criteria. We used the extracted data to calculate sensitivity, specificity, likelihood ratios and post-test probabilities. Results: We included 15 studies of modest methodologic quality. For the Canadian C-spine rule, sensitivity ranged from 0.90 to 1.00 and specificity ranged from 0.01 to 0.77. For NEXUS, sensitivity ranged from 0.83 to 1.00 and specificity ranged from 0.02 to 0.46. One study directly compared the accuracy of these 2 rules using the same cohort and found that the Canadian C-spine rule had better accuracy. For both rules, a negative test was more informative for reducing the probability of a clinically important cervical spine injury. Interpretation: Based on studies with modest methodologic quality and only one direct comparison, we found that the Canadian C-spine rule appears to have better diagnostic accuracy than the NEXUS criteria. Future studies need to follow rigorous methodologic procedures to ensure that the findings are as free of bias as possible. PMID:23048086

Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis.

PubMed

Lee, Kwang-Hoon; Choi, Sang-Tae; Lee, Soo-Kyung; Lee, Joo-Hyun; Yoon, Bo-Young

2015-06-01

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more 'high', and less 'low' probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

An Embedded Rule-Based Diagnostic Expert System in Ada

NASA Technical Reports Server (NTRS)

Jones, Robert E.; Liberman, Eugene M.

1992-01-01

Ada is becoming an increasingly popular programming language for large Government-funded software projects. Ada with it portability, transportability, and maintainability lends itself well to today's complex programming environment. In addition, expert systems have also assumed a growing role in providing human-like reasoning capability expertise for computer systems. The integration is discussed of expert system technology with Ada programming language, especially a rule-based expert system using an ART-Ada (Automated Reasoning Tool for Ada) system shell. NASA Lewis was chosen as a beta test site for ART-Ada. The test was conducted by implementing the existing Autonomous Power EXpert System (APEX), a Lisp-based power expert system, in ART-Ada. Three components, the rule-based expert systems, a graphics user interface, and communications software make up SMART-Ada (Systems fault Management with ART-Ada). The rules were written in the ART-Ada development environment and converted to Ada source code. The graphics interface was developed with the Transportable Application Environment (TAE) Plus, which generates Ada source code to control graphics images. SMART-Ada communicates with a remote host to obtain either simulated or real data. The Ada source code generated with ART-Ada, TAE Plus, and communications code was incorporated into an Ada expert system that reads the data from a power distribution test bed, applies the rule to determine a fault, if one exists, and graphically displays it on the screen. The main objective, to conduct a beta test on the ART-Ada rule-based expert system shell, was achieved. The system is operational. New Ada tools will assist in future successful projects. ART-Ada is one such tool and is a viable alternative to the straight Ada code when an application requires a rule-based or knowledge-based approach.

Intelligent Diagnostic Assistant for Complicated Skin Diseases through C5's Algorithm.

PubMed

Jeddi, Fatemeh Rangraz; Arabfard, Masoud; Kermany, Zahra Arab

2017-09-01

Intelligent Diagnostic Assistant can be used for complicated diagnosis of skin diseases, which are among the most common causes of disability. The aim of this study was to design and implement a computerized intelligent diagnostic assistant for complicated skin diseases through C5's Algorithm. An applied-developmental study was done in 2015. Knowledge base was developed based on interviews with dermatologists through questionnaires and checklists. Knowledge representation was obtained from the train data in the database using Excel Microsoft Office. Clementine Software and C5's Algorithms were applied to draw the decision tree. Analysis of test accuracy was performed based on rules extracted using inference chains. The rules extracted from the decision tree were entered into the CLIPS programming environment and the intelligent diagnostic assistant was designed then. The rules were defined using forward chaining inference technique and were entered into Clips programming environment as RULE. The accuracy and error rates obtained in the training phase from the decision tree were 99.56% and 0.44%, respectively. The accuracy of the decision tree was 98% and the error was 2% in the test phase. Intelligent diagnostic assistant can be used as a reliable system with high accuracy, sensitivity, specificity, and agreement.

Diagnostic Value of Run Chart Analysis: Using Likelihood Ratios to Compare Run Chart Rules on Simulated Data Series

PubMed Central

Anhøj, Jacob

2015-01-01

Run charts are widely used in healthcare improvement, but there is little consensus on how to interpret them. The primary aim of this study was to evaluate and compare the diagnostic properties of different sets of run chart rules. A run chart is a line graph of a quality measure over time. The main purpose of the run chart is to detect process improvement or process degradation, which will turn up as non-random patterns in the distribution of data points around the median. Non-random variation may be identified by simple statistical tests including the presence of unusually long runs of data points on one side of the median or if the graph crosses the median unusually few times. However, there is no general agreement on what defines “unusually long” or “unusually few”. Other tests of questionable value are frequently used as well. Three sets of run chart rules (Anhoej, Perla, and Carey rules) have been published in peer reviewed healthcare journals, but these sets differ significantly in their sensitivity and specificity to non-random variation. In this study I investigate the diagnostic values expressed by likelihood ratios of three sets of run chart rules for detection of shifts in process performance using random data series. The study concludes that the Anhoej rules have good diagnostic properties and are superior to the Perla and the Carey rules. PMID:25799549

42 CFR 415.180 - Teaching setting requirements for the interpretation of diagnostic radiology and other diagnostic...

Code of Federal Regulations, 2011 CFR

2011-10-01

... interpretation of diagnostic radiology and other diagnostic tests. 415.180 Section 415.180 Public Health CENTERS... for the interpretation of diagnostic radiology and other diagnostic tests. (a) General rule. Physician fee schedule payment is made for the interpretation of diagnostic radiology and other diagnostic tests...

42 CFR 415.180 - Teaching setting requirements for the interpretation of diagnostic radiology and other diagnostic...

Code of Federal Regulations, 2010 CFR

2010-10-01

... interpretation of diagnostic radiology and other diagnostic tests. 415.180 Section 415.180 Public Health CENTERS... for the interpretation of diagnostic radiology and other diagnostic tests. (a) General rule. Physician fee schedule payment is made for the interpretation of diagnostic radiology and other diagnostic tests...

R package PRIMsrc: Bump Hunting by Patient Rule Induction Method for Survival, Regression and Classification

PubMed Central

Dazard, Jean-Eudes; Choe, Michael; LeBlanc, Michael; Rao, J. Sunil

2015-01-01

PRIMsrc is a novel implementation of a non-parametric bump hunting procedure, based on the Patient Rule Induction Method (PRIM), offering a unified treatment of outcome variables, including censored time-to-event (Survival), continuous (Regression) and discrete (Classification) responses. To fit the model, it uses a recursive peeling procedure with specific peeling criteria and stopping rules depending on the response. To validate the model, it provides an objective function based on prediction-error or other specific statistic, as well as two alternative cross-validation techniques, adapted to the task of decision-rule making and estimation in the three types of settings. PRIMsrc comes as an open source R package, including at this point: (i) a main function for fitting a Survival Bump Hunting model with various options allowing cross-validated model selection to control model size (#covariates) and model complexity (#peeling steps) and generation of cross-validated end-point estimates; (ii) parallel computing; (iii) various S3-generic and specific plotting functions for data visualization, diagnostic, prediction, summary and display of results. It is available on CRAN and GitHub. PMID:26798326

The diagnostic accuracy of Clinical Dehydration Scale in identifying dehydration in children with acute gastroenteritis: a systematic review.

PubMed

Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

2014-10-01

To systematically update diagnostic accuracy of the Clinical Dehydration Scale (CDS) in clinical recognition of dehydration in children with acute gastroenteritis. Six databases were searched for diagnostic accuracy studies in which population were children aged 1 to 36 months with acute gastroenteritis; index test was the CDS; and reference test was post-illness weight gain. Three studies involving 360 children were included. Limited evidence showed that in high-income countries the CDS provides strong diagnostic accuracy for ruling in moderate and severe (>6%) dehydration (positive likelihood ratio 5.2-6.6), but has limited value for ruling it out (negative likelihood ratio 0.4-0.55). In low-income countries, the CDS has limited value either for ruling moderate or severe dehydration in or out. In both settings, the CDS had limited value for ruling in or out dehydration <3% or dehydration 3% to 6%. The CDS can help assess moderate to severe dehydration in high-income settings. Given the limited data, the evidence should be viewed with caution. © The Author(s) 2014.

Value of transmission electron microscopy for primary ciliary dyskinesia diagnosis in the era of molecular medicine: Genetic defects with normal and non-diagnostic ciliary ultrastructure.

PubMed

Shapiro, Adam J; Leigh, Margaret W

2017-01-01

Primary ciliary dyskinesia (PCD) is a genetic disorder causing chronic oto-sino-pulmonary disease. No single diagnostic test will detect all PCD cases. Transmission electron microscopy (TEM) of respiratory cilia was previously considered the gold standard diagnostic test for PCD, but 30% of all PCD cases have either normal ciliary ultrastructure or subtle changes which are non-diagnostic. These cases are identified through alternate diagnostic tests, including nasal nitric oxide measurement, high-speed videomicroscopy analysis, immunofluorescent staining of axonemal proteins, and/or mutation analysis of various PCD causing genes. Autosomal recessive mutations in DNAH11 and HYDIN produce normal TEM ciliary ultrastructure, while mutations in genes encoding for radial spoke head proteins result in some cross-sections with non-diagnostic alterations in the central apparatus interspersed with normal ciliary cross-sections. Mutations in nexin link and dynein regulatory complex genes lead to a collection of different ciliary ultrastructures; mutations in CCDC65, CCDC164, and GAS8 produce normal ciliary ultrastructure, while mutations in CCDC39 and CCDC40 cause absent inner dynein arms and microtubule disorganization in some ciliary cross-sections. Mutations in CCNO and MCIDAS cause near complete absence of respiratory cilia due to defects in generation of multiple cellular basal bodies; however, the scant cilia generated may have normal ultrastructure. Lastly, a syndromic form of PCD with retinal degeneration results in normal ciliary ultrastructure through mutations in the RPGR gene. Clinicians must be aware of these genetic causes of PCD resulting in non-diagnostic TEM ciliary ultrastructure and refrain from using TEM of respiratory cilia as a test to rule out PCD.

Learning Parsimonious Classification Rules from Gene Expression Data Using Bayesian Networks with Local Structure.

PubMed

Lustgarten, Jonathan Lyle; Balasubramanian, Jeya Balaji; Visweswaran, Shyam; Gopalakrishnan, Vanathi

2017-03-01

The comprehensibility of good predictive models learned from high-dimensional gene expression data is attractive because it can lead to biomarker discovery. Several good classifiers provide comparable predictive performance but differ in their abilities to summarize the observed data. We extend a Bayesian Rule Learning (BRL-GSS) algorithm, previously shown to be a significantly better predictor than other classical approaches in this domain. It searches a space of Bayesian networks using a decision tree representation of its parameters with global constraints, and infers a set of IF-THEN rules. The number of parameters and therefore the number of rules are combinatorial to the number of predictor variables in the model. We relax these global constraints to a more generalizable local structure (BRL-LSS). BRL-LSS entails more parsimonious set of rules because it does not have to generate all combinatorial rules. The search space of local structures is much richer than the space of global structures. We design the BRL-LSS with the same worst-case time-complexity as BRL-GSS while exploring a richer and more complex model space. We measure predictive performance using Area Under the ROC curve (AUC) and Accuracy. We measure model parsimony performance by noting the average number of rules and variables needed to describe the observed data. We evaluate the predictive and parsimony performance of BRL-GSS, BRL-LSS and the state-of-the-art C4.5 decision tree algorithm, across 10-fold cross-validation using ten microarray gene-expression diagnostic datasets. In these experiments, we observe that BRL-LSS is similar to BRL-GSS in terms of predictive performance, while generating a much more parsimonious set of rules to explain the same observed data. BRL-LSS also needs fewer variables than C4.5 to explain the data with similar predictive performance. We also conduct a feasibility study to demonstrate the general applicability of our BRL methods on the newer RNA sequencing gene-expression data.

Comparison of dermatoscopic diagnostic algorithms based on calculation: The ABCD rule of dermatoscopy, the seven-point checklist, the three-point checklist and the CASH algorithm in dermatoscopic evaluation of melanocytic lesions.

PubMed

Unlu, Ezgi; Akay, Bengu N; Erdem, Cengizhan

2014-07-01

Dermatoscopic analysis of melanocytic lesions using the CASH algorithm has rarely been described in the literature. The purpose of this study was to compare the sensitivity, specificity, and diagnostic accuracy rates of the ABCD rule of dermatoscopy, the seven-point checklist, the three-point checklist, and the CASH algorithm in the diagnosis and dermatoscopic evaluation of melanocytic lesions on the hairy skin. One hundred and fifteen melanocytic lesions of 115 patients were examined retrospectively using dermatoscopic images and compared with the histopathologic diagnosis. Four dermatoscopic algorithms were carried out for all lesions. The ABCD rule of dermatoscopy showed sensitivity of 91.6%, specificity of 60.4%, and diagnostic accuracy of 66.9%. The seven-point checklist showed sensitivity, specificity, and diagnostic accuracy of 87.5, 65.9, and 70.4%, respectively; the three-point checklist 79.1, 62.6, 66%; and the CASH algorithm 91.6, 64.8, and 70.4%, respectively. To our knowledge, this is the first study that compares the sensitivity, specificity and diagnostic accuracy of the ABCD rule of dermatoscopy, the three-point checklist, the seven-point checklist, and the CASH algorithm for the diagnosis of melanocytic lesions on the hairy skin. In our study, the ABCD rule of dermatoscopy and the CASH algorithm showed the highest sensitivity for the diagnosis of melanoma. © 2014 Japanese Dermatological Association.

Defining the Needs for Next Generation Assays for Tuberculosis

PubMed Central

Denkinger, Claudia M.; Kik, Sandra V.; Cirillo, Daniela Maria; Casenghi, Martina; Shinnick, Thomas; Weyer, Karin; Gilpin, Chris; Boehme, Catharina C.; Schito, Marco; Kimerling, Michael; Pai, Madhukar

2015-01-01

To accelerate the fight against tuberculosis, major diagnostic challenges need to be addressed urgently. Post-2015 targets are unlikely to be met without the use of novel diagnostics that are more accurate and can be used closer to where patients first seek care in affordable diagnostic algorithms. This article describes the efforts by the stakeholder community that led to the identification of the high-priority diagnostic needs in tuberculosis. Subsequently target product profiles for the high-priority diagnostic needs were developed and reviewed in a World Health Organization (WHO)-led consensus meeting. The high-priority diagnostic needs included (1) a sputum-based replacement test for smear-microscopy; (2) a non-sputum-based biomarker test for all forms of tuberculosis, ideally suitable for use at levels below microscopy centers; (3) a simple, low cost triage test for use by first-contact care providers as a rule-out test, ideally suitable for use by community health workers; and (4) a rapid drug susceptibility test for use at the microscopy center level. The developed target product profiles, along with complimentary work presented in this supplement, will help to facilitate the interaction between the tuberculosis community and the diagnostics industry with the goal to lead the way toward the post-2015 global tuberculosis targets. PMID:25765104

Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome.

PubMed

Greenslade, Jaimi H; Carlton, Edward W; Van Hise, Christopher; Cho, Elizabeth; Hawkins, Tracey; Parsonage, William A; Tate, Jillian; Ungerer, Jacobus; Cullen, Louise

2018-04-01

This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome. Measures of diagnostic accuracy for each rule were calculated. Data included 96 patients (5.3%) with acute myocardial infarction and 139 (7.7%) with acute coronary syndrome. The new Vancouver Chest Pain Rule and No Objective Testing Rule had high sensitivity for acute myocardial infarction (100%; 95% confidence interval [CI] 96.2% to 100% for both) and acute coronary syndrome (98.6% [95% CI 94.9% to 99.8%] and 99.3% [95% CI 96.1% to 100%]). The m-ADAPT, EDACS, and HEART pathways also yielded high sensitivity for acute myocardial infarction (96.9% [95% CI 91.1% to 99.4%] for m-ADAPT and 97.9% [95% CI 92.7% to 99.7%] for EDACS and HEART), but lower sensitivity for acute coronary syndrome (≤95.0% for all). The m-ADAPT, EDACS, and HEART rules classified more patients as being at low risk (64.3%, 62.5%, and 49.8%, respectively) than the new Vancouver Chest Pain Rule and No Objective Testing Rule (28.2% and 34.5%, respectively). In this cohort with a low prevalence of acute myocardial infarction and acute coronary syndrome, using the Beckman's Access high-sensitivity troponin I assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled approximately one third of patients to be safely discharged after 2-hour risk stratification with no further testing. The EDACS, m-ADAPT, or HEART pathway enabled half of ED patients to be rapidly referred for objective testing. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

On recursion.

PubMed

Watumull, Jeffrey; Hauser, Marc D; Roberts, Ian G; Hornstein, Norbert

2014-01-08

It is a truism that conceptual understanding of a hypothesis is required for its empirical investigation. However, the concept of recursion as articulated in the context of linguistic analysis has been perennially confused. Nowhere has this been more evident than in attempts to critique and extend Hauseretal's. (2002) articulation. These authors put forward the hypothesis that what is uniquely human and unique to the faculty of language-the faculty of language in the narrow sense (FLN)-is a recursive system that generates and maps syntactic objects to conceptual-intentional and sensory-motor systems. This thesis was based on the standard mathematical definition of recursion as understood by Gödel and Turing, and yet has commonly been interpreted in other ways, most notably and incorrectly as a thesis about the capacity for syntactic embedding. As we explain, the recursiveness of a function is defined independent of such output, whether infinite or finite, embedded or unembedded-existent or non-existent. And to the extent that embedding is a sufficient, though not necessary, diagnostic of recursion, it has not been established that the apparent restriction on embedding in some languages is of any theoretical import. Misunderstanding of these facts has generated research that is often irrelevant to the FLN thesis as well as to other theories of language competence that focus on its generative power of expression. This essay is an attempt to bring conceptual clarity to such discussions as well as to future empirical investigations by explaining three criterial properties of recursion: computability (i.e., rules in intension rather than lists in extension); definition by induction (i.e., rules strongly generative of structure); and mathematical induction (i.e., rules for the principled-and potentially unbounded-expansion of strongly generated structure). By these necessary and sufficient criteria, the grammars of all natural languages are recursive.

On recursion

PubMed Central

Watumull, Jeffrey; Hauser, Marc D.; Roberts, Ian G.; Hornstein, Norbert

2014-01-01

It is a truism that conceptual understanding of a hypothesis is required for its empirical investigation. However, the concept of recursion as articulated in the context of linguistic analysis has been perennially confused. Nowhere has this been more evident than in attempts to critique and extend Hauseretal's. (2002) articulation. These authors put forward the hypothesis that what is uniquely human and unique to the faculty of language—the faculty of language in the narrow sense (FLN)—is a recursive system that generates and maps syntactic objects to conceptual-intentional and sensory-motor systems. This thesis was based on the standard mathematical definition of recursion as understood by Gödel and Turing, and yet has commonly been interpreted in other ways, most notably and incorrectly as a thesis about the capacity for syntactic embedding. As we explain, the recursiveness of a function is defined independent of such output, whether infinite or finite, embedded or unembedded—existent or non-existent. And to the extent that embedding is a sufficient, though not necessary, diagnostic of recursion, it has not been established that the apparent restriction on embedding in some languages is of any theoretical import. Misunderstanding of these facts has generated research that is often irrelevant to the FLN thesis as well as to other theories of language competence that focus on its generative power of expression. This essay is an attempt to bring conceptual clarity to such discussions as well as to future empirical investigations by explaining three criterial properties of recursion: computability (i.e., rules in intension rather than lists in extension); definition by induction (i.e., rules strongly generative of structure); and mathematical induction (i.e., rules for the principled—and potentially unbounded—expansion of strongly generated structure). By these necessary and sufficient criteria, the grammars of all natural languages are recursive. PMID:24409164

IOTA Simple Rules in Differentiating between Benign and Malignant Adnexal Masses by Non-expert Examiners.

PubMed

Tinnangwattana, Dangcheewan; Vichak-Ururote, Linlada; Tontivuthikul, Paponrad; Charoenratana, Cholaros; Lerthiranwong, Thitikarn; Tongsong, Theera

2015-01-01

To evaluate the diagnostic performance of IOTA simple rules in predicting malignant adnexal tumors by non-expert examiners. Five obstetric/gynecologic residents, who had never performed gynecologic ultrasound examination by themselves before, were trained for IOTA simple rules by an experienced examiner. One trained resident performed ultrasound examinations including IOTA simple rules on 100 women, who were scheduled for surgery due to ovarian masses, within 24 hours of surgery. The gold standard diagnosis was based on pathological or operative findings. The five-trained residents performed IOTA simple rules on 30 patients for evaluation of inter-observer variability. A total of 100 patients underwent ultrasound examination for the IOTA simple rules. Of them, IOTA simple rules could be applied in 94 (94%) masses including 71 (71.0%) benign masses and 29 (29.0%) malignant masses. The diagnostic performance of IOTA simple rules showed sensitivity of 89.3% (95%CI, 77.8%; 100.7%), specificity 83.3% (95%CI, 74.3%; 92.3%). Inter-observer variability was analyzed using Cohen's kappa coefficient. Kappa indices of the four pairs of raters are 0.713-0.884 (0.722, 0.827, 0.713, and 0.884). IOTA simple rules have high diagnostic performance in discriminating adnexal masses even when are applied by non-expert sonographers, though a training course may be required. Nevertheless, they should be further tested by a greater number of general practitioners before widely use.

Expert systems for diagnostic purposes, prospected applications to the radar field

NASA Astrophysics Data System (ADS)

Filippi, Riccardo

Expert systems applied to fault diagnosis, particularly electrical circuit troubleshooting, are introduced. Diagnostic systems consisting of sequences of rules of the symptom-disease type (rule based system) and systems based upon a physical and functional description of the unit subjected to fault diagnosis are treated. Application of such systems to radar equipment troubleshooting, in particular to the transmitter, is discussed.

Comparison of Effectiveness in Differentiating Benign from Malignant Ovarian Masses between IOTA Simple Rules and Subjective Sonographic Assessment.

PubMed

Tongsong, Theera; Tinnangwattana, Dangcheewan; Vichak-Ururote, Linlada; Tontivuthikul, Paponrad; Charoenratana, Cholaros; Lerthiranwong, Thitikarn

2016-01-01

To compare diagnostic performance in differentiating benign from malignant ovarian masses between IOTA (the International Ovarian Tumor Analysis) simple rules and subjective sonographic assessment. Women scheduled for elective surgery because of ovarian masses were recruited into the study and underwent ultrasound examination within 24 hours of surgery to apply the IOTA simple rules by general gynecologists and to record video clips for subjective assessment by an experienced sonographer. The diagnostic performance of the IOTA rules and subjective assessment for differentiation between benign and malignant masses was compared. The gold standard diagnosis was pathological or operative findings. A total of 150 ovarian masses were covered, comprising 105 (70%) benign and 45 (30%) malignant. Of them, the IOTA simple rules could be applied in 119 (79.3%) and were inconclusive in 31 (20.7%) whereas subjective assessment could be applied in all cases (100%). The sensitivity and the specificity of the IOTA simple rules and subjective assessment were not significantly different, 82.9% vs 86.7% and 94.0% vs 94.3% respectively. The agreement of the two methods in prediction was high with a Kappa index of 0.835. Both techniques had a high diagnostic performance in differentiation between benign and malignant ovarian masses but the IOTA rules had a relatively high rate of inconclusive results. The IOTA rules can be used as an effective screening technique by general gynecologists but when the results are inconclusive they should consult experienced sonographers.

Combining High Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction.

PubMed

van der Linden, Noreen; Wildi, Karin; Twerenbold, Raphael; Pickering, John W; Than, Martin; Cullen, Louise; Greenslade, Jaimi; Parsonage, William; Nestelberger, Thomas; Boeddinghaus, Jasper; Badertscher, Patrick; Rubini Giménez, Maria; Klinkenberg, Lieke J J; Bekers, Otto; Schöni, Aline; Keller, Dagmar I; Sabti, Zaid; Puelacher, Christian; Cupa, Janosch; Schumacher, Lukas; Kozhuharov, Nikola; Grimm, Karin; Shrestha, Samyut; Flores, Dayana; Freese, Michael; Stelzig, Claudia; Strebel, Ivo; Miró, Òscar; Rentsch, Katharina; Morawiec, Beata; Kawecki, Damian; Kloos, Wanda; Lohrmann, Jens; Richards, A Mark; Troughton, Richard; Pemberton, Christopher; Osswald, Stefan; van Dieijen-Visser, Marja P; Mingels, Alma M; Reichlin, Tobias; Meex, Steven J R; Mueller, Christian

2018-04-24

Background -Combining two signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction (AMI) with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of AMI. Methods -The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected AMI. The optimal rule out and rule in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule out was compared with the ESC 0/1 and 0/3 hour algorithms. Results -Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the ESC 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule out criteria after the baseline blood sampling was limited (6-24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng2/L2) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34-41% in the original (sum: negative predictive value (NPV) 100% (95%CI: 99.5-100%); product: NPV 100% (95%CI: 99.5-100%) and in the validation cohort (sum: NPV 99.6% (95%CI: 99.0-99.9%); product: NPV 99.4% (95%CI: 98.8-99.8%). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule out (40-43% ruled out; NPV original cohort 99.9% (95%CI: 99.2-100%); NPV validation cohort 99.5% (95%CI: 98.9-99.8%)) and rule-in (PPV original cohort 74.4% (95%Cl 69.6-78.8%); PPV validation cohort 84.0% (95%Cl 79.7-87.6%)). Conclusions -New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of AMI. Clinical Trial Registration -APACE URL: www.clinicaltrial.gov, Unique Identifier: NCT00470587; ADAPT URL: www.anzctr.org.au, Unique Identifier: ACTRN12611001069943.

A rule-based software test data generator

NASA Technical Reports Server (NTRS)

Deason, William H.; Brown, David B.; Chang, Kai-Hsiung; Cross, James H., II

1991-01-01

Rule-based software test data generation is proposed as an alternative to either path/predicate analysis or random data generation. A prototype rule-based test data generator for Ada programs is constructed and compared to a random test data generator. Four Ada procedures are used in the comparison. Approximately 2000 rule-based test cases and 100,000 randomly generated test cases are automatically generated and executed. The success of the two methods is compared using standard coverage metrics. Simple statistical tests showing that even the primitive rule-based test data generation prototype is significantly better than random data generation are performed. This result demonstrates that rule-based test data generation is feasible and shows great promise in assisting test engineers, especially when the rule base is developed further.

ADAM: An Accident Diagnostic,Analysis and Management System - Applications to Severe Accident Simulation and Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zavisca, M.J.; Khatib-Rahbar, M.; Esmaili, H.

2002-07-01

The Accident Diagnostic, Analysis and Management (ADAM) computer code has been developed as a tool for on-line applications to accident diagnostics, simulation, management and training. ADAM's severe accident simulation capabilities incorporate a balance of mechanistic, phenomenologically based models with simple parametric approaches for elements including (but not limited to) thermal hydraulics; heat transfer; fuel heatup, meltdown, and relocation; fission product release and transport; combustible gas generation and combustion; and core-concrete interaction. The overall model is defined by a relatively coarse spatial nodalization of the reactor coolant and containment systems and is advanced explicitly in time. The result is to enablemore » much faster than real time (i.e., 100 to 1000 times faster than real time on a personal computer) applications to on-line investigations and/or accident management training. Other features of the simulation module include provision for activation of water injection, including the Engineered Safety Features, as well as other mechanisms for the assessment of accident management and recovery strategies and the evaluation of PSA success criteria. The accident diagnostics module of ADAM uses on-line access to selected plant parameters (as measured by plant sensors) to compute the thermodynamic state of the plant, and to predict various margins to safety (e.g., times to pressure vessel saturation and steam generator dryout). Rule-based logic is employed to classify the measured data as belonging to one of a number of likely scenarios based on symptoms, and a number of 'alarms' are generated to signal the state of the reactor and containment. This paper will address the features and limitations of ADAM with particular focus on accident simulation and management. (authors)« less

Empirical Analysis and Refinement of Expert System Knowledge Bases

DTIC Science & Technology

1988-08-31

refinement. Both a simulated case generation program, and a random rule basher were developed to enhance rule refinement experimentation. *Substantial...the second fiscal year 88 objective was fully met. Rule Refinement System Simulated Rule Basher Case Generator Stored Cases Expert System Knowledge...generated until the rule is satisfied. Cases may be randomly generated for a given rule or hypothesis. Rule Basher Given that one has a correct

Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study

PubMed Central

Gräni, Christoph; Senn, Oliver; Bischof, Manuel; Cippà, Pietro E; Hauffe, Till; Zimmerli, Lukas; Battegay, Edouard; Franzen, Daniel

2015-01-01

Objectives Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. Methods In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. Results 121 patients (60.3% male, median age 47 years, IQR 34–66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). Conclusions This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. Trial registration number ClinicalTrial.gov: NCT01724996. PMID:25631316

PathEdEx – Uncovering High-explanatory Visual Diagnostics Heuristics Using Digital Pathology and Multiscale Gaze Data

PubMed Central

Shin, Dmitriy; Kovalenko, Mikhail; Ersoy, Ilker; Li, Yu; Doll, Donald; Shyu, Chi-Ren; Hammer, Richard

2017-01-01

Background: Visual heuristics of pathology diagnosis is a largely unexplored area where reported studies only provided a qualitative insight into the subject. Uncovering and quantifying pathology visual and nonvisual diagnostic patterns have great potential to improve clinical outcomes and avoid diagnostic pitfalls. Methods: Here, we present PathEdEx, an informatics computational framework that incorporates whole-slide digital pathology imaging with multiscale gaze-tracking technology to create web-based interactive pathology educational atlases and to datamine visual and nonvisual diagnostic heuristics. Results: We demonstrate the capabilities of PathEdEx for mining visual and nonvisual diagnostic heuristics using the first PathEdEx volume of a hematopathology atlas. We conducted a quantitative study on the time dynamics of zooming and panning operations utilized by experts and novices to come to the correct diagnosis. We then performed association rule mining to determine sets of diagnostic factors that consistently result in a correct diagnosis, and studied differences in diagnostic strategies across different levels of pathology expertise using Markov chain (MC) modeling and MC Monte Carlo simulations. To perform these studies, we translated raw gaze points to high-explanatory semantic labels that represent pathology diagnostic clues. Therefore, the outcome of these studies is readily transformed into narrative descriptors for direct use in pathology education and practice. Conclusion: PathEdEx framework can be used to capture best practices of pathology visual and nonvisual diagnostic heuristics that can be passed over to the next generation of pathologists and have potential to streamline implementation of precision diagnostics in precision medicine settings. PMID:28828200

PathEdEx - Uncovering High-explanatory Visual Diagnostics Heuristics Using Digital Pathology and Multiscale Gaze Data.

PubMed

Shin, Dmitriy; Kovalenko, Mikhail; Ersoy, Ilker; Li, Yu; Doll, Donald; Shyu, Chi-Ren; Hammer, Richard

2017-01-01

Visual heuristics of pathology diagnosis is a largely unexplored area where reported studies only provided a qualitative insight into the subject. Uncovering and quantifying pathology visual and nonvisual diagnostic patterns have great potential to improve clinical outcomes and avoid diagnostic pitfalls. Here, we present PathEdEx, an informatics computational framework that incorporates whole-slide digital pathology imaging with multiscale gaze-tracking technology to create web-based interactive pathology educational atlases and to datamine visual and nonvisual diagnostic heuristics. We demonstrate the capabilities of PathEdEx for mining visual and nonvisual diagnostic heuristics using the first PathEdEx volume of a hematopathology atlas. We conducted a quantitative study on the time dynamics of zooming and panning operations utilized by experts and novices to come to the correct diagnosis. We then performed association rule mining to determine sets of diagnostic factors that consistently result in a correct diagnosis, and studied differences in diagnostic strategies across different levels of pathology expertise using Markov chain (MC) modeling and MC Monte Carlo simulations. To perform these studies, we translated raw gaze points to high-explanatory semantic labels that represent pathology diagnostic clues. Therefore, the outcome of these studies is readily transformed into narrative descriptors for direct use in pathology education and practice. PathEdEx framework can be used to capture best practices of pathology visual and nonvisual diagnostic heuristics that can be passed over to the next generation of pathologists and have potential to streamline implementation of precision diagnostics in precision medicine settings.

Using Copula Distributions to Support More Accurate Imaging-Based Diagnostic Classifiers for Neuropsychiatric Disorders

PubMed Central

Bansal, Ravi; Hao, Xuejun; Liu, Jun; Peterson, Bradley S.

2014-01-01

Many investigators have tried to apply machine learning techniques to magnetic resonance images (MRIs) of the brain in order to diagnose neuropsychiatric disorders. Usually the number of brain imaging measures (such as measures of cortical thickness and measures of local surface morphology) derived from the MRIs (i.e., their dimensionality) has been large (e.g. >10) relative to the number of participants who provide the MRI data (<100). Sparse data in a high dimensional space increases the variability of the classification rules that machine learning algorithms generate, thereby limiting the validity, reproducibility, and generalizability of those classifiers. The accuracy and stability of the classifiers can improve significantly if the multivariate distributions of the imaging measures can be estimated accurately. To accurately estimate the multivariate distributions using sparse data, we propose to estimate first the univariate distributions of imaging data and then combine them using a Copula to generate more accurate estimates of their multivariate distributions. We then sample the estimated Copula distributions to generate dense sets of imaging measures and use those measures to train classifiers. We hypothesize that the dense sets of brain imaging measures will generate classifiers that are stable to variations in brain imaging measures, thereby improving the reproducibility, validity, and generalizability of diagnostic classification algorithms in imaging datasets from clinical populations. In our experiments, we used both computer-generated and real-world brain imaging datasets to assess the accuracy of multivariate Copula distributions in estimating the corresponding multivariate distributions of real-world imaging data. Our experiments showed that diagnostic classifiers generated using imaging measures sampled from the Copula were significantly more accurate and more reproducible than were the classifiers generated using either the real-world imaging measures or their multivariate Gaussian distributions. Thus, our findings demonstrate that estimated multivariate Copula distributions can generate dense sets of brain imaging measures that can in turn be used to train classifiers, and those classifiers are significantly more accurate and more reproducible than are those generated using real-world imaging measures alone. PMID:25093634

Detection of halitosis in breath: Between the past, present, and future.

PubMed

Nakhleh, M K; Quatredeniers, M; Haick, H

2017-06-16

To develop a new generation of diagnostics for halitosis, replacing the subjective organoleptic assessment, a series of exhaled breath analyzers has been developed and assessed. All three devices rely on the assessment of exhaled volatile sulfuric compounds (VSCs), which are mainly generated in and emitted from the oral cavity, contributing to the malodor. Portable, on-site and easy to use, these devices have potential for non-invasive diagnosis of halitosis. However, global assessment of exhaled VSCs alone has two main drawbacks: (i) the absence of VSCs does not rule out halitosis; (ii) non-sulfuric volatile compounds that could be biomarkers of systemic diseases, found in up to 15% of halitosis cases, are neglected. In this article, we review and discuss progress to date in the field of oral/exhaled volatile compounds as potential non-invasive diagnostics for halitosis. We will briefly describe the generation of these compounds both from local (oral) and distal (extra-oral) sources. In addition, we debate the different analytical approaches in use and discuss the potential value of bio-inspired artificially intelligent olfaction in diagnosing and classifying oral and systemic diseases by analyzing exhaled breath. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.

27 The DiPEP (Diagnosis of PE in Pregnancy) study: can clinical assessment, d-dimer or chest x-ray be used to select pregnant or postpartum women with suspected PE for diagnostic imaging?

PubMed

Goodacre, Steve; Horspool, Kimberley; Nelson-Piercy, Catherine; Knight, Marian; Shephard, Neil; Lecky, Fiona; Thomas, Steven; Hunt, Beverley; Fuller, Gordon

2017-12-01

To determine whether clinical features (in the form of a clinical decision rule) or d-dimer can be used to select pregnant or postpartum women with suspected PE for diagnostic imaging. Observational cohort study augmented with additional cases. Consultant-led maternity units participating in the UK Obstetric Surveillance System (UKOSS) and emergency departments and maternity units at eleven prospectively recruiting sites. 198 pregnant or postpartum women with diagnosed PE identified through UKOSS and 324 pregnant or postpartum women with suspected PE from prospectively recruiting sites. Data were collected relating to clinical features, elements of clinical decision rules, d-dimer measurements, diagnostic imaging, treatment for PE and adverse outcomes. Women were classified as having or not having PE on the basis of diagnostic imaging, treatment and subsequent adverse outcomes. Primary analysis was limited to women with conclusive diagnostic imaging. Secondary analyses included women with clinically diagnosed or ruled out PE. The primary analysis included 181 women with PE and 259 without. Most clinical features showed no association with PE. The only exceptions were number of previous pregnancies over 24 weeks (p=0.017), no varicose veins (p=0.045), no recent long haul travel (p=0.006), recent surgery including caesarean section (p=0.001), increased temperature (p=0.003), low oxygen saturation (p<0.001), PE-related chest x-ray abnormality (p=0.01) and other chest x-ray abnormality (p=0.001).Clinical decision rules had areas under the receiver-operator characteristic curve ranging from 0.577 to 0.732. No clinically useful threshold for decision-making was identified for any rule. The sensitivities and specificities of d-dimer were 88.4% and 8.8% using the standard laboratory threshold and 69.8% and 32.8% using a pregnancy-specific threshold. Clinical decision rules, d-dimer and chest x-ray should not be used to select pregnant or postpartum women with suspected PE for diagnostic imaging. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Defining the needs for next generation assays for tuberculosis.

PubMed

Denkinger, Claudia M; Kik, Sandra V; Cirillo, Daniela Maria; Casenghi, Martina; Shinnick, Thomas; Weyer, Karin; Gilpin, Chris; Boehme, Catharina C; Schito, Marco; Kimerling, Michael; Pai, Madhukar

2015-04-01

To accelerate the fight against tuberculosis, major diagnostic challenges need to be addressed urgently. Post-2015 targets are unlikely to be met without the use of novel diagnostics that are more accurate and can be used closer to where patients first seek care in affordable diagnostic algorithms. This article describes the efforts by the stakeholder community that led to the identification of the high-priority diagnostic needs in tuberculosis. Subsequently target product profiles for the high-priority diagnostic needs were developed and reviewed in a World Health Organization (WHO)-led consensus meeting. The high-priority diagnostic needs included (1) a sputum-based replacement test for smear-microscopy; (2) a non-sputum-based biomarker test for all forms of tuberculosis, ideally suitable for use at levels below microscopy centers; (3) a simple, low cost triage test for use by first-contact care providers as a rule-out test, ideally suitable for use by community health workers; and (4) a rapid drug susceptibility test for use at the microscopy center level. The developed target product profiles, along with complimentary work presented in this supplement, will help to facilitate the interaction between the tuberculosis community and the diagnostics industry with the goal to lead the way toward the post-2015 global tuberculosis targets. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Selective testing strategies for diagnosing group A streptococcal infection in children with pharyngitis: a systematic review and prospective multicentre external validation study

PubMed Central

Cohen, Jérémie F.; Cohen, Robert; Levy, Corinne; Thollot, Franck; Benani, Mohamed; Bidet, Philippe; Chalumeau, Martin

2015-01-01

Background: Several clinical prediction rules for diagnosing group A streptococcal infection in children with pharyngitis are available. We aimed to compare the diagnostic accuracy of rules-based selective testing strategies in a prospective cohort of children with pharyngitis. Methods: We identified clinical prediction rules through a systematic search of MEDLINE and Embase (1975–2014), which we then validated in a prospective cohort involving French children who presented with pharyngitis during a 1-year period (2010–2011). We diagnosed infection with group A streptococcus using two throat swabs: one obtained for a rapid antigen detection test (StreptAtest, Dectrapharm) and one obtained for culture (reference standard). We validated rules-based selective testing strategies as follows: low risk of group A streptococcal infection, no further testing or antibiotic therapy needed; intermediate risk of infection, rapid antigen detection for all patients and antibiotic therapy for those with a positive test result; and high risk of infection, empiric antibiotic treatment. Results: We identified 8 clinical prediction rules, 6 of which could be prospectively validated. Sensitivity and specificity of rules-based selective testing strategies ranged from 66% (95% confidence interval [CI] 61–72) to 94% (95% CI 92–97) and from 40% (95% CI 35–45) to 88% (95% CI 85–91), respectively. Use of rapid antigen detection testing following the clinical prediction rule ranged from 24% (95% CI 21–27) to 86% (95% CI 84–89). None of the rules-based selective testing strategies achieved our diagnostic accuracy target (sensitivity and specificity > 85%). Interpretation: Rules-based selective testing strategies did not show sufficient diagnostic accuracy in this study population. The relevance of clinical prediction rules for determining which children with pharyngitis should undergo a rapid antigen detection test remains questionable. PMID:25487666

A principled approach to setting optimal diagnostic thresholds: where ROC and indifference curves meet.

PubMed

Irwin, R John; Irwin, Timothy C

2011-06-01

Making clinical decisions on the basis of diagnostic tests is an essential feature of medical practice and the choice of the decision threshold is therefore crucial. A test's optimal diagnostic threshold is the threshold that maximizes expected utility. It is given by the product of the prior odds of a disease and a measure of the importance of the diagnostic test's sensitivity relative to its specificity. Choosing this threshold is the same as choosing the point on the Receiver Operating Characteristic (ROC) curve whose slope equals this product. We contend that a test's likelihood ratio is the canonical decision variable and contrast diagnostic thresholds based on likelihood ratio with two popular rules of thumb for choosing a threshold. The two rules are appealing because they have clear graphical interpretations, but they yield optimal thresholds only in special cases. The optimal rule can be given similar appeal by presenting indifference curves, each of which shows a set of equally good combinations of sensitivity and specificity. The indifference curve is tangent to the ROC curve at the optimal threshold. Whereas ROC curves show what is feasible, indifference curves show what is desirable. Together they show what should be chosen. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

An inference engine for embedded diagnostic systems

NASA Technical Reports Server (NTRS)

Fox, Barry R.; Brewster, Larry T.

1987-01-01

The implementation of an inference engine for embedded diagnostic systems is described. The system consists of two distinct parts. The first is an off-line compiler which accepts a propositional logical statement of the relationship between facts and conclusions and produces data structures required by the on-line inference engine. The second part consists of the inference engine and interface routines which accept assertions of fact and return the conclusions which necessarily follow. Given a set of assertions, it will generate exactly the conclusions which logically follow. At the same time, it will detect any inconsistencies which may propagate from an inconsistent set of assertions or a poorly formulated set of rules. The memory requirements are fixed and the worst case execution times are bounded at compile time. The data structures and inference algorithms are very simple and well understood. The data structures and algorithms are described in detail. The system has been implemented on Lisp, Pascal, and Modula-2.

Model-based diagnostics for Space Station Freedom

NASA Technical Reports Server (NTRS)

Fesq, Lorraine M.; Stephan, Amy; Martin, Eric R.; Lerutte, Marcel G.

1991-01-01

An innovative approach to fault management was recently demonstrated for the NASA LeRC Space Station Freedom (SSF) power system testbed. This project capitalized on research in model-based reasoning, which uses knowledge of a system's behavior to monitor its health. The fault management system (FMS) can isolate failures online, or in a post analysis mode, and requires no knowledge of failure symptoms to perform its diagnostics. An in-house tool called MARPLE was used to develop and run the FMS. MARPLE's capabilities are similar to those available from commercial expert system shells, although MARPLE is designed to build model-based as opposed to rule-based systems. These capabilities include functions for capturing behavioral knowledge, a reasoning engine that implements a model-based technique known as constraint suspension, and a tool for quickly generating new user interfaces. The prototype produced by applying MARPLE to SSF not only demonstrated that model-based reasoning is a valuable diagnostic approach, but it also suggested several new applications of MARPLE, including an integration and testing aid, and a complement to state estimation.

Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study.

PubMed

Gräni, Christoph; Senn, Oliver; Bischof, Manuel; Cippà, Pietro E; Hauffe, Till; Zimmerli, Lukas; Battegay, Edouard; Franzen, Daniel

2015-01-28

Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. 121 patients (60.3% male, median age 47 years, IQR 34-66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. ClinicalTrial.gov: NCT01724996. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Reducing a Knowledge-Base Search Space When Data Are Missing

NASA Technical Reports Server (NTRS)

James, Mark

2007-01-01

This software addresses the problem of how to efficiently execute a knowledge base in the presence of missing data. Computationally, this is an exponentially expensive operation that without heuristics generates a search space of 1 + 2n possible scenarios, where n is the number of rules in the knowledge base. Even for a knowledge base of the most modest size, say 16 rules, it would produce 65,537 possible scenarios. The purpose of this software is to reduce the complexity of this operation to a more manageable size. The problem that this system solves is to develop an automated approach that can reason in the presence of missing data. This is a meta-reasoning capability that repeatedly calls a diagnostic engine/model to provide prognoses and prognosis tracking. In the big picture, the scenario generator takes as its input the current state of a system, including probabilistic information from Data Forecasting. Using model-based reasoning techniques, it returns an ordered list of fault scenarios that could be generated from the current state, i.e., the plausible future failure modes of the system as it presently stands. The scenario generator models a Potential Fault Scenario (PFS) as a black box, the input of which is a set of states tagged with priorities and the output of which is one or more potential fault scenarios tagged by a confidence factor. The results from the system are used by a model-based diagnostician to predict the future health of the monitored system.

Fuzzy logic algorithm for quantitative tissue characterization of diffuse liver diseases from ultrasound images.

PubMed

Badawi, A M; Derbala, A S; Youssef, A M

1999-08-01

Computerized ultrasound tissue characterization has become an objective means for diagnosis of liver diseases. It is difficult to differentiate diffuse liver diseases, namely cirrhotic and fatty liver by visual inspection from the ultrasound images. The visual criteria for differentiating diffused diseases are rather confusing and highly dependent upon the sonographer's experience. This often causes a bias effects in the diagnostic procedure and limits its objectivity and reproducibility. Computerized tissue characterization to assist quantitatively the sonographer for the accurate differentiation and to minimize the degree of risk is thus justified. Fuzzy logic has emerged as one of the most active area in classification. In this paper, we present an approach that employs Fuzzy reasoning techniques to automatically differentiate diffuse liver diseases using numerical quantitative features measured from the ultrasound images. Fuzzy rules were generated from over 140 cases consisting of normal, fatty, and cirrhotic livers. The input to the fuzzy system is an eight dimensional vector of feature values: the mean gray level (MGL), the percentile 10%, the contrast (CON), the angular second moment (ASM), the entropy (ENT), the correlation (COR), the attenuation (ATTEN) and the speckle separation. The output of the fuzzy system is one of the three categories: cirrhosis, fatty or normal. The steps done for differentiating the pathologies are data acquisition and feature extraction, dividing the input spaces of the measured quantitative data into fuzzy sets. Based on the expert knowledge, the fuzzy rules are generated and applied using the fuzzy inference procedures to determine the pathology. Different membership functions are developed for the input spaces. This approach has resulted in very good sensitivities and specificity for classifying diffused liver pathologies. This classification technique can be used in the diagnostic process, together with the history information, laboratory, clinical and pathological examinations.

Creating of structure of facts for the knowledge base of an expert system for wind power plant's equipment diagnosis

NASA Astrophysics Data System (ADS)

Duer, Stanisław; Wrzesień, Paweł; Duer, Radosław

2017-10-01

This article describes rules and conditions for making a structure (a set) of facts for an expert knowledge base of the intelligent system to diagnose Wind Power Plants' equipment. Considering particular operational conditions of a technical object, that is a set of Wind Power Plant's equipment, this is a significant issue. A structural model of Wind Power Plant's equipment is developed. Based on that, a functional - diagnostic model of Wind Power Plant's equipment is elaborated. That model is a basis for determining primary elements of the object structure, as well as for interpreting a set of diagnostic signals and their reference signals. The key content of this paper is a description of rules for building of facts on the basis of developed analytical dependence. According to facts, their dependence is described by rules for transferring of a set of pieces of diagnostic information into a specific set of facts. The article consists of four chapters that concern particular issues on the subject.

Clinical prediction rule for suspected scaphoid fractures: A prospective cohort study.

PubMed

Rhemrev, S J; Beeres, F J P; van Leerdam, R H; Hogervorst, M; Ring, D

2010-10-01

The low prevalence of true fractures amongst suspected fractures magnifies the shortcomings of the diagnostic tests used to triage suspected scaphoid fractures. The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a scaphoid fracture than others who lacked the subset criteria. Seventy-eight consecutive patients diagnosed with a suspected scaphoid fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Analysis revealed three significant independent predictors: extension <50%, supination strength ≤ 10% and the presence of a previous fracture. Clinical prediction rules have the potential to increase the prevalence of true fractures amongst patients with suspected scaphoid fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage. 2010 Elsevier Ltd. All rights reserved.

Diagnostics aid for mass spectrometer trouble-shooting

NASA Astrophysics Data System (ADS)

Filby, E. E.; Rankin, R. A.; Webb, G. W.

The MS Expert system provides problem diagnostics for instruments used in the Mass Spectrometry Laboratory (MSL). The most critical results generated on these mass spectrometers are the uranium concentration and isotopic content data used for process control and materials accountability at the Idaho Chemical Processing Plant. The two purposes of the system are: (1) to minimize instrument downtime and thereby provide the best possible support to the Plant, and (2) to improve long-term data quality. This system combines the knowledge of several experts on mass spectrometry to provide a diagnostic tool, and can make these skills available on a more timely basis. It integrates code written in the Pascal language with a knowledge base entered into a commercial expert system shell. The user performs some preliminary status checks, and then selects from among several broad diagnostic categories. These initial steps provide input to the rule base. The overall analysis provides the user with a set of possible solutions to the observed problems, graded as to their probabilities. Besides the trouble-shooting benefits expected from this system, it will also provide structures diagnostic training for lab personnel. In addition, development of the system knowledge base has already produced a better understanding of instrument behavior. Two key findings are that a good user interface is necessary for full acceptance of the tool, and a development system should include standard programming capabilities as well as the expert system shell.

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

PubMed

Marin, Jennifer R; Mills, Angela M

2015-12-01

The 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization" was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging use and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified before the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with the planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were a total of 164 individuals involved in the conference and spanned various specialties, including general emergency medicine, pediatric emergency medicine, radiology, surgery, medical physics, and the decision sciences.

Developing a Learning Progression for Number Sense Based on the Rule Space Model in China

ERIC Educational Resources Information Center

Chen, Fu; Yan, Yue; Xin, Tao

2017-01-01

The current study focuses on developing the learning progression of number sense for primary school students, and it applies a cognitive diagnostic model, the rule space model, to data analysis. The rule space model analysis firstly extracted nine cognitive attributes and their hierarchy model from the analysis of previous research and the…

Control and Diagnostic Model of Brushless Dc Motor

NASA Astrophysics Data System (ADS)

Abramov, Ivan V.; Nikitin, Yury R.; Abramov, Andrei I.; Sosnovich, Ella V.; Božek, Pavol

2014-09-01

A simulation model of brushless DC motor (BLDC) control and diagnostics is considered. The model has been developed using a freeware complex "Modeling in technical devices". Faults and diagnostic parameters of BLDC are analyzed. A logicallinguistic diagnostic model of BLDC has been developed on basis of fuzzy logic. The calculated rules determine dependence of technical condition on diagnostic parameters, their trends and utilized lifetime of BLDC. Experimental results of BLDC technical condition diagnostics are discussed. It is shown that in the course of BLDC degradation the motor condition change depends on diagnostic parameter values

An easy-to-use diagnostic system development shell

NASA Technical Reports Server (NTRS)

Tsai, L. C.; Ross, J. B.; Han, C. Y.; Wee, W. G.

1987-01-01

The Diagnostic System Development Shell (DSDS), an expert system development shell for diagnostic systems, is described. The major objective of building the DSDS is to create a very easy to use and friendly environment for knowledge engineers and end-users. The DSDS is written in OPS5 and CommonLisp. It runs on a VAX/VMS system. A set of domain independent, generalized rules is built in the DSDS, so the users need not be concerned about building the rules. The facts are explicitly represented in a unified format. A powerful check facility which helps the user to check the errors in the created knowledge bases is provided. A judgement facility and other useful facilities are also available. A diagnostic system based on the DSDS system is question driven and can call or be called by other knowledge based systems written in OPS5 and CommonLisp. A prototype diagnostic system for diagnosing a Philips constant potential X-ray system has been built using the DSDS.

Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis.

PubMed

Décary, Simon; Ouellet, Philippe; Vendittoli, Pascal-André; Roy, Jean-Sébastien; Desmeules, François

2017-01-01

More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests. To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders. A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR. Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions. When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests. Copyright © 2016 Elsevier Ltd. All rights reserved.

Performance of Thirteen Clinical Rules to Distinguish Bacterial and Presumed Viral Meningitis in Vietnamese Children

PubMed Central

Huy, Nguyen Tien; Thao, Nguyen Thanh Hong; Tuan, Nguyen Anh; Khiem, Nguyen Tuan; Moore, Christopher C.; Thi Ngoc Diep, Doan; Hirayama, Kenji

2012-01-01

Background and Purpose Successful outcomes from bacterial meningitis require rapid antibiotic treatment; however, unnecessary treatment of viral meningitis may lead to increased toxicities and expense. Thus, improved diagnostics are required to maximize treatment and minimize side effects and cost. Thirteen clinical decision rules have been reported to identify bacterial from viral meningitis. However, few rules have been tested and compared in a single study, while several rules are yet to be tested by independent researchers or in pediatric populations. Thus, simultaneous test and comparison of these rules are required to enable clinicians to select an optimal diagnostic rule for bacterial meningitis in settings and populations similar to ours. Methods A retrospective cross-sectional study was conducted at the Infectious Department of Pediatric Hospital Number 1, Ho Chi Minh City, Vietnam. The performance of the clinical rules was evaluated by area under a receiver operating characteristic curve (ROC-AUC) using the method of DeLong and McNemar test for specificity comparison. Results Our study included 129 patients, of whom 80 had bacterial meningitis and 49 had presumed viral meningitis. Spanos's rule had the highest AUC at 0.938 but was not significantly greater than other rules. No rule provided 100% sensitivity with a specificity higher than 50%. Based on our calculation of theoretical sensitivity and specificity, we suggest that a perfect rule requires at least four independent variables that posses both sensitivity and specificity higher than 85–90%. Conclusions No clinical decision rules provided an acceptable specificity (>50%) with 100% sensitivity when applying our data set in children. More studies in Vietnam and developing countries are required to develop and/or validate clinical rules and more very good biomarkers are required to develop such a perfect rule. PMID:23209715

Performance of thirteen clinical rules to distinguish bacterial and presumed viral meningitis in Vietnamese children.

PubMed

Huy, Nguyen Tien; Thao, Nguyen Thanh Hong; Tuan, Nguyen Anh; Khiem, Nguyen Tuan; Moore, Christopher C; Thi Ngoc Diep, Doan; Hirayama, Kenji

2012-01-01

Successful outcomes from bacterial meningitis require rapid antibiotic treatment; however, unnecessary treatment of viral meningitis may lead to increased toxicities and expense. Thus, improved diagnostics are required to maximize treatment and minimize side effects and cost. Thirteen clinical decision rules have been reported to identify bacterial from viral meningitis. However, few rules have been tested and compared in a single study, while several rules are yet to be tested by independent researchers or in pediatric populations. Thus, simultaneous test and comparison of these rules are required to enable clinicians to select an optimal diagnostic rule for bacterial meningitis in settings and populations similar to ours. A retrospective cross-sectional study was conducted at the Infectious Department of Pediatric Hospital Number 1, Ho Chi Minh City, Vietnam. The performance of the clinical rules was evaluated by area under a receiver operating characteristic curve (ROC-AUC) using the method of DeLong and McNemar test for specificity comparison. Our study included 129 patients, of whom 80 had bacterial meningitis and 49 had presumed viral meningitis. Spanos's rule had the highest AUC at 0.938 but was not significantly greater than other rules. No rule provided 100% sensitivity with a specificity higher than 50%. Based on our calculation of theoretical sensitivity and specificity, we suggest that a perfect rule requires at least four independent variables that posses both sensitivity and specificity higher than 85-90%. No clinical decision rules provided an acceptable specificity (>50%) with 100% sensitivity when applying our data set in children. More studies in Vietnam and developing countries are required to develop and/or validate clinical rules and more very good biomarkers are required to develop such a perfect rule.

Clinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis.

PubMed

Moore, Abigail; Ashdown, Helen F; Shinkins, Bethany; Roberts, Nia W; Grant, Cameron C; Lasserson, Daniel S; Harnden, Anthony

2017-08-01

Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping, and posttussive vomiting, but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough. We systematically searched CINAHL, Embase, Medline, and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction, and quality and bias assessments. For each characteristic, RevMan was used to produce descriptive forest plots. The bivariate meta-analysis method was used to generate pooled estimates of sensitivity and specificity. Of 1,969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever have a high sensitivity (93.2% [CI, 83.2-97.4] and 81.8% [CI, 72.2-88.7], respectively) and low specificity (20.6% [CI, 14.7-28.1] and 18.8% [CI, 8.1-37.9]), whereas posttussive vomiting and whooping have low sensitivity (32.5% [CI, 24.5-41.6] and 29.8% [CI, 8.0-45.2]) and high specificity (77.7% [CI, 73.1-81.7] and 79.5% [CI, 69.4-86.9]). Posttussive vomiting in children is moderately sensitive (60.0% [CI, 40.3-77.0]) and specific (66.0% [CI, 52.5-77.3]). In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Do recent US Supreme Court rulings on patenting of genes and genetic diagnostics affect the practice of genetic screening and diagnosis in prenatal and reproductive care?

PubMed Central

Chandrasekharan, Subhashini; McGuire, Amy L.; Van den Veyver, Ignatia B.

2015-01-01

Thousands of patents have been awarded that claim human gene sequences and their uses, and some have been challenged in court. In a recent high-profile case, Association for Molecular Pathology, et al. vs. Myriad Genetics, Inc., et al., the United States Supreme Court ruled that genes are natural occurring substances and therefore not patentable through “composition of matter” claims. The consequences of this ruling will extend well beyond ending Myriad's monopoly over BRCA testing, and may affect similar monopolies of other commercial laboratories for tests involving other genes. It could also simplify intellectual property issues surrounding genome-wide clinical sequencing, which can generate results for genes covered by intellectual property. Non-invasive prenatal testing (NIPT) for common aneuploidies using cell-free fetal (cff) DNA in maternal blood is currently offered through commercial laboratories and is also the subject of ongoing patent litigation. The recent Supreme Court decision in the Myriad case has already been invoked by a lower district court in NIPT litigation and resulted in invalidation of primary claims in a patent on currently marketed cffDNA-based testing for chromosomal aneuploidies. PMID:24989832

Acquisition, representation and rule generation for procedural knowledge

NASA Technical Reports Server (NTRS)

Ortiz, Chris; Saito, Tim; Mithal, Sachin; Loftin, R. Bowen

1991-01-01

Current research into the design and continuing development of a system for the acquisition of procedural knowledge, its representation in useful forms, and proposed methods for automated C Language Integrated Production System (CLIPS) rule generation is discussed. The Task Analysis and Rule Generation Tool (TARGET) is intended to permit experts, individually or collectively, to visually describe and refine procedural tasks. The system is designed to represent the acquired knowledge in the form of graphical objects with the capacity for generating production rules in CLIPS. The generated rules can then be integrated into applications such as NASA's Intelligent Computer Aided Training (ICAT) architecture. Also described are proposed methods for use in translating the graphical and intermediate knowledge representations into CLIPS rules.

Simulation-Based Rule Generation Considering Readability

PubMed Central

Yahagi, H.; Shimizu, S.; Ogata, T.; Hara, T.; Ota, J.

2015-01-01

Rule generation method is proposed for an aircraft control problem in an airport. Designing appropriate rules for motion coordination of taxiing aircraft in the airport is important, which is conducted by ground control. However, previous studies did not consider readability of rules, which is important because it should be operated and maintained by humans. Therefore, in this study, using the indicator of readability, we propose a method of rule generation based on parallel algorithm discovery and orchestration (PADO). By applying our proposed method to the aircraft control problem, the proposed algorithm can generate more readable and more robust rules and is found to be superior to previous methods. PMID:27347501

Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score.

PubMed

Aalbers, Jolien; O'Brien, Kirsty K; Chan, Wai-Sun; Falk, Gavin A; Teljeur, Conor; Dimitrov, Borislav D; Fahey, Tom

2011-06-01

Stratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms. A systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used. A total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37). Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care.

The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability.

PubMed

Knuuti, Juhani; Ballo, Haitham; Juarez-Orozco, Luis Eduardo; Saraste, Antti; Kolh, Philippe; Rutjes, Anne Wilhelmina Saskia; Jüni, Peter; Windecker, Stephan; Bax, Jeroen J; Wijns, William

2018-05-29

To determine the ranges of pre-test probability (PTP) of coronary artery disease (CAD) in which stress electrocardiogram (ECG), stress echocardiography, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance (CMR) can reclassify patients into a post-test probability that defines (>85%) or excludes (<15%) anatomically (defined by visual evaluation of invasive coronary angiography [ICA]) and functionally (defined by a fractional flow reserve [FFR] ≤0.8) significant CAD. A broad search in electronic databases until August 2017 was performed. Studies on the aforementioned techniques in >100 patients with stable CAD that utilized either ICA or ICA with FFR measurement as reference, were included. Study-level data was pooled using a hierarchical bivariate random-effects model and likelihood ratios were obtained for each technique. The PTP ranges for each technique to rule-in or rule-out significant CAD were defined. A total of 28 664 patients from 132 studies that used ICA as reference and 4131 from 23 studies using FFR, were analysed. Stress ECG can rule-in and rule-out anatomically significant CAD only when PTP is ≥80% (76-83) and ≤19% (15-25), respectively. Coronary computed tomography angiography is able to rule-in anatomic CAD at a PTP ≥58% (45-70) and rule-out at a PTP ≤80% (65-94). The corresponding PTP values for functionally significant CAD were ≥75% (67-83) and ≤57% (40-72) for CCTA, and ≥71% (59-81) and ≤27 (24-31) for ICA, demonstrating poorer performance of anatomic imaging against FFR. In contrast, functional imaging techniques (PET, stress CMR, and SPECT) are able to rule-in functionally significant CAD when PTP is ≥46-59% and rule-out when PTP is ≤34-57%. The various diagnostic modalities have different optimal performance ranges for the detection of anatomically and functionally significant CAD. Stress ECG appears to have very limited diagnostic power. The selection of a diagnostic technique for any given patient to rule-in or rule-out CAD should be based on the optimal PTP range for each test and on the assumed reference standard.

An International Comparison Using a Diagnostic Testing Model: Turkish Students' Profile of Mathematical Skills on TIMSS-R

ERIC Educational Resources Information Center

Dogan, Enis; Tatsuoka, Kikumi

2008-01-01

This study illustrates how a diagnostic testing model can be used to make detailed comparisons between student populations participating in international assessments. The performance of Turkish students on the TIMSS-R mathematics test was reanalyzed with a diagnostic testing model called the Rule Space Model. First, mathematical and cognitive…

A hierarchical fuzzy rule-based approach to aphasia diagnosis.

PubMed

Akbarzadeh-T, Mohammad-R; Moshtagh-Khorasani, Majid

2007-10-01

Aphasia diagnosis is a particularly challenging medical diagnostic task due to the linguistic uncertainty and vagueness, inconsistencies in the definition of aphasic syndromes, large number of measurements with imprecision, natural diversity and subjectivity in test objects as well as in opinions of experts who diagnose the disease. To efficiently address this diagnostic process, a hierarchical fuzzy rule-based structure is proposed here that considers the effect of different features of aphasia by statistical analysis in its construction. This approach can be efficient for diagnosis of aphasia and possibly other medical diagnostic applications due to its fuzzy and hierarchical reasoning construction. Initially, the symptoms of the disease which each consists of different features are analyzed statistically. The measured statistical parameters from the training set are then used to define membership functions and the fuzzy rules. The resulting two-layered fuzzy rule-based system is then compared with a back propagating feed-forward neural network for diagnosis of four Aphasia types: Anomic, Broca, Global and Wernicke. In order to reduce the number of required inputs, the technique is applied and compared on both comprehensive and spontaneous speech tests. Statistical t-test analysis confirms that the proposed approach uses fewer Aphasia features while also presenting a significant improvement in terms of accuracy.

Medicare program; revisions to payment policies under the Physician Fee Schedule, and other part B payment policies for CY 2008; delay of the date of applicability of the revised anti-markup provisions for certain services furnished in certain locations (Sec. 414.50). Final rule.

PubMed

2008-01-03

This final rule delays until January 1, 2009 the applicability of the anti-markup provisions in Sec. 414.50, as revised at 72 FR 66222, except with respect to the technical component of a purchased diagnostic test and with respect to any anatomic pathology diagnostic testing services furnished in space that: Is utilized by a physician group practice as a "centralized building" (as defined at Sec. 411.351 of this chapter) for purposes of complying with the physician self-referral rules; and does not qualify as a "same building" under Sec. 411.355(b)(2)(i) of this chapter.

21 CFR 892.1700 - Diagnostic x-ray high voltage generator.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Diagnostic x-ray high voltage generator. 892.1700... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1700 Diagnostic x-ray high voltage generator. (a) Identification. A diagnostic x-ray high voltage generator is a device that is intended to...

21 CFR 892.1700 - Diagnostic x-ray high voltage generator.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Diagnostic x-ray high voltage generator. 892.1700... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1700 Diagnostic x-ray high voltage generator. (a) Identification. A diagnostic x-ray high voltage generator is a device that is intended to...

21 CFR 892.1700 - Diagnostic x-ray high voltage generator.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Diagnostic x-ray high voltage generator. 892.1700... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1700 Diagnostic x-ray high voltage generator. (a) Identification. A diagnostic x-ray high voltage generator is a device that is intended to...

21 CFR 892.1700 - Diagnostic x-ray high voltage generator.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Diagnostic x-ray high voltage generator. 892.1700... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1700 Diagnostic x-ray high voltage generator. (a) Identification. A diagnostic x-ray high voltage generator is a device that is intended to...

21 CFR 892.1700 - Diagnostic x-ray high voltage generator.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Diagnostic x-ray high voltage generator. 892.1700... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1700 Diagnostic x-ray high voltage generator. (a) Identification. A diagnostic x-ray high voltage generator is a device that is intended to...

Incremental Learning of Context Free Grammars by Parsing-Based Rule Generation and Rule Set Search

NASA Astrophysics Data System (ADS)

Nakamura, Katsuhiko; Hoshina, Akemi

This paper discusses recent improvements and extensions in Synapse system for inductive inference of context free grammars (CFGs) from sample strings. Synapse uses incremental learning, rule generation based on bottom-up parsing, and the search for rule sets. The form of production rules in the previous system is extended from Revised Chomsky Normal Form A→βγ to Extended Chomsky Normal Form, which also includes A→B, where each of β and γ is either a terminal or nonterminal symbol. From the result of bottom-up parsing, a rule generation mechanism synthesizes minimum production rules required for parsing positive samples. Instead of inductive CYK algorithm in the previous version of Synapse, the improved version uses a novel rule generation method, called ``bridging,'' which bridges the lacked part of the derivation tree for the positive string. The improved version also employs a novel search strategy, called serial search in addition to minimum rule set search. The synthesis of grammars by the serial search is faster than the minimum set search in most cases. On the other hand, the size of the generated CFGs is generally larger than that by the minimum set search, and the system can find no appropriate grammar for some CFL by the serial search. The paper shows experimental results of incremental learning of several fundamental CFGs and compares the methods of rule generation and search strategies.

Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule.

PubMed

Cheung, Tung C; Tank, Yeliz; Breederveld, Roelf S; Tuinebreijer, Wim E; de Lange-de Klerk, Elly S M; Derksen, Robert J

2013-04-01

The aim of this present study was to compare the diagnostic accuracy and reproducibility of 2 clinical decision rules (the Ottawa Knee Rules [OKR] and Pittsburgh Decision Rules [PDR]) developed for selective use of x-rays in the evaluation of isolated knee trauma. Application of a decision rule leads to a more efficient evaluation of knee injuries and a reduction in health care costs. The diagnostic accuracy and reproducibility are compared in this study. A cross-sectional interobserver study was conducted in the emergency department of an urban teaching hospital from October 2008 to July 2009. Two observer groups collected data on standardized case-report forms: emergency medicine residents and surgical residents. Standard knee radiographs were performed in each patient. Participants were patients 18 years and older with isolated knee injuries. Pooled sensitivity and specificity were compared using χ(2) statistics, and interobserver agreement was calculated by using κ statistics. Ninety injuries were assessed. Seven injuries concerned fractures (7.8%). For the OKR, the pooled sensitivity and specificity were 0.86 (95% confidence interval [CI], 0.57-0.96) and 0.27 (95% CI, 0.21-0.35), respectively. The PDR had a pooled sensitivity and specificity of 0.86 (95% CI, 0.57-0.96) and 0.51 (95% CI, 0.44-0.59). The PDR was significantly (P = .002) more specific. The κ values for the OKR and PDR were 0.51 (95% CI, 0.32-0.71) and 0.71 (95% CI, 0.57-0.86), respectively. The PDR was found to be more specific than the OKR, with equal sensitivity. Interobserver agreement was moderate for the OKR and substantial for the PDR. Copyright © 2013 Elsevier Inc. All rights reserved.

Using hypermedia to develop an intelligent tutorial/diagnostic system for the Space Shuttle Main Engine Controller Lab

NASA Technical Reports Server (NTRS)

Oreilly, Daniel; Williams, Robert; Yarborough, Kevin

1988-01-01

This is a tutorial/diagnostic system for training personnel in the use of the Space Shuttle Main Engine Controller (SSMEC) Simulation Lab. It also provides a diagnostic capable of isolating lab failures at least to the major lab component. The system was implemented using Hypercard, which is an program of hypermedia running on Apple Macintosh computers. Hypercard proved to be a viable platform for the development and use of sophisticated tutorial systems and moderately capable diagnostic systems. This tutorial/diagnostic system uses the basic Hypercard tools to provide the tutorial. The diagnostic part of the system uses a simple interpreter written in the Hypercard language (Hypertalk) to implement the backward chaining rule based logic commonly found in diagnostic systems using Prolog. Some of the advantages of Hypercard in developing this type of system include sophisticated graphics, animation, sound and voice capabilities, its ability as a hypermedia tool, and its ability to include digitized pictures. The major disadvantage is the slow execution time for evaluation of rules (due to the interpretive processing of the language). Other disadvantages include the limitation on the size of the cards, that color is not supported, that it does not support grey scale graphics, and its lack of selectable fonts for text fields.

Radioactive waste management in a hospital.

PubMed

Khan, Shoukat; Syed, At; Ahmad, Reyaz; Rather, Tanveer A; Ajaz, M; Jan, Fa

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations.

Sex-specific performance of pre-imaging diagnostic algorithms for pulmonary embolism.

PubMed

van Mens, T E; van der Pol, L M; van Es, N; Bistervels, I M; Mairuhu, A T A; van der Hulle, T; Klok, F A; Huisman, M V; Middeldorp, S

2018-05-01

Essentials Decision rules for pulmonary embolism are used indiscriminately despite possible sex-differences. Various pre-imaging diagnostic algorithms have been investigated in several prospective studies. When analysed at an individual patient data level the algorithms perform similarly in both sexes. Estrogen use and male sex were associated with a higher prevalence in suspected pulmonary embolism. Background In patients suspected of pulmonary embolism (PE), clinical decision rules are combined with D-dimer testing to rule out PE, avoiding the need for imaging in those at low risk. Despite sex differences in several aspects of the disease, including its diagnosis, these algorithms are used indiscriminately in women and men. Objectives To compare the performance, defined as efficiency and failure rate, of three pre-imaging diagnostic algorithms for PE between women and men: the Wells rule with fixed or with age-adjusted D-dimer cut-off, and a recently validated algorithm (YEARS). A secondary aim was to determine the sex-specific prevalence of PE. Methods Individual patient data were obtained from six studies using the Wells rule (fixed D-dimer, n = 5; age adjusted, n = 1) and from one study using the YEARS algorithm. All studies prospectively enrolled consecutive patients with suspected PE. Main outcomes were efficiency (proportion of patients in which the algorithm ruled out PE without imaging) and failure rate (proportion of patients with PE not detected by the algorithm). Outcomes were estimated using (multilevel) logistic regression models. Results The main outcomes showed no sex differences in any of the separate algorithms. With all three, the prevalence of PE was lower in women (OR, 0.66, 0.68 and 0.74). In women, estrogen use, adjusted for age, was associated with lower efficiency and higher prevalence and D-dimer levels. Conclusions The investigated pre-imaging diagnostic algorithms for patients suspected of PE show no sex differences in performance. Male sex and estrogen use are both associated with a higher probability of having the disease. © 2018 International Society on Thrombosis and Haemostasis.

Effect of Temporal Relationships in Associative Rule Mining for Web Log Data

PubMed Central

Mohd Khairudin, Nazli; Mustapha, Aida

2014-01-01

The advent of web-based applications and services has created such diverse and voluminous web log data stored in web servers, proxy servers, client machines, or organizational databases. This paper attempts to investigate the effect of temporal attribute in relational rule mining for web log data. We incorporated the characteristics of time in the rule mining process and analysed the effect of various temporal parameters. The rules generated from temporal relational rule mining are then compared against the rules generated from the classical rule mining approach such as the Apriori and FP-Growth algorithms. The results showed that by incorporating the temporal attribute via time, the number of rules generated is subsequently smaller but is comparable in terms of quality. PMID:24587757

Automatic rule generation for high-level vision

NASA Technical Reports Server (NTRS)

Rhee, Frank Chung-Hoon; Krishnapuram, Raghu

1992-01-01

A new fuzzy set based technique that was developed for decision making is discussed. It is a method to generate fuzzy decision rules automatically for image analysis. This paper proposes a method to generate rule-based approaches to solve problems such as autonomous navigation and image understanding automatically from training data. The proposed method is also capable of filtering out irrelevant features and criteria from the rules.

Development of the Diagnostic Expert System for Tea Processing

NASA Astrophysics Data System (ADS)

Yoshitomi, Hitoshi; Yamaguchi, Yuichi

A diagnostic expert system for tea processing which can presume the cause of the defect of the processed tea was developed to contribute to the improvement of tea processing. This system that consists of some programs can be used through the Internet. The inference engine, the core of the system adopts production system which is well used on artificial intelligence, and is coded by Prolog as the artificial intelligence oriented language. At present, 176 rules for inference have been registered on this system. The system will be able to presume better if more rules are added to the system.

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

PubMed

Marin, Jennifer R; Mills, Angela M

2015-12-01

The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging. © 2015 by the Society for Academic Emergency Medicine.

[Cognitive errors in diagnostic decision making].

PubMed

Gäbler, Martin

2017-10-01

Approximately 10-15% of our diagnostic decisions are faulty and may lead to unfavorable and dangerous outcomes, which could be avoided. These diagnostic errors are mainly caused by cognitive biases in the diagnostic reasoning process.Our medical diagnostic decision-making is based on intuitive "System 1" and analytical "System 2" diagnostic decision-making and can be deviated by unconscious cognitive biases.These deviations can be positively influenced on a systemic and an individual level. For the individual, metacognition (internal withdrawal from the decision-making process) and debiasing strategies, such as verification, falsification and rule out worst-case scenarios, can lead to improved diagnostic decisions making.

A clinical decision support system for diagnosis of Allergic Rhinitis based on intradermal skin tests.

PubMed

Jabez Christopher, J; Khanna Nehemiah, H; Kannan, A

2015-10-01

Allergic Rhinitis is a universal common disease, especially in populated cities and urban areas. Diagnosis and treatment of Allergic Rhinitis will improve the quality of life of allergic patients. Though skin tests remain the gold standard test for diagnosis of allergic disorders, clinical experts are required for accurate interpretation of test outcomes. This work presents a clinical decision support system (CDSS) to assist junior clinicians in the diagnosis of Allergic Rhinitis. Intradermal Skin tests were performed on patients who had plausible allergic symptoms. Based on patient׳s history, 40 clinically relevant allergens were tested. 872 patients who had allergic symptoms were considered for this study. The rule based classification approach and the clinical test results were used to develop and validate the CDSS. Clinical relevance of the CDSS was compared with the Score for Allergic Rhinitis (SFAR). Tests were conducted for junior clinicians to assess their diagnostic capability in the absence of an expert. The class based Association rule generation approach provides a concise set of rules that is further validated by clinical experts. The interpretations of the experts are considered as the gold standard. The CDSS diagnoses the presence or absence of rhinitis with an accuracy of 88.31%. The allergy specialist and the junior clinicians prefer the rule based approach for its comprehendible knowledge model. The Clinical Decision Support Systems with rule based classification approach assists junior doctors and clinicians in the diagnosis of Allergic Rhinitis to make reliable decisions based on the reports of intradermal skin tests. Copyright © 2015 Elsevier Ltd. All rights reserved.

Shifting Diagnostic Systems for Defining Intellectual Disability in Death Penalty Cases: Hall vs. Florida.

PubMed

Mukherjee, Mina; Westphal, Alexander

2015-07-01

The case of Hall vs. Florida tested Florida's so called "bright line rule" in determining intellectual disability in capital cases. The Supreme Court Decision reflects a more general trend from categorical to dimensional approaches in psychiatric diagnostic systems.

Shifting Diagnostic Systems for Defining Intellectual Disability in Death Penalty Cases: Hall vs. Florida

ERIC Educational Resources Information Center

Mukherjee, Mina; Westphal, Alexander

2015-01-01

The case of Hall vs. Florida tested Florida's so called "bright line rule" in determining intellectual disability in capital cases. The Supreme Court Decision reflects a more general trend from categorical to dimensional approaches in psychiatric diagnostic systems.

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.

PubMed

Verbakel, Jan Y; Lemiengre, Marieke B; De Burghgraeve, Tine; De Sutter, An; Aertgeerts, Bert; Bullens, Dominique M A; Shinkins, Bethany; Van den Bruel, Ann; Buntinx, Frank

2015-08-07

Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population. Diagnostic accuracy study validating a clinical prediction rule. Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department. Physicians were asked to score the decision tree in every child. The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values. In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%. In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. NCT02024282. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Automatic rule generation for high-level vision

NASA Technical Reports Server (NTRS)

Rhee, Frank Chung-Hoon; Krishnapuram, Raghu

1992-01-01

Many high-level vision systems use rule-based approaches to solving problems such as autonomous navigation and image understanding. The rules are usually elaborated by experts. However, this procedure may be rather tedious. In this paper, we propose a method to generate such rules automatically from training data. The proposed method is also capable of filtering out irrelevant features and criteria from the rules.

Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds

PubMed Central

Carpenter, Christopher R.; Hussain, Adnan M.; Ward, Michael J.; Zipfel, Gregory J.; Fowler, Susan; Pines, Jesse M.; Sivilotti, Marco L.A.

2016-01-01

Background Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic. Objectives To perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH. A secondary objective was to delineate probability of disease thresholds for imaging and lumbar puncture (LP). Methods PUBMED, EMBASE, SCOPUS, and research meeting abstracts were searched up to June 2015 for studies of emergency department (ED) patients with acute headache clinically concerning for spontaneous SAH. QUADAS-2 was used to assess study quality and, when appropriate, meta-analysis was conducted using random effects models. Outcomes were sensitivity, specificity, positive (LR+) and negative (LR−) likelihood ratios. To identify test- and treatment-thresholds, we employed the Pauker-Kassirer method with Bernstein test-indication curves using the summary estimates of diagnostic accuracy. Results A total of 5,022 publications were identified, of which 122 underwent full text-review; 22 studies were included (average SAH prevalence 7.5%). Diagnostic studies differed in assessment of history and physical exam findings, CT technology, analytical techniques used to identify xanthochromia, and criterion standards for SAH. Study quality by QUADAS-2 was variable; however, most had a relatively low-risk of biases. A history of neck pain (LR+ 4.1 [95% CI 2.2-7.6]) and neck stiffness on physical exam (LR+ 6.6 [4.0-11.0]) were the individual findings most strongly associated with SAH. Combinations of findings may rule out SAH, yet promising clinical decision rules await external validation. Non-contrast cranial CT within 6 hours of headache onset accurately ruled-in (LR+ 230 [6-8700]) and ruled-out SAH (LR− 0.01 [0-0.04]); CT beyond 6 hours had a LR− of 0.07 [0.01-0.61]. CSF analyses had lower diagnostic accuracy, whether using red blood cell (RBC) count or xanthochromia. At a threshold RBC count of 1,000 × 106/L, the LR+ was 5.7 [1.4-23] and LR− 0.21 [0.03-1.7]. Using the pooled estimates of diagnostic accuracy and testing risks and benefits, we estimate LP only benefits CT negative patients when the pre-LP probability of SAH is on the order of 5%, which corresponds to a pre-CT probability greater than 20%. Conclusions Less than one in ten headache patients concerning for SAH are ultimately diagnosed with SAH in recent studies. While certain symptoms and signs increase or decrease the likelihood of SAH, no single characteristic is sufficient to rule-in or rule-out SAH. Within 6 hours of symptom onset, non-contrast cranial CT is highly accurate, while a negative CT beyond 6 hours substantially reduces the likelihood of SAH. LP appears to benefit relatively few patients within a narrow pre-test probability range. With improvements in CT technology and an expanding body of evidence, test-thresholds for LP may become more precise, obviating the need for a post-CT LP in more acute headache patients. Existing SAH clinical decision rules await external validation, but offer the potential to identify subsets most likely to benefit from post-CT LP, angiography, or no further testing. PMID:27306497

75 FR 45080 - Revisions to the California State Implementation Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... revisions concern oxides of nitrogen (NO X ) emissions from boilers, steam generators and process heaters... 1--Submitted Rule Local agency Rule No. Rule title Adopted Submitted SJVUAPCD 4308 Boilers, Steam... regulations that control NO X emissions. Rule 4308 limits NO X and CO emissions from boilers, steam generators...

76 FR 28689 - Microbiology Devices; Classification of In Vitro Diagnostic Device for Bacillus Species Detection

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

.... FDA-2011-N-0103] Microbiology Devices; Classification of In Vitro Diagnostic Device for Bacillus... of the Microbiology Devices Advisory Panel (the Panel). In addition, the proposed rule would... in the Federal Register. 1. Transcript of the FDA Microbiology Devices Panel meeting, March 7, 2002...

Controlled Trial Using Computerized Feedback to Improve Physicians' Diagnostic Judgments.

ERIC Educational Resources Information Center

Poses, Roy M.; And Others

1992-01-01

A study involving 14 experienced physicians investigated the effectiveness of a computer program (providing statistical feedback to teach a clinical diagnostic rule that predicts the probability of streptococcal pharyngitis), in conjunction with traditional lecture and periodic disease-prevalence reports. Results suggest the integrated method is a…

Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection: a systematic review and meta-analysis.

PubMed

Yoon, Jung-Ro; Yang, Se-Hyun; Shin, Young-Soo

2018-06-01

Many studies have found associations between laboratory biomarkers and periprosthetic joint infection (PJI), but it remains unclear whether these biomarkers are clinically useful in ruling out PJI. This meta-analysis compared the performance of interleukin-6 (IL-6) versus procalcitonin (PCT) for the diagnosis of PJI. In this meta-analysis, we reviewed studies that evaluated IL-6 or/and PCT as a diagnostic biomarker for PJI and provided sufficient data to permit sensitivity and specificity analyses for each test. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through February 28, 2017. No restrictions were placed on language of publication. We identified 18 studies encompassing a total of 1,835 subjects; 16 studies reported on IL-6 and 6 studies reported on PCT. The area under the curve (AUC) was 0.93 (95% CI, 0.91-0.95) for IL-6 and 0.83 (95% CI, 0.79-0.86) for PCT. The pooled sensitivity was 0.83 (95% CI, 0.74-0.89) for IL-6 and 0.58 (95% CI, 0.31-0.81) for PCT. The pooled specificity was 0.91 (95% CI, 0.84-0.95) for IL-6 and 0.95 (95% CI, 0.63-1.00) for PCT. Both the IL-6 and PCT tests had a high positive likelihood ratio (LR); 9.3 (95% CI, 5.3-16.2) and 12.4 (95% CI, 1.7-89.8), respectively, making them excellent rule-in tests for the diagnosis of PJI. The pooled negative LR for IL-6 was 0.19 (95% CI, 0.12-0.29), making it suitable as a rule-out test, whereas the pooled negative LR for PCT was 0.44 (95% CI, 0.25-0.78), making it unsuitable as a rule-out diagnostic tool. Based on the results of the present meta-analysis, IL-6 has higher diagnostic value than PCT for the diagnosis of PJI. Moreover, the specificity of the IL-6 test is higher than its sensitivity. Conversely, PCT is not recommended for use as a rule-out diagnostic tool.

Whole-body multislice computed tomography as the primary and sole diagnostic tool in patients with blunt trauma: searching for its appropriate indication.

PubMed

Wurmb, Thomas Erik; Frühwald, Peter; Hopfner, Wittiko; Roewer, Norbert; Brederlau, Jörg

2007-11-01

In our hospital, whole-body multislice computed tomography is used as the primary diagnostic tool in patients with suspected multiple trauma. A triage rule is used for its indication. We have retrospectively analyzed data of sedated, intubated and ventilated patients consecutively admitted to our trauma center to assess whether the triage rule can help identify patients with severe trauma (injury severity score > or = 16). We have found that overtriage (injury severity score < 16) occurs in 30%, and undertriage occurs in 6% of patients. Although we have found the triage rule to be highly sensitive, this results in a high rate of overtriage. Until we know more about the most relevant and independent predictive factors, sole reliance upon multislice computed tomography in triaging suspected polytrauma victims will imply the risk to overscan many patients.

Applying the Rule Space Model to Develop a Learning Progression for Thermochemistry

ERIC Educational Resources Information Center

Chen, Fu; Zhang, Shanshan; Guo, Yanfang; Xin, Tao

2017-01-01

We used the Rule Space Model, a cognitive diagnostic model, to measure the learning progression for thermochemistry for senior high school students. We extracted five attributes and proposed their hierarchical relationships to model the construct of thermochemistry at four levels using a hypothesized learning progression. For this study, we…

Spotting Erroneous Rules of Operation by the Individual Consistency Index.

ERIC Educational Resources Information Center

Tatsuoka, Kikumi K.; Tatsuoka, Maurice M.

1983-01-01

This study introduces the individual consistency index (ICI), which measures the extent to which patterns of responses to parallel sets of items remain consistent over time. ICI is used as an error diagnostic tool to detect aberrant response patterns resulting from the consistent application of erroneous rules of operation. (Author/PN)

Creation of a diagnostic wait times measurement framework based on evidence and consensus.

PubMed

Gilbert, Julie E; Dobrow, Mark J; Kaan, Melissa; Dobranowski, Julian; Srigley, John R; Jusko Friedman, Audrey; Irish, Jonathan C

2014-09-01

Public reporting of wait times worldwide has to date focused largely on treatment wait times and is limited in its ability to capture earlier parts of the patient journey. The interval between suspicion and diagnosis or ruling out of cancer is a complex phase of the cancer journey. Diagnostic delays and inefficient use of diagnostic imaging procedures can result in poor patient outcomes, both physical and psychosocial. This study was designed to develop a framework that could be adopted for multiple disease sites across different jurisdictions to enable the measurement of diagnostic wait times and diagnostic delay. Diagnostic benchmarks and targets in cancer systems were explored through a targeted literature review and jurisdictional scan. Cancer system leaders and clinicians were interviewed to validate the information found in the jurisdictional scan. An expert panel was assembled to review and, through a modified Delphi consensus process, provide feedback on a diagnostic wait times framework. The consensus process resulted in agreement on a measurement framework that identified suspicion, referral, diagnosis, and treatment as the main time points for measuring this critical phase of the patient journey. This work will help guide initiatives designed to improve patient access to health services by developing an evidence-based approach to standardization of the various waypoints during the diagnostic pathway. The diagnostic wait times measurement framework provides a yardstick to measure the performance of programs that are designed to manage and expedite care processes between referral and diagnosis or ruling out of cancer. Copyright © 2014 by American Society of Clinical Oncology.

Gene Ontology synonym generation rules lead to increased performance in biomedical concept recognition.

PubMed

Funk, Christopher S; Cohen, K Bretonnel; Hunter, Lawrence E; Verspoor, Karin M

2016-09-09

Gene Ontology (GO) terms represent the standard for annotation and representation of molecular functions, biological processes and cellular compartments, but a large gap exists between the way concepts are represented in the ontology and how they are expressed in natural language text. The construction of highly specific GO terms is formulaic, consisting of parts and pieces from more simple terms. We present two different types of manually generated rules to help capture the variation of how GO terms can appear in natural language text. The first set of rules takes into account the compositional nature of GO and recursively decomposes the terms into their smallest constituent parts. The second set of rules generates derivational variations of these smaller terms and compositionally combines all generated variants to form the original term. By applying both types of rules, new synonyms are generated for two-thirds of all GO terms and an increase in F-measure performance for recognition of GO on the CRAFT corpus from 0.498 to 0.636 is observed. Additionally, we evaluated the combination of both types of rules over one million full text documents from Elsevier; manual validation and error analysis show we are able to recognize GO concepts with reasonable accuracy (88 %) based on random sampling of annotations. In this work we present a set of simple synonym generation rules that utilize the highly compositional and formulaic nature of the Gene Ontology concepts. We illustrate how the generated synonyms aid in improving recognition of GO concepts on two different biomedical corpora. We discuss other applications of our rules for GO ontology quality assurance, explore the issue of overgeneration, and provide examples of how similar methodologies could be applied to other biomedical terminologies. Additionally, we provide all generated synonyms for use by the text-mining community.

Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score

PubMed Central

2011-01-01

Background Stratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms. Methods A systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used. Results A total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37). Conclusions Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care. PMID:21631919

A proposed computer diagnostic system for malignant melanoma (CDSMM).

PubMed

Shao, S; Grams, R R

1994-04-01

This paper describes a computer diagnostic system for malignant melanoma. The diagnostic system is a rule base system based on image analyses and works under the PC windows environment. It consists of seven modules: I/O module, Patient/Clinic database, image processing module, classification module, rule base module and system control module. In the system, the image analyses are automatically carried out, and database management is efficient and fast. Both final clinic results and immediate results from various modules such as measured features, feature pictures and history records of the disease lesion can be presented on screen or printed out from each corresponding module or from the I/O module. The system can also work as a doctor's office-based tool to aid dermatologists with details not perceivable by the human eye. Since the system operates on a general purpose PC, it can be made portable if the I/O module is disconnected.

Parent-based diagnosis of ADHD is as accurate as a teacher-based diagnosis of ADHD.

PubMed

Bied, Adam; Biederman, Joseph; Faraone, Stephen

2017-04-01

To review the literature evaluating the psychometric properties of parent and teacher informants relative to a gold-standard ADHD diagnosis in pediatric populations. We included studies that included both a parent and teacher informant, a gold-standard diagnosis, and diagnostic accuracy metrics. Potential confounds were evaluated. We also assessed the 'OR' and the 'AND' rules for combining informant reports. Eight articles met inclusion criteria. The diagnostic accuracy for predicting gold standard ADHD diagnoses did not differ between parents and teachers. Sample size, sample type, participant drop-out, participant age, participant gender, geographic area of the study, and date of study publication were assessed as potential confounds. Parent and teachers both yielded moderate to good diagnostic accuracy for ADHD diagnoses. Parent reports were statistically indistinguishable from those of teachers. The predictive features of the 'OR' and 'AND' rules are useful in evaluating approaches to better integrating information from these informants.

Data-driven backward chaining

NASA Technical Reports Server (NTRS)

Haley, Paul

1991-01-01

The C Language Integrated Production System (CLIPS) cannot effectively perform sound and complete logical inference in most real-world contexts. The problem facing CLIPS is its lack of goal generation. Without automatic goal generation and maintenance, forward chaining can only deduce all instances of a relationship. Backward chaining, which requires goal generation, allows deduction of only that subset of what is logically true which is also relevant to ongoing problem solving. Goal generation can be mimicked in simple cases using forward chaining. However, such mimicry requires manual coding of additional rules which can assert an inadequate goal representation for every condition in every rule that can have corresponding facts derived by backward chaining. In general, for N rules with an average of M conditions per rule the number of goal generation rules required is on the order of N*M. This is clearly intractable from a program maintenance perspective. We describe the support in Eclipse for backward chaining which it automatically asserts as it checks rule conditions. Important characteristics of this extension are that it does not assert goals which cannot match any rule conditions, that 2 equivalent goals are never asserted, and that goals persist as long as, but no longer than, they remain relevant.

Re-examining the differential familial liability of agoraphobia and panic disorder.

PubMed

Knappe, Susanne; Beesdo-Baum, Katja; Nocon, Agnes; Wittchen, Hans-Ulrich

2012-11-01

Controversy surrounds the question of whether agoraphobia (AG) exists as an independent diagnostic entity apart from panic. In favor of this position, AG without panic disorder (PD) in parents was found being unrelated to offsprings' risk for AG or PD, albeit it may enhance the familial transmission of PD (Nocon et al., Depress Anxiety 2008;25:422-434). However, a recent behavioral genetic analysis (Mosing et al., Depress Anxiety 2009;26:1004-1011) found an increased risk for both PD and AG in siblings of those with AG without PD, casting doubt on whether AG exists independently of PD. Convincing evidence for either position notably requires considering also other anxiety disorders to establish the position of AG relative to the panic/anxiety spectrum. Familial transmission of panic attacks (PAs), PD, and AG was examined in a 10-year prospective-longitudinal community study of 3,021 adolescents and young adults including completed direct and indirect information on parental psychopathology. Standardized diagnostic assessments using the Munich-Composite International Diagnostic Interview allowed generating exclusive diagnostic groups independent from diagnostic hierarchy rules. Parental PD without AG was associated with an increased risk for PA and PD+AG, but not for PD without AG or AG without PD in offspring. Parental AG without PD was unrelated to the offsprings' risk for PA, exclusive PD or AG, or PD+AG. Findings were largely unaffected by adjustment for other offspring or parental anxiety disorders. Findings provide further evidence for the independence of AG apart from the PD spectrum. © 2012 Wiley Periodicals, Inc.

Evaluation of Machine Learning and Rules-Based Approaches for Predicting Antimicrobial Resistance Profiles in Gram-negative Bacilli from Whole Genome Sequence Data.

PubMed

Pesesky, Mitchell W; Hussain, Tahir; Wallace, Meghan; Patel, Sanket; Andleeb, Saadia; Burnham, Carey-Ann D; Dantas, Gautam

2016-01-01

The time-to-result for culture-based microorganism recovery and phenotypic antimicrobial susceptibility testing necessitates initial use of empiric (frequently broad-spectrum) antimicrobial therapy. If the empiric therapy is not optimal, this can lead to adverse patient outcomes and contribute to increasing antibiotic resistance in pathogens. New, more rapid technologies are emerging to meet this need. Many of these are based on identifying resistance genes, rather than directly assaying resistance phenotypes, and thus require interpretation to translate the genotype into treatment recommendations. These interpretations, like other parts of clinical diagnostic workflows, are likely to be increasingly automated in the future. We set out to evaluate the two major approaches that could be amenable to automation pipelines: rules-based methods and machine learning methods. The rules-based algorithm makes predictions based upon current, curated knowledge of Enterobacteriaceae resistance genes. The machine-learning algorithm predicts resistance and susceptibility based on a model built from a training set of variably resistant isolates. As our test set, we used whole genome sequence data from 78 clinical Enterobacteriaceae isolates, previously identified to represent a variety of phenotypes, from fully-susceptible to pan-resistant strains for the antibiotics tested. We tested three antibiotic resistance determinant databases for their utility in identifying the complete resistome for each isolate. The predictions of the rules-based and machine learning algorithms for these isolates were compared to results of phenotype-based diagnostics. The rules based and machine-learning predictions achieved agreement with standard-of-care phenotypic diagnostics of 89.0 and 90.3%, respectively, across twelve antibiotic agents from six major antibiotic classes. Several sources of disagreement between the algorithms were identified. Novel variants of known resistance factors and incomplete genome assembly confounded the rules-based algorithm, resulting in predictions based on gene family, rather than on knowledge of the specific variant found. Low-frequency resistance caused errors in the machine-learning algorithm because those genes were not seen or seen infrequently in the test set. We also identified an example of variability in the phenotype-based results that led to disagreement with both genotype-based methods. Genotype-based antimicrobial susceptibility testing shows great promise as a diagnostic tool, and we outline specific research goals to further refine this methodology.

Automatic Generation of Supervisory Control System Software Using Graph Composition

NASA Astrophysics Data System (ADS)

Nakata, Hideo; Sano, Tatsuro; Kojima, Taizo; Seo, Kazuo; Uchida, Tomoyuki; Nakamura, Yasuaki

This paper describes the automatic generation of system descriptions for SCADA (Supervisory Control And Data Acquisition) systems. The proposed method produces various types of data and programs for SCADA systems from equipment definitions using conversion rules. At first, this method makes directed graphs, which represent connections between the equipment, from equipment definitions. System descriptions are generated using the conversion rules, by analyzing these directed graphs, and finding the groups of equipment that involve similar operations. This method can make the conversion rules multi levels by using the composition of graphs, and can reduce the number of rules. The developer can define and manage these rules efficiently.

40 CFR 52.226 - Control strategy and regulations: Particulate matter, San Joaquin Valley and Mountain Counties...

Code of Federal Regulations, 2014 CFR

2014-07-01

... previously approved in 40 CFR 52.223 is retained. (iii) The addition of Rule 209, Fossil Fuel-Steam Generator... CFR 52.223 are retained. (ii) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on July 22...) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on February 10, 1977, is disapproved and the...

40 CFR 52.226 - Control strategy and regulations: Particulate matter, San Joaquin Valley and Mountain Counties...

Code of Federal Regulations, 2011 CFR

2011-07-01

... previously approved in 40 CFR 52.223 is retained. (iii) The addition of Rule 209, Fossil Fuel-Steam Generator... CFR 52.223 are retained. (ii) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on July 22...) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on February 10, 1977, is disapproved and the...

40 CFR 52.226 - Control strategy and regulations: Particulate matter, San Joaquin Valley and Mountain Counties...

Code of Federal Regulations, 2013 CFR

2013-07-01

... previously approved in 40 CFR 52.223 is retained. (iii) The addition of Rule 209, Fossil Fuel-Steam Generator... CFR 52.223 are retained. (ii) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on July 22...) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on February 10, 1977, is disapproved and the...

40 CFR 52.226 - Control strategy and regulations: Particulate matter, San Joaquin Valley and Mountain Counties...

Code of Federal Regulations, 2010 CFR

2010-07-01

... previously approved in 40 CFR 52.223 is retained. (iii) The addition of Rule 209, Fossil Fuel-Steam Generator... CFR 52.223 are retained. (ii) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on July 22...) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on February 10, 1977, is disapproved and the...

40 CFR 52.226 - Control strategy and regulations: Particulate matter, San Joaquin Valley and Mountain Counties...

Code of Federal Regulations, 2012 CFR

2012-07-01

... previously approved in 40 CFR 52.223 is retained. (iii) The addition of Rule 209, Fossil Fuel-Steam Generator... CFR 52.223 are retained. (ii) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on July 22...) Rule 209, Fossil Fuel-Steam Generator Facility, submitted on February 10, 1977, is disapproved and the...

75 FR 7278 - Agency Information Collection Activities; Proposed Collection; Comment Request; Exception From...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-18

... the general requirements for informed consent to permit the use of investigational in vitro diagnostic... general requirements for informed consent, to permit the use of investigational in vitro diagnostic... exception to the general rule that informed consent is required for the use of an investigational in vitro...

A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.

PubMed

Noguchi, Yoshinori; Matsui, Kunihiko; Imura, Hiroshi; Kiyota, Masatomo; Fukui, Tsuguya

2004-05-01

Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students' estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. A carefully designed, but traditionally administered, short course could not improve the students' abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the "rule-in conscious paradigm."

Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T.

PubMed

Mueller, Christian; Giannitsis, Evangelos; Christ, Michael; Ordóñez-Llanos, Jorge; deFilippi, Christopher; McCord, James; Body, Richard; Panteghini, Mauro; Jernberg, Tomas; Plebani, Mario; Verschuren, Franck; French, John; Christenson, Robert; Weiser, Silvia; Bendig, Garnet; Dilba, Peter; Lindahl, Bertil

2016-07-01

We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

A simple diagnostic model for ruling out pneumoconiosis among construction workers.

PubMed

Suarthana, Eva; Moons, Karel G M; Heederik, Dick; Meijer, Evert

2007-09-01

Construction workers exposed to silica-containing dust are at risk of developing silicosis even at low exposure levels. Health surveillance among these workers is commonly advised but the exact diagnostic work-up is not specified and therefore may result in unnecessary chest x ray investigations. To develop a simple diagnostic model to estimate the probability of an individual worker having pneumoconiosis from questionnaire and spirometry results, in order to accurately rule out workers without pneumoconiosis. The study was performed using cross-sectional data of 1291 Dutch natural stone and construction workers with potentially high quartz dust exposure. A multivariable logistic regression model was developed using chest x ray with ILO profusion category > or =1/1 as the reference standard. The model's calibration was evaluated with the Hosmer-Lemeshow test; the discriminative ability was determined by calculating the area under the receiver operating characteristic curve (ROC area). Internal validity of the final model was assessed by a bootstrapping procedure. For clinical application, the diagnostic model was transformed into an easy-to-use score chart. Age 40 years or older, current smoker, high-exposure job, working 15 years or longer in the construction industry, "feeling unhealthy" and FEV1 were independent predictors in the diagnostic model. The model showed good calibration (a non-significant Hosmer-Lemeshow test) and discriminative ability (ROC area 0.81, 95% CI 0.74 to 0.85). Internal validity was reasonable; the optimism corrected ROC area was 0.76. By using a cut-off point with a high negative predictive value the occupational physician can efficiently detect a large proportion of workers with a low probability of having pneumoconiosis and exclude them from unnecessary x ray investigations. This diagnostic model is an efficient and effective instrument to rule out pneumoconiosis among construction workers. Its use in health surveillance among these workers can reduce the number of redundant x ray investigations.

An ontology for Autism Spectrum Disorder (ASD) to infer ASD phenotypes from Autism Diagnostic Interview-Revised data.

PubMed

Mugzach, Omri; Peleg, Mor; Bagley, Steven C; Guter, Stephen J; Cook, Edwin H; Altman, Russ B

2015-08-01

Our goal is to create an ontology that will allow data integration and reasoning with subject data to classify subjects, and based on this classification, to infer new knowledge on Autism Spectrum Disorder (ASD) and related neurodevelopmental disorders (NDD). We take a first step toward this goal by extending an existing autism ontology to allow automatic inference of ASD phenotypes and Diagnostic & Statistical Manual of Mental Disorders (DSM) criteria based on subjects' Autism Diagnostic Interview-Revised (ADI-R) assessment data. Knowledge regarding diagnostic instruments, ASD phenotypes and risk factors was added to augment an existing autism ontology via Ontology Web Language class definitions and semantic web rules. We developed a custom Protégé plugin for enumerating combinatorial OWL axioms to support the many-to-many relations of ADI-R items to diagnostic categories in the DSM. We utilized a reasoner to infer whether 2642 subjects, whose data was obtained from the Simons Foundation Autism Research Initiative, meet DSM-IV-TR (DSM-IV) and DSM-5 diagnostic criteria based on their ADI-R data. We extended the ontology by adding 443 classes and 632 rules that represent phenotypes, along with their synonyms, environmental risk factors, and frequency of comorbidities. Applying the rules on the data set showed that the method produced accurate results: the true positive and true negative rates for inferring autistic disorder diagnosis according to DSM-IV criteria were 1 and 0.065, respectively; the true positive rate for inferring ASD based on DSM-5 criteria was 0.94. The ontology allows automatic inference of subjects' disease phenotypes and diagnosis with high accuracy. The ontology may benefit future studies by serving as a knowledge base for ASD. In addition, by adding knowledge of related NDDs, commonalities and differences in manifestations and risk factors could be automatically inferred, contributing to the understanding of ASD pathophysiology. Copyright © 2015 Elsevier Inc. All rights reserved.

A systems engineering approach to automated failure cause diagnosis in space power systems

NASA Technical Reports Server (NTRS)

Dolce, James L.; Faymon, Karl A.

1987-01-01

Automatic failure-cause diagnosis is a key element in autonomous operation of space power systems such as Space Station's. A rule-based diagnostic system has been developed for determining the cause of degraded performance. The knowledge required for such diagnosis is elicited from the system engineering process by using traditional failure analysis techniques. Symptoms, failures, causes, and detector information are represented with structured data; and diagnostic procedural knowledge is represented with rules. Detected symptoms instantiate failure modes and possible causes consistent with currently held beliefs about the likelihood of the cause. A diagnosis concludes with an explanation of the observed symptoms in terms of a chain of possible causes and subcauses.

How children perceive fractals: Hierarchical self-similarity and cognitive development

PubMed Central

Martins, Maurício Dias; Laaha, Sabine; Freiberger, Eva Maria; Choi, Soonja; Fitch, W. Tecumseh

2014-01-01

The ability to understand and generate hierarchical structures is a crucial component of human cognition, available in language, music, mathematics and problem solving. Recursion is a particularly useful mechanism for generating complex hierarchies by means of self-embedding rules. In the visual domain, fractals are recursive structures in which simple transformation rules generate hierarchies of infinite depth. Research on how children acquire these rules can provide valuable insight into the cognitive requirements and learning constraints of recursion. Here, we used fractals to investigate the acquisition of recursion in the visual domain, and probed for correlations with grammar comprehension and general intelligence. We compared second (n = 26) and fourth graders (n = 26) in their ability to represent two types of rules for generating hierarchical structures: Recursive rules, on the one hand, which generate new hierarchical levels; and iterative rules, on the other hand, which merely insert items within hierarchies without generating new levels. We found that the majority of fourth graders, but not second graders, were able to represent both recursive and iterative rules. This difference was partially accounted by second graders’ impairment in detecting hierarchical mistakes, and correlated with between-grade differences in grammar comprehension tasks. Empirically, recursion and iteration also differed in at least one crucial aspect: While the ability to learn recursive rules seemed to depend on the previous acquisition of simple iterative representations, the opposite was not true, i.e., children were able to acquire iterative rules before they acquired recursive representations. These results suggest that the acquisition of recursion in vision follows learning constraints similar to the acquisition of recursion in language, and that both domains share cognitive resources involved in hierarchical processing. PMID:24955884

Convergence between DSM-IV-TR and DSM-5 diagnostic models for personality disorder: evaluation of strategies for establishing diagnostic thresholds.

PubMed

Morey, Leslie C; Skodol, Andrew E

2013-05-01

The Personality and Personality Disorders Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recommended substantial revisions to the personality disorders (PDs) section of DSM-IV-TR, proposing a hybrid categorical-dimensional model that represented PDs as combinations of core personality dysfunctions and various configurations of maladaptive personality traits. Although the DSM-5 Task Force endorsed the proposal, the Board of Trustees of the American Psychiatric Association (APA) did not, placing the Work Group's model in DSM-5 Section III ("Emerging Measures and Models") with other concepts thought to be in need of additional research. This paper documents the impact of using this alternative model in a national sample of 337 patients as described by clinicians familiar with their cases. In particular, the analyses focus on alternative strategies considered by the Work Group for deriving decision rules, or diagnostic thresholds, with which to assign categorical diagnoses. Results demonstrate that diagnostic rules could be derived that yielded appreciable correspondence between DSM-IV-TR and proposed DSM-5 PD diagnoses-correspondence greater than that observed in the transition between DSM-III and DSM-III-R PDs. The approach also represents the most comprehensive attempt to date to provide conceptual and empirical justification for diagnostic thresholds utilized within the DSM PDs.

Radioactive Waste Management in A Hospital

PubMed Central

Khan, Shoukat; Syed, AT; Ahmad, Reyaz; Rather, Tanveer A.; Ajaz, M; Jan, FA

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations. PMID:21475524

Diagnostic aids: the Surgical Sieve revisited.

PubMed

Chai, Jason; Evans, Lloyd; Hughes, Tom

2017-08-01

Diagnostic errors are well documented in the literature and emphasise the need to teach diagnostic skills at an early stage in medical school to create effective and safe clinicians. Hence, there may be a place for diagnostic aids (such as the Surgical Sieve) that provide a framework for generating ideas about diagnoses. With repeated use of the Surgical Sieve in teaching sessions with students, and prompted by the traditional handheld wheels used in antenatal clinics, we developed the Compass Medicine, a handheld diagnostic wheel comprising three concentric discs attached at the centre. We report a preliminary study comparing the Surgical Sieve and the Compass Medicine in generating differential diagnoses. A total of 48 third-year medical students from Cardiff University participated in a study aimed at measuring the efficacy of diagnostic aids (Surgical Sieve and Compass Medicine) in generating diagnoses. We quantified the effect each aid had on the number of diagnoses generated, and compared the size of the effect between the two diagnostic aids. There may be a place for diagnostic aids that provide a framework for generating ideas about diagnoses RESULTS: The study suggests that both diagnostic aids prompted users to generate a greater number of diagnoses, but there was no significant difference in the size of effect between the two diagnostic aids. We hope that our study with diagnostic aids will encourage the use of robust tools to teach medical students an easily visualised framework for diagnostic thinking. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Equations for Scoring Rules When Data Are Missing

NASA Technical Reports Server (NTRS)

James, Mark

2006-01-01

A document presents equations for scoring rules in a diagnostic and/or prognostic artificial-intelligence software system of the rule-based inference-engine type. The equations define a set of metrics that characterize the evaluation of a rule when data required for the antecedence clause(s) of the rule are missing. The metrics include a primary measure denoted the rule completeness metric (RCM) plus a number of subsidiary measures that contribute to the RCM. The RCM is derived from an analysis of a rule with respect to its truth and a measure of the completeness of its input data. The derivation is such that the truth value of an antecedent is independent of the measure of its completeness. The RCM can be used to compare the degree of completeness of two or more rules with respect to a given set of data. Hence, the RCM can be used as a guide to choosing among rules during the rule-selection phase of operation of the artificial-intelligence system..

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium.

PubMed

Hunt, Beverley J; Parmar, Kiran; Horspool, Kimberley; Shephard, Neil; Nelson-Piercy, Catherine; Goodacre, Steve

2018-03-01

This study aimed to estimate the diagnostic utility of biomarkers for suspected venous thromboembolism (VTE) in pregnancy and the puerperium. Research nurses/midwives collected blood samples from 310 pregnant/postpartum women with suspected pulmonary emboli (PE) and 18 with diagnosed deep vein thrombosis (DVT). VTE was diagnosed using imaging, treatment and adverse outcome data. Primary analysis was limited to women with conclusive imaging (36 with VTE, 247 without). The area under the curve (AUC) for each biomarker was: activated partial thromboplastin time 0·669 (95% confidence interval 0·570-0·768), B-type natriuretic peptide 0·549 (0·453-0·645), C-reactive protein 0·542 (0·445-0·639), Clauss fibrinogen 0·589 (0·476-0·701), D-Dimer (by enzyme-linked immunosorbent assay) 0·668 (0·561-0·776), near-patient D-Dimer 0·651 (0·545-0·758), mid-regional pro-atrial natriuretic peptide 0·524 (0·418-0·630), prothrombin fragment 1 + 2 0·562 (0·462-0·661), plasmin-antiplasmin complexes 0·639 (0·536-0·742), prothombin time 0·613 (0·508-0·718), thrombin generation lag time 0·702 (0·598-0·806), thrombin generation endogenous potential 0·559 (0·437-0·681), thrombin generation peak 0·596 (0·478-0·715), thrombin generation time to peak 0·655 (0·541-0·769), soluble tissue factor 0·531 (0·424-0·638) and serum troponin 0·597 (0·499-0·695). No diagnostically useful threshold for diagnosing or ruling out VTE was identified. In pregnancy and the puerperium, conventional and candidate biomarkers have no utility either for their negative or positive predictive value in the diagnosis of VTE. © 2018 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd.

Assessment and mitigation of diagnostic-generated electromagnetic interference at the National Ignition Facilitya)

NASA Astrophysics Data System (ADS)

Brown, C. G.; Ayers, J.; Felker, B.; Ferguson, W.; Holder, J. P.; Nagel, S. R.; Piston, K. W.; Simanovskaia, N.; Throop, A. L.; Chung, M.; Hilsabeck, T.

2012-10-01

Electromagnetic interference (EMI) is an ever-present challenge at laser facilities such as the National Ignition Facility (NIF). The major source of EMI at such facilities is laser-target interaction that can generate intense electromagnetic fields within, and outside of, the laser target chamber. In addition, the diagnostics themselves can be a source of EMI, even interfering with themselves. In this paper we describe EMI generated by ARIANE and DIXI, present measurements, and discuss effects of the diagnostic-generated EMI on ARIANE's CCD and on a PMT nearby DIXI. Finally we present some of the efforts we have made to mitigate the effects of diagnostic-generated EMI on NIF diagnostics.

Ares I-X Ground Diagnostic Prototype

NASA Technical Reports Server (NTRS)

Schwabacher, Mark A.; Martin, Rodney Alexander; Waterman, Robert D.; Oostdyk, Rebecca Lynn; Ossenfort, John P.; Matthews, Bryan

2010-01-01

The automation of pre-launch diagnostics for launch vehicles offers three potential benefits: improving safety, reducing cost, and reducing launch delays. The Ares I-X Ground Diagnostic Prototype demonstrated anomaly detection, fault detection, fault isolation, and diagnostics for the Ares I-X first-stage Thrust Vector Control and for the associated ground hydraulics while the vehicle was in the Vehicle Assembly Building at Kennedy Space Center (KSC) and while it was on the launch pad. The prototype combines three existing tools. The first tool, TEAMS (Testability Engineering and Maintenance System), is a model-based tool from Qualtech Systems Inc. for fault isolation and diagnostics. The second tool, SHINE (Spacecraft Health Inference Engine), is a rule-based expert system that was developed at the NASA Jet Propulsion Laboratory. We developed SHINE rules for fault detection and mode identification, and used the outputs of SHINE as inputs to TEAMS. The third tool, IMS (Inductive Monitoring System), is an anomaly detection tool that was developed at NASA Ames Research Center. The three tools were integrated and deployed to KSC, where they were interfaced with live data. This paper describes how the prototype performed during the period of time before the launch, including accuracy and computer resource usage. The paper concludes with some of the lessons that we learned from the experience of developing and deploying the prototype.

Comparing Eighth-Grade Diagnostic Test Results for Korean, Czech, and American Students.

ERIC Educational Resources Information Center

Um, Eunkyoung; Dogan, Enis; Im, Seongah; Tatsuoka, Kimumi; Corter, James E.

Diagnostic analyses were conducted on data from the Third International Mathematics and Science Study second population (TIMSS-R; 1999) from the United States, Korea, and the Czech Republic in terms of test item attributes (i.e., content, processing skills, and item format) and inferred students' knowledge. The Rule Space model (K. Tatsuoka, 1998)…

Diagnostic games: from adequate formalization of clinical experience to structure discovery.

PubMed

Shifrin, Michael A; Kasparova, Eva I

2008-01-01

A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

Rapid Rule-Out of Acute Myocardial Injury Using a Single High-Sensitivity Cardiac Troponin I Measurement.

PubMed

Sandoval, Yader; Smith, Stephen W; Shah, Anoop S V; Anand, Atul; Chapman, Andrew R; Love, Sara A; Schulz, Karen; Cao, Jing; Mills, Nicholas L; Apple, Fred S

2017-01-01

Rapid rule-out strategies using high-sensitivity cardiac troponin assays are largely supported by studies performed outside the US in selected cohorts of patients with chest pain that are atypical of US practice, and focused exclusively on ruling out acute myocardial infarction (AMI), rather than acute myocardial injury, which is more common and associated with a poor prognosis. Prospective, observational study of consecutive patients presenting to emergency departments [derivation (n = 1647) and validation (n = 2198) cohorts], where high-sensitivity cardiac troponin I (hs-cTnI) was measured on clinical indication. The negative predictive value (NPV) and diagnostic sensitivity of an hs-cTnI concentration

Primer on clinical acid-base problem solving.

PubMed

Whittier, William L; Rutecki, Gregory W

2004-03-01

Acid-base problem solving has been an integral part of medical practice in recent generations. Diseases discovered in the last 30-plus years, for example, Bartter syndrome and Gitelman syndrome, D-lactic acidosis, and bulimia nervosa, can be diagnosed according to characteristic acid-base findings. Accuracy in acid-base problem solving is a direct result of a reproducible, systematic approach to arterial pH, partial pressure of carbon dioxide, bicarbonate concentration, and electrolytes. The 'Rules of Five' is one tool that enables clinicians to determine the cause of simple and complex disorders, even triple acid-base disturbances, with consistency. In addition, other electrolyte abnormalities that accompany acid-base disorders, such as hypokalemia, can be incorporated into algorithms that complement the Rules and contribute to efficient problem solving in a wide variety of diseases. Recently urine electrolytes have also assisted clinicians in further characterizing select disturbances. Acid-base patterns, in many ways, can serve as a 'common diagnostic pathway' shared by all subspecialties in medicine. From infectious disease (eg, lactic acidemia with highly active antiviral therapy therapy) through endocrinology (eg, Conn's syndrome, high urine chloride alkalemia) to the interface between primary care and psychiatry (eg, bulimia nervosa with multiple potential acid-base disturbances), acid-base problem solving is the key to unlocking otherwise unrelated diagnoses. Inasmuch as the Rules are clinical tools, they are applied throughout this monograph to diverse pathologic conditions typical in contemporary practice.

Collective intelligence meets medical decision-making: the collective outperforms the best radiologist.

PubMed

Wolf, Max; Krause, Jens; Carney, Patricia A; Bogart, Andy; Kurvers, Ralf H J M

2015-01-01

While collective intelligence (CI) is a powerful approach to increase decision accuracy, few attempts have been made to unlock its potential in medical decision-making. Here we investigated the performance of three well-known collective intelligence rules ("majority", "quorum", and "weighted quorum") when applied to mammography screening. For any particular mammogram, these rules aggregate the independent assessments of multiple radiologists into a single decision (recall the patient for additional workup or not). We found that, compared to single radiologists, any of these CI-rules both increases true positives (i.e., recalls of patients with cancer) and decreases false positives (i.e., recalls of patients without cancer), thereby overcoming one of the fundamental limitations to decision accuracy that individual radiologists face. Importantly, we find that all CI-rules systematically outperform even the best-performing individual radiologist in the respective group. Our findings demonstrate that CI can be employed to improve mammography screening; similarly, CI may have the potential to improve medical decision-making in a much wider range of contexts, including many areas of diagnostic imaging and, more generally, diagnostic decisions that are based on the subjective interpretation of evidence.

A "Trans-Dyadic" Perspective on the Goldwater Rule.

PubMed

Plakun, Eric M

2017-11-01

The Goldwater Rule has been debated, redefined, and debated further since the election of Donald Trump as President of the United States. This column offers a perspective on the Goldwater Rule that moves beyond psychiatry's current preoccupation with precision DSM-5 diagnosis of individuals, which ethically requires consent or other legal authorization for release of diagnostic information to others, and into the realm of leadership as seen through the "trans-dyadic" lens of psychoanalytic understanding of large group processes on a societal level. Concepts from large group psychology are introduced to illustrate "trans-dyadic" perspectives on leadership that do not challenge the Goldwater Rule.

[Diagnostic imaging and acute abdominal pain].

PubMed

Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

2015-01-19

Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

Assessment and Mitigation of Diagnostic-Generated Electromagnetic Interference at the National Ignition Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, C G; Ayers, M J; Felker, B

2012-04-20

Electromagnetic interference (EMI) is an ever-present challenge at laser facilities such as the National Ignition Facility (NIF). The major source of EMI at such facilities is laser-target interaction that can generate intense electromagnetic fields within, and outside of, the laser target chamber. In addition, the diagnostics themselves can be a source of EMI, even interfering with themselves. In this paper we describe EMI generated by ARIANE and DIXI, present measurements, and discuss effects of the diagnostic-generated EMI on ARIANE's CCD and on a PMT nearby DIXI. Finally we present some of the efforts we have made to mitigate the effectsmore » of diagnostic-generated EMI on NIF diagnostics.« less

Frequent Questions about the Hazardous Waste Generator Improvements Final Rule

EPA Pesticide Factsheets

FAQs including What are the benefits of these revisions to the generator regulations? What changed in the final regulations since proposal? How and why will the hazardous waste generator regulations be reorganized? When will this rule become effective?

Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds.

PubMed

Carpenter, Christopher R; Hussain, Adnan M; Ward, Michael J; Zipfel, Gregory J; Fowler, Susan; Pines, Jesse M; Sivilotti, Marco L A

2016-09-01

Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic. The objective was to perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH. A secondary objective was to delineate probability of disease thresholds for imaging and lumbar puncture (LP). PubMed, Embase, Scopus, and research meeting abstracts were searched up to June 2015 for studies of emergency department patients with acute headache clinically concerning for spontaneous SAH. QUADAS-2 was used to assess study quality and, when appropriate, meta-analysis was conducted using random effects models. Outcomes were sensitivity, specificity, and positive (LR+) and negative (LR-) likelihood ratios. To identify test and treatment thresholds, we employed the Pauker-Kassirer method with Bernstein test indication curves using the summary estimates of diagnostic accuracy. A total of 5,022 publications were identified, of which 122 underwent full-text review; 22 studies were included (average SAH prevalence = 7.5%). Diagnostic studies differed in assessment of history and physical examination findings, CT technology, analytical techniques used to identify xanthochromia, and criterion standards for SAH. Study quality by QUADAS-2 was variable; however, most had a relatively low risk of biases. A history of neck pain (LR+ = 4.1; 95% confidence interval [CI] = 2.2 to 7.6) and neck stiffness on physical examination (LR+ = 6.6; 95% CI = 4.0 to 11.0) were the individual findings most strongly associated with SAH. Combinations of findings may rule out SAH, yet promising clinical decision rules await external validation. Noncontrast cranial CT within 6 hours of headache onset accurately ruled in (LR+ = 230; 95% CI = 6 to 8,700) and ruled out SAH (LR- = 0.01; 95% CI = 0 to 0.04); CT beyond 6 hours had a LR- of 0.07 (95% CI = 0.01 to 0.61). CSF analyses had lower diagnostic accuracy, whether using red blood cell (RBC) count or xanthochromia. At a threshold RBC count of 1,000 × 10(6) /L, the LR+ was 5.7 (95% CI = 1.4 to 23) and LR- was 0.21 (95% CI = 0.03 to 1.7). Using the pooled estimates of diagnostic accuracy and testing risks and benefits, we estimate that LP only benefits CT-negative patients when the pre-LP probability of SAH is on the order of 5%, which corresponds to a pre-CT probability greater than 20%. Less than one in 10 headache patients concerning for SAH are ultimately diagnosed with SAH in recent studies. While certain symptoms and signs increase or decrease the likelihood of SAH, no single characteristic is sufficient to rule in or rule out SAH. Within 6 hours of symptom onset, noncontrast cranial CT is highly accurate, while a negative CT beyond 6 hours substantially reduces the likelihood of SAH. LP appears to benefit relatively few patients within a narrow pretest probability range. With improvements in CT technology and an expanding body of evidence, test thresholds for LP may become more precise, obviating the need for a post-CT LP in more acute headache patients. Existing SAH clinical decision rules await external validation, but offer the potential to identify subsets most likely to benefit from post-CT LP, angiography, or no further testing. © 2016 by the Society for Academic Emergency Medicine.

Real-time diagnostics for a reusable rocket engine

NASA Technical Reports Server (NTRS)

Guo, T. H.; Merrill, W.; Duyar, A.

1992-01-01

A hierarchical, decentralized diagnostic system is proposed for the Real-Time Diagnostic System component of the Intelligent Control System (ICS) for reusable rocket engines. The proposed diagnostic system has three layers of information processing: condition monitoring, fault mode detection, and expert system diagnostics. The condition monitoring layer is the first level of signal processing. Here, important features of the sensor data are extracted. These processed data are then used by the higher level fault mode detection layer to do preliminary diagnosis on potential faults at the component level. Because of the closely coupled nature of the rocket engine propulsion system components, it is expected that a given engine condition may trigger more than one fault mode detector. Expert knowledge is needed to resolve the conflicting reports from the various failure mode detectors. This is the function of the diagnostic expert layer. Here, the heuristic nature of this decision process makes it desirable to use an expert system approach. Implementation of the real-time diagnostic system described above requires a wide spectrum of information processing capability. Generally, in the condition monitoring layer, fast data processing is often needed for feature extraction and signal conditioning. This is usually followed by some detection logic to determine the selected faults on the component level. Three different techniques are used to attack different fault detection problems in the NASA LeRC ICS testbed simulation. The first technique employed is the neural network application for real-time sensor validation which includes failure detection, isolation, and accommodation. The second approach demonstrated is the model-based fault diagnosis system using on-line parameter identification. Besides these model based diagnostic schemes, there are still many failure modes which need to be diagnosed by the heuristic expert knowledge. The heuristic expert knowledge is implemented using a real-time expert system tool called G2 by Gensym Corp. Finally, the distributed diagnostic system requires another level of intelligence to oversee the fault mode reports generated by component fault detectors. The decision making at this level can best be done using a rule-based expert system. This level of expert knowledge is also implemented using G2.

Utility of non-rule-based visual matching as a strategy to allow novices to achieve skin lesion diagnosis.

PubMed

Aldridge, R Benjamin; Glodzik, Dominik; Ballerini, Lucia; Fisher, Robert B; Rees, Jonathan L

2011-05-01

Non-analytical reasoning is thought to play a key role in dermatology diagnosis. Considering its potential importance, surprisingly little work has been done to research whether similar identification processes can be supported in non-experts. We describe here a prototype diagnostic support software, which we have used to examine the ability of medical students (at the beginning and end of a dermatology attachment) and lay volunteers, to diagnose 12 images of common skin lesions. Overall, the non-experts using the software had a diagnostic accuracy of 98% (923/936) compared with 33% for the control group (215/648) (Wilcoxon p < 0.0001). We have demonstrated, within the constraints of a simplified clinical model, that novices' diagnostic scores are significantly increased by the use of a structured image database coupled with matching of index and referent images. The novices achieve this high degree of accuracy without any use of explicit definitions of likeness or rule-based strategies.

Diameter measurement of optical nanofiber based on high-order Bragg reflections using a ruled grating.

PubMed

Zhu, Ming; Wang, Yao-Ting; Sun, Yi-Zhi; Zhang, Lijian; Ding, Wei

2018-02-01

A convenient method using a commercially available ruled grating for precise and overall diameter measurement of optical nanofibers (ONFs) is presented. We form a composite Bragg reflector with a micronscale period by dissolving aluminum coating, slicing the grating along ruling lines, and mounting it on an ONF. The resonant wavelengths of high-order Bragg reflections possess fiber diameter dependence, enabling nondestructive measurement of the ONF diameter profile. This method provides an easy and economic diagnostic tool for wide varieties of ONF-based applications.

Optimal Test Design with Rule-Based Item Generation

ERIC Educational Resources Information Center

Geerlings, Hanneke; van der Linden, Wim J.; Glas, Cees A. W.

2013-01-01

Optimal test-design methods are applied to rule-based item generation. Three different cases of automated test design are presented: (a) test assembly from a pool of pregenerated, calibrated items; (b) test generation on the fly from a pool of calibrated item families; and (c) test generation on the fly directly from calibrated features defining…

Final Rule for Control of Air Pollution From Motor Vehicles and New Motor Vehicle Engines; Modification of Federal Onboard Diagnostic Regulations for Light-Duty Vehicles and Light-Duty Trucks; Extension of Acceptance of California OBD

EPA Pesticide Factsheets

This action finalizes modifications to the federal on-board diagnostics regulations, including: harmonizing the emission levels above which a component or system is considered malfunctioning with those of the California Air Resources Board (CARB).

A computational framework for converting textual clinical diagnostic criteria into the quality data model.

PubMed

Hong, Na; Li, Dingcheng; Yu, Yue; Xiu, Qiongying; Liu, Hongfang; Jiang, Guoqian

2016-10-01

Constructing standard and computable clinical diagnostic criteria is an important but challenging research field in the clinical informatics community. The Quality Data Model (QDM) is emerging as a promising information model for standardizing clinical diagnostic criteria. To develop and evaluate automated methods for converting textual clinical diagnostic criteria in a structured format using QDM. We used a clinical Natural Language Processing (NLP) tool known as cTAKES to detect sentences and annotate events in diagnostic criteria. We developed a rule-based approach for assigning the QDM datatype(s) to an individual criterion, whereas we invoked a machine learning algorithm based on the Conditional Random Fields (CRFs) for annotating attributes belonging to each particular QDM datatype. We manually developed an annotated corpus as the gold standard and used standard measures (precision, recall and f-measure) for the performance evaluation. We harvested 267 individual criteria with the datatypes of Symptom and Laboratory Test from 63 textual diagnostic criteria. We manually annotated attributes and values in 142 individual Laboratory Test criteria. The average performance of our rule-based approach was 0.84 of precision, 0.86 of recall, and 0.85 of f-measure; the performance of CRFs-based classification was 0.95 of precision, 0.88 of recall and 0.91 of f-measure. We also implemented a web-based tool that automatically translates textual Laboratory Test criteria into the QDM XML template format. The results indicated that our approaches leveraging cTAKES and CRFs are effective in facilitating diagnostic criteria annotation and classification. Our NLP-based computational framework is a feasible and useful solution in developing diagnostic criteria representation and computerization. Copyright © 2016 Elsevier Inc. All rights reserved.

Intelligent model-based diagnostics for vehicle health management

NASA Astrophysics Data System (ADS)

Luo, Jianhui; Tu, Fang; Azam, Mohammad S.; Pattipati, Krishna R.; Willett, Peter K.; Qiao, Liu; Kawamoto, Masayuki

2003-08-01

The recent advances in sensor technology, remote communication and computational capabilities, and standardized hardware/software interfaces are creating a dramatic shift in the way the health of vehicles is monitored and managed. These advances facilitate remote monitoring, diagnosis and condition-based maintenance of automotive systems. With the increased sophistication of electronic control systems in vehicles, there is a concomitant increased difficulty in the identification of the malfunction phenomena. Consequently, the current rule-based diagnostic systems are difficult to develop, validate and maintain. New intelligent model-based diagnostic methodologies that exploit the advances in sensor, telecommunications, computing and software technologies are needed. In this paper, we will investigate hybrid model-based techniques that seamlessly employ quantitative (analytical) models and graph-based dependency models for intelligent diagnosis. Automotive engineers have found quantitative simulation (e.g. MATLAB/SIMULINK) to be a vital tool in the development of advanced control systems. The hybrid method exploits this capability to improve the diagnostic system's accuracy and consistency, utilizes existing validated knowledge on rule-based methods, enables remote diagnosis, and responds to the challenges of increased system complexity. The solution is generic and has the potential for application in a wide range of systems.

Increasing organ donation via changes in the default choice or allocation rule

PubMed Central

Li, Danyang; Hawley, Zackary; Schnier, Kurt

2013-01-01

This research utilizes a laboratory experiment to evaluate the effectiveness of alternative public policies targeted at increasing the rate of deceased donor organ donation. The experiment includes treatments across different default choices and organ allocation rules inspired by the donor registration systems applied in different countries. Our results indicate that the opt-out with priority rule system generates the largest increase in organ donation relative to an opt-in only program. However, sizeable gains are achievable using either a priority rule or opt-out program separately, with the opt-out rule generating approximately 80% of the benefits achieved under a priority rule program. PMID:24135615

Validation of the Oudega diagnostic decision rule for diagnosing deep vein thrombosis in frail older out-of-hospital patients.

PubMed

Schouten, Henrike J; Koek, Huiberdina L; Oudega, Ruud; van Delden, Johannes J M; Moons, Karel G M; Geersing, Geert-Jan

2015-02-01

We aimed to validate the Oudega diagnostic decision rule-which was developed and validated among younger aged primary care patients-to rule-out deep vein thrombosis (DVT) in frail older outpatients. In older patients (>60 years, either community dwelling or residing in nursing homes) with clinically suspected DVT, physicians recorded the score on the Oudega rule and d-dimer test. DVT was confirmed with a composite reference standard including ultrasonography examination and 3-month follow-up. The proportion of patients with a very low probability of DVT according to the Oudega rule (efficiency), and the proportion of patients with symptomatic venous thromboembolism during 3 months follow-up within this 'very low risk' group (failure rate) was calculated. DVT occurred in 164 (47%) of the 348 study participants (mean age 81 years, 85% residing in nursing homes). The probability of DVT was very low in 69 patients (Oudega score ≤3 points plus a normal d-dimer test; efficiency 20%) of whom four had non-fatal DVT (failure rate 5.8%; 2.3-14%). With a simple revised version of the Oudega rule for older suspected patients, 43 patients had a low risk of DVT (12% of the total population) of whom only one had DVT (failure rate 2.3%; 0.4-12%). In older suspected patients, application of the original Oudega rule to exclude DVT resulted in a higher failure rate as compared to previous studies. A revised and simplified Oudega strategy specifically developed for elderly suspected patients resulted in a lower failure rate though at the expense of a lower efficiency. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Rules and Self-Rules: Effects of Variation upon Behavioral Sensitivity to Change

ERIC Educational Resources Information Center

Baumann, Ana A.; Abreu-Rodrigues, Josele; da Silva Souza, Alessandra

2009-01-01

Four experiments compared the effects of self-rules and rules, and varied and specific schedules of reinforcement. Participants were first exposed to either several schedules (varied groups) or to one schedule (specific groups) and either were asked to generate rules (self-rule groups), were provided rules (rule groups), or were not asked nor…

Heat exchanger expert system logic

NASA Technical Reports Server (NTRS)

Cormier, R.

1988-01-01

The reduction is described of the operation and fault diagnostics of a Deep Space Network heat exchanger to a rule base by the application of propositional calculus to a set of logic statements. The value of this approach lies in the ease of converting the logic and subsequently implementing it on a computer as an expert system. The rule base was written in Process Intelligent Control software.

The cost-effectiveness of diagnostic management strategies for adults with minor head injury.

PubMed

Holmes, M W; Goodacre, S; Stevenson, M D; Pandor, A; Pickering, A

2012-09-01

To estimate the cost-effectiveness of diagnostic management strategies for adults with minor head injury. A mathematical model was constructed to evaluate the incremental costs and effectiveness (Quality Adjusted Life years Gained, QALYs) of ten diagnostic management strategies for adults with minor head injuries. Secondary analyses were undertaken to determine the cost-effectiveness of hospital admission compared to discharge home and to explore the cost-effectiveness of strategies when no responsible adult was available to observe the patient after discharge. The apparent optimal strategy was based on the high and medium risk Canadian CT Head Rule (CCHRhm), although the costs and outcomes associated with each strategy were broadly similar. Hospital admission for patients with non-neurosurgical injury on CT dominated discharge home, whilst hospital admission for clinically normal patients with a normal CT was not cost-effective compared to discharge home with or without a responsible adult at £39 and £2.5 million per QALY, respectively. A selective CT strategy with discharge home if the CT scan was normal remained optimal compared to not investigating or CT scanning all patients when there was no responsible adult available to observe them after discharge. Our economic analysis confirms that the recent extension of access to CT scanning for minor head injury is appropriate. Liberal use of CT scanning based on a high sensitivity decision rule is not only effective but also cost-saving. The cost of CT scanning is very small compared to the estimated cost of caring for patients with brain injury worsened by delayed treatment. It is recommended therefore that all hospitals receiving patients with minor head injury should have unrestricted access to CT scanning for use in conjunction with evidence based guidelines. Provisionally the CCHRhm decision rule appears to be the best strategy although there is considerable uncertainty around the optimal decision rule. However, the CCHRhm rule appears to be the most widely validated and it therefore seems appropriate to conclude that the CCHRhm rule has the best evidence to support its use. Copyright © 2011 Elsevier Ltd. All rights reserved.

Economic evaluation of the one-hour rule-out and rule-in algorithm for acute myocardial infarction using the high-sensitivity cardiac troponin T assay in the emergency department.

PubMed

Ambavane, Apoorva; Lindahl, Bertil; Giannitsis, Evangelos; Roiz, Julie; Mendivil, Joan; Frankenstein, Lutz; Body, Richard; Christ, Michael; Bingisser, Roland; Alquezar, Aitor; Mueller, Christian

2017-01-01

The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists. Length of stay (LoS), resource utilization (RU), and predicted diagnostic accuracy of the 1-h algorithm compared to standard of care (SoC) in the ED were estimated. The ED LoS, RU, and accuracy of the 1-h algorithm was compared to that achieved by the SoC at ED discharge. Expert opinion was sought to characterize clinical implementation of the 1-h algorithm, which required blood draws at ED presentation and 1h, after which "rule-in" patients were transferred for coronary angiography, "rule-out" patients underwent outpatient stress testing, and "observation" patients received SoC. Unit costs were for the United Kingdom, Switzerland, and Germany. The sensitivity and specificity for the 1-h algorithm were 87% and 96%, respectively, compared to 69% and 98% for SoC. The mean ED LoS for the 1-h algorithm was 4.3h-it was 6.5h for SoC, which is a reduction of 33%. The 1-h algorithm was associated with reductions in RU, driven largely by the shorter LoS in the ED for patients with a diagnosis other than AMI. The estimated total costs per patient were £2,480 for the 1-h algorithm compared to £4,561 for SoC, a reduction of up to 46%. The analysis shows that the use of 1-h algorithm is associated with reduction in overall AMI diagnostic costs, provided it is carefully implemented in clinical practice. These results need to be prospectively validated in the future.

Constraints in cancer evolution.

PubMed

Venkatesan, Subramanian; Birkbak, Nicolai J; Swanton, Charles

2017-02-08

Next-generation deep genome sequencing has only recently allowed us to quantitatively dissect the extent of heterogeneity within a tumour, resolving patterns of cancer evolution. Intratumour heterogeneity and natural selection contribute to resistance to anticancer therapies in the advanced setting. Recent evidence has also revealed that cancer evolution might be constrained. In this review, we discuss the origins of intratumour heterogeneity and subsequently focus on constraints imposed upon cancer evolution. The presence of (1) parallel evolution, (2) convergent evolution and (3) the biological impact of acquiring mutations in specific orders suggest that cancer evolution may be exploitable. These constraints on cancer evolution may help us identify cancer evolutionary rule books, which could eventually inform both diagnostic and therapeutic approaches to improve survival outcomes. © 2017 The Author(s); published by Portland Press Limited on behalf of the Biochemical Society.

Dissipative quantum hydrodynamics model of x-ray Thomson scattering in dense plasmas

NASA Astrophysics Data System (ADS)

Diaw, Abdourahmane; Murillo, Michael

2017-10-01

X-ray Thomson scattering (XRTS) provides detailed diagnostic information about dense plasma experiments. The inferences made rely on an accurate model for the form factor, which is typically expressed in terms of a well-known response function. Here, we develop an alternate approach based on quantum hydrodynamics using a viscous form of dynamical density functional theory. This approach is shown to include the equation of state self-consistently, including sum rules, as well as irreversibility arising from collisions. This framework is used to generate a model for the scattering spectrum, and it offers an avenue for measuring hydrodynamic properties, such as transport coefficients, using XRTS. This work was supported by the Air Force Office of Scientific Research (Grant No. FA9550-12-1-0344).

Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview).

PubMed

Grassi, Luigi; Caruso, Rosangela; Mitchell, Alex J; Sabato, Silvana; Nanni, Maria Giulia

2018-06-01

Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses. A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments. The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex. The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society. © 2018 American Cancer Society.

Widespread neural oscillations in the delta band dissociate rule convergence from rule divergence during creative idea generation.

PubMed

Boot, Nathalie; Baas, Matthijs; Mühlfeld, Elisabeth; de Dreu, Carsten K W; van Gaal, Simon

2017-09-01

Critical to creative cognition and performance is both the generation of multiple alternative solutions in response to open-ended problems (divergent thinking) and a series of cognitive operations that converges on the correct or best possible answer (convergent thinking). Although the neural underpinnings of divergent and convergent thinking are still poorly understood, several electroencephalography (EEG) studies point to differences in alpha-band oscillations between these thinking modes. We reason that, because most previous studies employed typical block designs, these pioneering findings may mainly reflect the more sustained aspects of creative processes that extend over longer time periods, and that still much is unknown about the faster-acting neural mechanisms that dissociate divergent from convergent thinking during idea generation. To this end, we developed a new event-related paradigm, in which we measured participants' tendency to implicitly follow a rule set by examples, versus breaking that rule, during the generation of novel names for specific categories (e.g., pasta, planets). This approach allowed us to compare the oscillatory dynamics of rule convergent and rule divergent idea generation and at the same time enabled us to measure spontaneous switching between these thinking modes on a trial-to-trial basis. We found that, relative to more systematic, rule convergent thinking, rule divergent thinking was associated with widespread decreases in delta band activity. Therefore, this study contributes to advancing our understanding of the neural underpinnings of creativity by addressing some methodological challenges that neuroscientific creativity research faces. Copyright © 2017 Elsevier Ltd. All rights reserved.

System diagnostic builder

NASA Technical Reports Server (NTRS)

Nieten, Joseph L.; Burke, Roger

1992-01-01

The System Diagnostic Builder (SDB) is an automated software verification and validation tool using state-of-the-art Artificial Intelligence (AI) technologies. The SDB is used extensively by project BURKE at NASA-JSC as one component of a software re-engineering toolkit. The SDB is applicable to any government or commercial organization which performs verification and validation tasks. The SDB has an X-window interface, which allows the user to 'train' a set of rules for use in a rule-based evaluator. The interface has a window that allows the user to plot up to five data parameters (attributes) at a time. Using these plots and a mouse, the user can identify and classify a particular behavior of the subject software. Once the user has identified the general behavior patterns of the software, he can train a set of rules to represent his knowledge of that behavior. The training process builds rules and fuzzy sets to use in the evaluator. The fuzzy sets classify those data points not clearly identified as a particular classification. Once an initial set of rules is trained, each additional data set given to the SDB will be used by a machine learning mechanism to refine the rules and fuzzy sets. This is a passive process and, therefore, it does not require any additional operator time. The evaluation component of the SDB can be used to validate a single software system using some number of different data sets, such as a simulator. Moreover, it can be used to validate software systems which have been re-engineered from one language and design methodology to a totally new implementation.

Synthesis of Polysyllabic Sequences of Thai Tones Using a Generative Model of Fundamental Frequency Contours

NASA Astrophysics Data System (ADS)

Seresangtakul, Pusadee; Takara, Tomio

In this paper, the distinctive tones of Thai in running speech are studied. We present rules to synthesize F0 contours of Thai tones in running speech by using the generative model of F0 contours. Along with our method, the pitch contours of Thai polysyllabic words, both disyllabic and trisyllabic words, were analyzed. The coarticulation effect of Thai tones in running speech were found. Based on the analysis of the polysyllabic words using this model, rules are derived and applied to synthesize Thai polysyllabic tone sequences. We performed listening tests to evaluate intelligibility of the rules for Thai tones generation. The average intelligibility scores became 98.8%, and 96.6% for disyllabic and trisyllabic words, respectively. From these result, the rule of the tones' generation was shown to be effective. Furthermore, we constructed the connecting rules to synthesize suprasegmental F0 contours using the trisyllable training rules' parameters. The parameters of the first, the third, and the second syllables were selected and assigned to the initial, the ending, and the remaining syllables in a sentence, respectively. Even such a simple rule, the synthesized phrases/senetences were completely identified in listening tests. The MOSs (Mean Opinion Score) was 3.50 while the original and analysis/synthesis samples were 4.82 and 3.59, respectively.

The diagnostic performance of expert dermoscopists vs a computer-vision system on small-diameter melanomas.

PubMed

Friedman, Robert J; Gutkowicz-Krusin, Dina; Farber, Michele J; Warycha, Melanie; Schneider-Kels, Lori; Papastathis, Nicole; Mihm, Martin C; Googe, Paul; King, Roy; Prieto, Victor G; Kopf, Alfred W; Polsky, David; Rabinovitz, Harold; Oliviero, Margaret; Cognetta, Armand; Rigel, Darrell S; Marghoob, Ashfaq; Rivers, Jason; Johr, Robert; Grant-Kels, Jane M; Tsao, Hensin

2008-04-01

To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter

System and method for embedding emotion in logic systems

NASA Technical Reports Server (NTRS)

Curtis, Steven A. (Inventor)

2012-01-01

A system, method, and computer readable-media for creating a stable synthetic neural system. The method includes training an intellectual choice-driven synthetic neural system (SNS), training an emotional rule-driven SNS by generating emotions from rules, incorporating the rule-driven SNS into the choice-driven SNS through an evolvable interface, and balancing the emotional SNS and the intellectual SNS to achieve stability in a nontrivial autonomous environment with a Stability Algorithm for Neural Entities (SANE). Generating emotions from rules can include coding the rules into the rule-driven SNS in a self-consistent way. Training the emotional rule-driven SNS can occur during a training stage in parallel with training the choice-driven SNS. The training stage can include a self assessment loop which measures performance characteristics of the rule-driven SNS against core genetic code. The method uses a stability threshold to measure stability of the incorporated rule-driven SNS and choice-driven SNS using SANE.

Combining independent decisions increases diagnostic accuracy of reading lumbosacral radiographs and magnetic resonance imaging.

PubMed

Kurvers, Ralf H J M; de Zoete, Annemarie; Bachman, Shelby L; Algra, Paul R; Ostelo, Raymond

2018-01-01

Diagnosing the causes of low back pain is a challenging task, prone to errors. A novel approach to increase diagnostic accuracy in medical decision making is collective intelligence, which refers to the ability of groups to outperform individual decision makers in solving problems. We investigated whether combining the independent ratings of chiropractors, chiropractic radiologists and medical radiologists can improve diagnostic accuracy when interpreting diagnostic images of the lumbosacral spine. Evaluations were obtained from two previously published studies: study 1 consisted of 13 raters independently rating 300 lumbosacral radiographs; study 2 consisted of 14 raters independently rating 100 lumbosacral magnetic resonance images. In both studies, raters evaluated the presence of "abnormalities", which are indicators of a serious health risk and warrant immediate further examination. We combined independent decisions of raters using a majority rule which takes as final diagnosis the decision of the majority of the group. We compared the performance of the majority rule to the performance of single raters. Our results show that with increasing group size (i.e., increasing the number of independent decisions) both sensitivity and specificity increased in both data-sets, with groups consistently outperforming single raters. These results were found for radiographs and MR image reading alike. Our findings suggest that combining independent ratings can improve the accuracy of lumbosacral diagnostic image reading.

DDS: The Dental Diagnostic Simulation System.

ERIC Educational Resources Information Center

Tira, Daniel E.

The Dental Diagnostic Simulation (DDS) System provides an alternative to simulation systems which represent diagnostic case studies of relatively limited scope. It may be used to generate simulated case studies in all of the dental specialty areas with case materials progressing through the gamut of the diagnostic process. The generation of a…

Learning and Tuning of Fuzzy Rules

NASA Technical Reports Server (NTRS)

Berenji, Hamid R.

1997-01-01

In this chapter, we review some of the current techniques for learning and tuning fuzzy rules. For clarity, we refer to the process of generating rules from data as the learning problem and distinguish it from tuning an already existing set of fuzzy rules. For learning, we touch on unsupervised learning techniques such as fuzzy c-means, fuzzy decision tree systems, fuzzy genetic algorithms, and linear fuzzy rules generation methods. For tuning, we discuss Jang's ANFIS architecture, Berenji-Khedkar's GARIC architecture and its extensions in GARIC-Q. We show that the hybrid techniques capable of learning and tuning fuzzy rules, such as CART-ANFIS, RNN-FLCS, and GARIC-RB, are desirable in development of a number of future intelligent systems.

Implementation of clinical decision rules in the emergency department.

PubMed

Stiell, Ian G; Bennett, Carol

2007-11-01

Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED care. However, further research is needed to identify barriers to implementation in order to achieve improved uptake in the ED.

A novel on-line spatial-temporal k-anonymity method for location privacy protection from sequence rules-based inference attacks.

PubMed

Zhang, Haitao; Wu, Chenxue; Chen, Zewei; Liu, Zhao; Zhu, Yunhong

2017-01-01

Analyzing large-scale spatial-temporal k-anonymity datasets recorded in location-based service (LBS) application servers can benefit some LBS applications. However, such analyses can allow adversaries to make inference attacks that cannot be handled by spatial-temporal k-anonymity methods or other methods for protecting sensitive knowledge. In response to this challenge, first we defined a destination location prediction attack model based on privacy-sensitive sequence rules mined from large scale anonymity datasets. Then we proposed a novel on-line spatial-temporal k-anonymity method that can resist such inference attacks. Our anti-attack technique generates new anonymity datasets with awareness of privacy-sensitive sequence rules. The new datasets extend the original sequence database of anonymity datasets to hide the privacy-sensitive rules progressively. The process includes two phases: off-line analysis and on-line application. In the off-line phase, sequence rules are mined from an original sequence database of anonymity datasets, and privacy-sensitive sequence rules are developed by correlating privacy-sensitive spatial regions with spatial grid cells among the sequence rules. In the on-line phase, new anonymity datasets are generated upon LBS requests by adopting specific generalization and avoidance principles to hide the privacy-sensitive sequence rules progressively from the extended sequence anonymity datasets database. We conducted extensive experiments to test the performance of the proposed method, and to explore the influence of the parameter K value. The results demonstrated that our proposed approach is faster and more effective for hiding privacy-sensitive sequence rules in terms of hiding sensitive rules ratios to eliminate inference attacks. Our method also had fewer side effects in terms of generating new sensitive rules ratios than the traditional spatial-temporal k-anonymity method, and had basically the same side effects in terms of non-sensitive rules variation ratios with the traditional spatial-temporal k-anonymity method. Furthermore, we also found the performance variation tendency from the parameter K value, which can help achieve the goal of hiding the maximum number of original sensitive rules while generating a minimum of new sensitive rules and affecting a minimum number of non-sensitive rules.

A novel on-line spatial-temporal k-anonymity method for location privacy protection from sequence rules-based inference attacks

PubMed Central

Wu, Chenxue; Liu, Zhao; Zhu, Yunhong

2017-01-01

Analyzing large-scale spatial-temporal k-anonymity datasets recorded in location-based service (LBS) application servers can benefit some LBS applications. However, such analyses can allow adversaries to make inference attacks that cannot be handled by spatial-temporal k-anonymity methods or other methods for protecting sensitive knowledge. In response to this challenge, first we defined a destination location prediction attack model based on privacy-sensitive sequence rules mined from large scale anonymity datasets. Then we proposed a novel on-line spatial-temporal k-anonymity method that can resist such inference attacks. Our anti-attack technique generates new anonymity datasets with awareness of privacy-sensitive sequence rules. The new datasets extend the original sequence database of anonymity datasets to hide the privacy-sensitive rules progressively. The process includes two phases: off-line analysis and on-line application. In the off-line phase, sequence rules are mined from an original sequence database of anonymity datasets, and privacy-sensitive sequence rules are developed by correlating privacy-sensitive spatial regions with spatial grid cells among the sequence rules. In the on-line phase, new anonymity datasets are generated upon LBS requests by adopting specific generalization and avoidance principles to hide the privacy-sensitive sequence rules progressively from the extended sequence anonymity datasets database. We conducted extensive experiments to test the performance of the proposed method, and to explore the influence of the parameter K value. The results demonstrated that our proposed approach is faster and more effective for hiding privacy-sensitive sequence rules in terms of hiding sensitive rules ratios to eliminate inference attacks. Our method also had fewer side effects in terms of generating new sensitive rules ratios than the traditional spatial-temporal k-anonymity method, and had basically the same side effects in terms of non-sensitive rules variation ratios with the traditional spatial-temporal k-anonymity method. Furthermore, we also found the performance variation tendency from the parameter K value, which can help achieve the goal of hiding the maximum number of original sensitive rules while generating a minimum of new sensitive rules and affecting a minimum number of non-sensitive rules. PMID:28767687

Diagnostic Hypothesis Generation and Human Judgment

ERIC Educational Resources Information Center

Thomas, Rick P.; Dougherty, Michael R.; Sprenger, Amber M.; Harbison, J. Isaiah

2008-01-01

Diagnostic hypothesis-generation processes are ubiquitous in human reasoning. For example, clinicians generate disease hypotheses to explain symptoms and help guide treatment, auditors generate hypotheses for identifying sources of accounting errors, and laypeople generate hypotheses to explain patterns of information (i.e., data) in the…

CHANGES IN THE LEGAL AND PSYCHIATRIC CONCEPTS OF OBJECTIVE CAUSE.

PubMed

Mester, Roberto; Margolin, Jacob

2014-12-01

As it can be observed in court rulings and psychiatric diagnostic criteria, the characteristics of the medico-legal concept of objective cause are undergoing evolutions in the psychiatric as well as in the legal areas. In this paper, we will analyze and discuss those evolutions, using two types of materials: (a) A recent Israeli Supreme Court ruling related to an appeal of an army officer who claimed to have developed a psychiatric disorder due to his military service. (B) The changes in the diagnostic criteria of Post-Traumatic Stress Disorder (PTSD) from the DSM-III through the DSM-IV till the recently published DSM-V. Awareness and understanding of those evolutions are helpful for psychiatrists in the process of preparing professional reports and/or acting as expert witnesses in Courts.

Highly scalable and robust rule learner: performance evaluation and comparison.

PubMed

Kurgan, Lukasz A; Cios, Krzysztof J; Dick, Scott

2006-02-01

Business intelligence and bioinformatics applications increasingly require the mining of datasets consisting of millions of data points, or crafting real-time enterprise-level decision support systems for large corporations and drug companies. In all cases, there needs to be an underlying data mining system, and this mining system must be highly scalable. To this end, we describe a new rule learner called DataSqueezer. The learner belongs to the family of inductive supervised rule extraction algorithms. DataSqueezer is a simple, greedy, rule builder that generates a set of production rules from labeled input data. In spite of its relative simplicity, DataSqueezer is a very effective learner. The rules generated by the algorithm are compact, comprehensible, and have accuracy comparable to rules generated by other state-of-the-art rule extraction algorithms. The main advantages of DataSqueezer are very high efficiency, and missing data resistance. DataSqueezer exhibits log-linear asymptotic complexity with the number of training examples, and it is faster than other state-of-the-art rule learners. The learner is also robust to large quantities of missing data, as verified by extensive experimental comparison with the other learners. DataSqueezer is thus well suited to modern data mining and business intelligence tasks, which commonly involve huge datasets with a large fraction of missing data.

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.

PubMed

Bösner, Stefan; Haasenritter, Jörg; Becker, Annette; Karatolios, Konstantinos; Vaucher, Paul; Gencer, Baris; Herzig, Lilli; Heinzel-Gutenbrunner, Monika; Schaefer, Juergen R; Abu Hani, Maren; Keller, Heidi; Sönnichsen, Andreas C; Baum, Erika; Donner-Banzhoff, Norbert

2010-09-07

Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result

Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements.

PubMed

Giménez-Arnau, A; Ferrer, M; Bartra, J; Jáuregui, I; Labrador-Horrillo, M; Frutos, J Ortiz de; Silvestre, J F; Sastre, J; Velasco, M; Valero, A

Chronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge. To explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management. An online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus. The questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic tests should be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second-generation H1-antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1-antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children. This work offers consensus recommendations that may be useful in the management of CSU. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Hyaluronan and N-ERC/mesothelin as key biomarkers in a specific two-step model to predict pleural malignant mesothelioma.

PubMed

Mundt, Filip; Nilsonne, Gustav; Arslan, Sertaç; Csürös, Karola; Hillerdal, Gunnar; Yildirim, Huseyin; Metintas, Muzaffer; Dobra, Katalin; Hjerpe, Anders

2013-01-01

Diagnosis of malignant mesothelioma is challenging. The first available diagnostic material is often an effusion and biochemical analysis of soluble markers may provide additional diagnostic information. This study aimed to establish a predictive model using biomarkers from pleural effusions, to allow early and accurate diagnosis. Effusions were collected prospectively from 190 consecutive patients at a regional referral centre. Hyaluronan, N-ERC/mesothelin, C-ERC/mesothelin, osteopontin, syndecan-1, syndecan-2, and thioredoxin were measured using ELISA and HPLC. A predictive model was generated and validated using a second prospective set of 375 effusions collected consecutively at a different referral centre. Biochemical markers significantly associated with mesothelioma were hyaluronan (odds ratio, 95% CI: 8.82, 4.82-20.39), N-ERC/mesothelin (4.81, 3.19-7.93), CERC/mesothelin (3.58, 2.43-5.59) and syndecan-1 (1.34, 1.03-1.77). A two-step model using hyaluronan and N-ERC/mesothelin, and combining a threshold decision rule with logistic regression, yielded good discrimination with an area under the ROC curve of 0.99 (95% CI: 0.97-1.00) in the model generation dataset and 0.83 (0.74-0.91) in the validation dataset, respectively. A two-step model using hyaluronan and N-ERC/mesothelin predicts mesothelioma with high specificity. This method can be performed on the first available effusion and could be a useful adjunct to the morphological diagnosis of mesothelioma.

Antibiotics for coughing in general practice: a qualitative decision analysis.

PubMed

Coenen, S; Van Royen, P; Vermeire, E; Hermann, I; Denekens, J

2000-10-01

In family practice, medical decisions are prompted most often by complaints about coughing. There is no single yardstick for the differential diagnosis of respiratory tract infections (RTIs). In 80% of cases, the excessive use of antibiotics in the treatment of RTIs is caused by the prescription behaviour of GPs. Our aim was to explicate GPs' diagnostic (and therapeutic) decisions regarding adult patients who consult them with complaints about coughing, and to investigate what determines decision making. Exploratory, descriptive focus groups were held with GPs. Hypotheses were generated on the basis of 'qualitative content analysis'. Results. Twenty-four GPs participated in four semi-structured group discussions. In order to differentiate RTIs from other possible diagnoses, less likely diagnoses were not ruled out explicitly. In the case of suspected RTI, there was a low degree of certainty in the differentiation between RTIs (e.g. between bronchitis and pneumonia). Clinical signs and symptoms, which determine the probability of disease, often left GPs with reasonable diagnostic doubt. In the end, the decision whether or not to prescribe antibiotics was taken. GPs' prescription behaviour was also determined by doctor- and patient-related factors (e.g. having missed pneumonia once, patient expectations). The 'chagrin factor' explains why these factors lead to a shift in the action threshold, in favour of antibiotics. This inductive research method enabled the generation of meaningful hypotheses regarding the complex decision processes pursued by GPs. The authors are developing an educational intervention that builds on these findings, focusing on the prescribing decision.

EDRN Breast and Ovary Cancer CVC, Study 2: Phase 3 retrospective validation of ovarian cancer early detection markers in serial preclinical samples from the PLCO trial — EDRN Public Portal

Cancer.gov

Over 70% of women with ovarian/fallopian tube cancer (OC) are diagnosed with advanced stage disease which has a 5-year relative survival rate of 30%. Five-year survival is 90% when disease is confined to the ovaries, but overall survival is poor because only 25% of cases are found early. Screening for ovarian cancer using tools with high sensitivity is potentially cost-effective, but because OC is so rare, very high specificity is needed to achieve an acceptable PPV. We have conducted preliminary work both in clinical and in preclinical (CARET) samples. We have identified candidate markers, developed assays for novel markers including HE4 and MSLN, and evaluated their diagnostic performance. We evaluated the markers’ contribution to a diagnostic panel in a standard set in order to identify the best of the candidates and developed methods for combining markers to define a decision rule for a marker panel. We found that our PEB rule yields comparable performance to the Single Threshold (ST) rule 2 years earlier, using the same two markers. The PEB makes an even larger contribution with the 4-marker panel. The 4-marker panel with the PEB rule represents a substantial improvement over any of the other decision rules as a first-line screen to select women for imaging. Our goal in the proposed work is to estimate the improvement in performance possible in the PLCO serial samples.

Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group

PubMed Central

Ameye, Lieveke; Fischerova, Daniela; Epstein, Elisabeth; Melis, Gian Benedetto; Guerriero, Stefano; Van Holsbeke, Caroline; Savelli, Luca; Fruscio, Robert; Lissoni, Andrea Alberto; Testa, Antonia Carla; Veldman, Joan; Vergote, Ignace; Van Huffel, Sabine; Bourne, Tom; Valentin, Lil

2010-01-01

Objectives To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. Design Prospective temporal and external validation of simple ultrasound rules to distinguish benign from malignant adnexal masses. The rules comprised five ultrasonic features (including shape, size, solidity, and results of colour Doppler examination) to predict a malignant tumour (M features) and five to predict a benign tumour (B features). If one or more M features were present in the absence of a B feature, the mass was classified as malignant. If one or more B features were present in the absence of an M feature, it was classified as benign. If both M features and B features were present, or if none of the features was present, the simple rules were inconclusive. Setting 19 ultrasound centres in eight countries. Participants 1938 women with an adnexal mass examined with ultrasound by the principal investigator at each centre with a standardised research protocol. Reference standard Histological classification of the excised adnexal mass as benign or malignant. Main outcome measures Diagnostic sensitivity and specificity. Results Of the 1938 patients with an adnexal mass, 1396 (72%) had benign tumours, 373 (19.2%) had primary invasive tumours, 111 (5.7%) had borderline malignant tumours, and 58 (3%) had metastatic tumours in the ovary. The simple rules yielded a conclusive result in 1501 (77%) masses, for which they resulted in a sensitivity of 92% (95% confidence interval 89% to 94%) and a specificity of 96% (94% to 97%). The corresponding sensitivity and specificity of subjective assessment were 91% (88% to 94%) and 96% (94% to 97%). In the 357 masses for which the simple rules yielded an inconclusive result and with available results of CA-125 measurements, the sensitivities were 89% (83% to 93%) for subjective assessment, 50% (42% to 58%) for the risk of malignancy index, 89% (83% to 93%) for logistic regression model 1, and 82% (75% to 87%) for logistic regression model 2; the corresponding specificities were 78% (72% to 83%), 84% (78% to 88%), 44% (38% to 51%), and 48% (42% to 55%). Use of the simple rules as a triage test and subjective assessment for those masses for which the simple rules yielded an inconclusive result gave a sensitivity of 91% (88% to 93%) and a specificity of 93% (91% to 94%), compared with a sensitivity of 90% (88% to 93%) and a specificity of 93% (91% to 94%) when subjective assessment was used in all masses. Conclusions The use of the simple rules has the potential to improve the management of women with adnexal masses. In adnexal masses for which the rules yielded an inconclusive result, subjective assessment of ultrasonic findings by an experienced ultrasound examiner was the most accurate diagnostic test; the risk of malignancy index and the two regression models were not useful. PMID:21156740

Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer.

PubMed

Görges, Rainer; Eising, E G; Fotescu, D; Renzing-Köhler, K; Frilling, A; Schmid, K W; Bockisch, A; Dirsch, O

2003-02-01

Ultrasonography is an established diagnostic modality in the follow-up of thyroid cancer. Color flow Doppler has been proposed by some authors as an additional tool for differentiating benign from malignant cervical lesions in various types of head and neck cancer. Over the last few years, a new generation of high-resolution ultrasound platforms with the "power-mode" feature has become available, that also enables the imaging of small vessel blood flow. The objective of our study was to find ways of optimizing the differentiation of benign and malignant cervical tumors in thyroid cancer follow-up by means of sonography. Hundred and twelve cervical lesions in 90 patients with thyroid cancer were evaluated by high-end ultrasonography (Sonoline Elegra, Siemens) using a small-part transducer (7.5 L 40, Siemens). B-mode sonography was performed at a frequency of 8 MHz. The Solbiati index (SI= ratio of largest to smallest diameter), configuration, echogenicity, intranodular structures, and margins were assessed. Perinodular and intranodular blood flow was evaluated by color flow Doppler (PRF 1250 Hz for conventional color flow Doppler, 868 Hz for power-mode Doppler). Possible malignancy was validated by histology, cytology, scintigraphy, and follow-up. Thirty five lesions were benign (diameter 0.4-3.0 cm) and 77 were malignant (0.4-5.4 cm). The patients were randomized into a test group and a learning group to determine the diagnostic value of various ultrasound criteria by means of statistical analysis. In the learning group, decision rules based on the dichotomized criteria were developed using a logistic regression model. Sensitivity and specificity of these decision rules were then evaluated in the test group. The presence of an echocomplex pattern or irregular hyperechoic small intranodular structures (criterion A) and the presence of an irregular diffuse intranodular blood flow (criterion B) are the best indicators of malignancy, whereas an SI >2 is highly indicative of benign changes. Color flow Doppler is a useful addition to B-mode scanning for distinguishing benign and malignant neoplasms in the follow-up of thyroid cancer. Power-mode Doppler sonography significantly improves imaging of perinodular and intranodular blood flow when compared with conventional color flow Doppler. We propose the following decision rules based on a combination of the criteria above: (A) and (B) fulfilled: malignant, if SI< or =4; (B) but not (A) fulfilled: malignant, if SI< or =3; (A) but not (B) fulfilled: malignant, if SI< or =2; neither (A) nor (B) fulfilled: malignant, if SI approximately equal to 1 (sensitivity: 90%; specificity: 82%; accuracy 88%).

Automatic generation of computable implementation guides from clinical information models.

PubMed

Boscá, Diego; Maldonado, José Alberto; Moner, David; Robles, Montserrat

2015-06-01

Clinical information models are increasingly used to describe the contents of Electronic Health Records. Implementation guides are a common specification mechanism used to define such models. They contain, among other reference materials, all the constraints and rules that clinical information must obey. However, these implementation guides typically are oriented to human-readability, and thus cannot be processed by computers. As a consequence, they must be reinterpreted and transformed manually into an executable language such as Schematron or Object Constraint Language (OCL). This task can be difficult and error prone due to the big gap between both representations. The challenge is to develop a methodology for the specification of implementation guides in such a way that humans can read and understand easily and at the same time can be processed by computers. In this paper, we propose and describe a novel methodology that uses archetypes as basis for generation of implementation guides. We use archetypes to generate formal rules expressed in Natural Rule Language (NRL) and other reference materials usually included in implementation guides such as sample XML instances. We also generate Schematron rules from NRL rules to be used for the validation of data instances. We have implemented these methods in LinkEHR, an archetype editing platform, and exemplify our approach by generating NRL rules and implementation guides from EN ISO 13606, openEHR, and HL7 CDA archetypes. Copyright © 2015 Elsevier Inc. All rights reserved.

Dynamic cluster generation for a fuzzy classifier with ellipsoidal regions.

PubMed

Abe, S

1998-01-01

In this paper, we discuss a fuzzy classifier with ellipsoidal regions that dynamically generates clusters. First, for the data belonging to a class we define a fuzzy rule with an ellipsoidal region. Namely, using the training data for each class, we calculate the center and the covariance matrix of the ellipsoidal region for the class. Then we tune the fuzzy rules, i.e., the slopes of the membership functions, successively until there is no improvement in the recognition rate of the training data. Then if the number of the data belonging to a class that are misclassified into another class exceeds a prescribed number, we define a new cluster to which those data belong and the associated fuzzy rule. Then we tune the newly defined fuzzy rules in the similar way as stated above, fixing the already obtained fuzzy rules. We iterate generation of clusters and tuning of the newly generated fuzzy rules until the number of the data belonging to a class that are misclassified into another class does not exceed the prescribed number. We evaluate our method using thyroid data, Japanese Hiragana data of vehicle license plates, and blood cell data. By dynamic cluster generation, the generalization ability of the classifier is improved and the recognition rate of the fuzzy classifier for the test data is the best among the neural network classifiers and other fuzzy classifiers if there are no discrete input variables.

Boosting association rule mining in large datasets via Gibbs sampling.

PubMed

Qian, Guoqi; Rao, Calyampudi Radhakrishna; Sun, Xiaoying; Wu, Yuehua

2016-05-03

Current algorithms for association rule mining from transaction data are mostly deterministic and enumerative. They can be computationally intractable even for mining a dataset containing just a few hundred transaction items, if no action is taken to constrain the search space. In this paper, we develop a Gibbs-sampling-induced stochastic search procedure to randomly sample association rules from the itemset space, and perform rule mining from the reduced transaction dataset generated by the sample. Also a general rule importance measure is proposed to direct the stochastic search so that, as a result of the randomly generated association rules constituting an ergodic Markov chain, the overall most important rules in the itemset space can be uncovered from the reduced dataset with probability 1 in the limit. In the simulation study and a real genomic data example, we show how to boost association rule mining by an integrated use of the stochastic search and the Apriori algorithm.

Resolving task rule incongruence during task switching by competitor rule suppression.

PubMed

Meiran, Nachshon; Hsieh, Shulan; Dimov, Eduard

2010-07-01

Task switching requires maintaining readiness to execute any task of a given set of tasks. However, when tasks switch, the readiness to execute the now-irrelevant task generates interference, as seen in the task rule incongruence effect. Overcoming such interference requires fine-tuned inhibition that impairs task readiness only minimally. In an experiment involving 2 object classification tasks and 2 location classification tasks, the authors show that irrelevant task rules that generate response conflicts are inhibited. This competitor rule suppression (CRS) is seen in response slowing in subsequent trials, when the competing rules become relevant. CRS is shown to operate on specific rules without affecting similar rules. CRS and backward inhibition, which is another inhibitory phenomenon, produced additive effects on reaction time, suggesting their mutual independence. Implications for current formal theories of task switching as well as for conflict monitoring theories are discussed. (c) 2010 APA, all rights reserved

A Systematic Review of Instruments to Identify Mental Health and Substance Use Problems Among Children in the Emergency Department.

PubMed

Newton, Amanda S; Soleimani, Amir; Kirkland, Scott W; Gokiert, Rebecca J

2017-05-01

Specialized instruments to screen and diagnose mental health problems in children and adolescents are not yet standard components of clinical assessments in emergency departments (EDs). We conducted a systematic review to investigate the psychometric properties, accuracy, and performance metrics of instruments used in the ED to identify pediatric mental health and substance use problems. We searched seven electronic databases and the gray literature for psychometric validation studies, diagnostic studies, and cohort studies that assessed any instrument to screen for or diagnose mental illness, emotional or behavioral problems, or substance use disorders. Studies had to include children and adolescents with mental health presentations or positive screens for substance use. Two reviewers independently screened studies for relevance and quality. Diagnostic study quality was assessed with the four QUADAS-2 domains. Psychometric study quality was assessed with published criteria for instrument reliability, validity, and usability. We present a descriptive analysis of the reported psychometric properties and diagnostic performance of instruments for each study. Of the 4,832 references screened, 14 met inclusion criteria. Included studies evaluate 18 instruments for identifying suicide risk (six studies), alcohol use disorders (six studies), mood disorders (one study), and ED decision making (need for assessment, admission; one study). Nine studies include a psychometric focus but quality varies, with no studies fully meeting criteria for reliability, validity, and usability. Seven studies examine diagnostic performance of an instrument, but no study has a low risk of bias for all QUADAS-2 domains. The HEADS-ED instrument has good inter-rater reliability (r = 0.785) for identifying general mental health problems and modest evidence for ruling in patients requiring hospital admission (positive likelihood ratio [LR+] = 6.30). Internal consistency (reliability) varies for instruments to screen for suicide risk (α = 0.46-0.97), and no instruments have both high sensitivity and high specificity. The Ask Suicide-Screening Questions (ASQ) is highly sensitive (98%) and has strong evidence for ruling out risk (negative likelihood ratio [LR-] = 0.04). Among screening instruments for alcohol use disorders, internal consistency is high for the consumption subscale of the Alcohol Use Disorders Identification Test (α = 0.83-0.88) and the Adolescent Drinking Index (α = 0.92). Both instruments also had sound internal validity. Diagnostically, a two-item instrument based on DSM-IV criteria is the most accurate in identifying patients with a disorder (area under the curve = 0.89) and has modest evidence for ruling in and out risk (LR+ = 8.80, LR- = 0.13). From available evidence, we recommend that ED clinicians use 1) the HEADS-ED to rule in ED admission among pediatric patients with visits for mental health care, 2) the ASQ to rule out suicide risk among pediatric patients with any visit type, and 3) the DSM-IV two-item instrument to rule in/rule out alcohol use disorders among pediatric patients currently using alcohol. These instruments require minimal to no training or time commitment. We also recommend that clinicians become familiar with each instrument's psychometric properties to understand the quality of the evidence base. In this review, however, we identify methodologic limitations in the evidence base. To develop a robust evidence base, additional research is necessary. © 2017 by the Society for Academic Emergency Medicine.

Standards Applicable to Generators of Hazardous Waste; Alternative Requirements for Hazardous Waste Determination and Accumulation of Unwanted Material at Laboratories Owned by Colleges and Universities and Other Eligible Academic Entities Formally Affiliated With Colleges and Universities. Final Rule. Federal Register, Environmental Protection Agency. 40 CFR Parts 261 and 262. Part II

ERIC Educational Resources Information Center

National Archives and Records Administration, 2008

2008-01-01

The Environmental Protection Agency (EPA or the Agency) is finalizing an alternative set of generator requirements applicable to laboratories owned by eligible academic entities, as defined in this final rule. The rule provides a flexible and protective set of regulations that address the specific nature of hazardous waste generation and…

Iopamidol as a responsive MRI-chemical exchange saturation transfer contrast agent for pH mapping of kidneys: In vivo studies in mice at 7 T.

PubMed

Longo, Dario Livio; Dastrù, Walter; Digilio, Giuseppe; Keupp, Jochen; Langereis, Sander; Lanzardo, Stefania; Prestigio, Simone; Steinbach, Oliver; Terreno, Enzo; Uggeri, Fulvio; Aime, Silvio

2011-01-01

Iopamidol (Isovue®-Bracco Diagnostic Inc.) is a clinically approved X-Ray contrast agent used in the last 30 years for a wide variety of diagnostic applications with a very good clinical acceptance. Iopamidol contains two types of amide functionalities that can be exploited for the generation of chemical exchange saturation transfer effect. The exchange rate of the two amide proton pools is markedly pH-dependent. Thus, a ratiometric method for pH assessment has been set-up based on the comparison of the saturation transfer effects induced by selective irradiation of the two resonances. This ratiometric approach allows to rule out the concentration effect of the contrast agent and provides accurate pH measurements in the 5.5-7.4 range. Upon injection of Iopamidol into healthy mice, it has been possible to acquire pH maps of kidney regions. Furthermore, it has been also shown that the proposed method is able to report about pH-changes induced in control mice fed with acidified or basified water for a period of a week before image acquisition. © 2010 Wiley-Liss, Inc.

Compartmental and Spatial Rule-Based Modeling with Virtual Cell.

PubMed

Blinov, Michael L; Schaff, James C; Vasilescu, Dan; Moraru, Ion I; Bloom, Judy E; Loew, Leslie M

2017-10-03

In rule-based modeling, molecular interactions are systematically specified in the form of reaction rules that serve as generators of reactions. This provides a way to account for all the potential molecular complexes and interactions among multivalent or multistate molecules. Recently, we introduced rule-based modeling into the Virtual Cell (VCell) modeling framework, permitting graphical specification of rules and merger of networks generated automatically (using the BioNetGen modeling engine) with hand-specified reaction networks. VCell provides a number of ordinary differential equation and stochastic numerical solvers for single-compartment simulations of the kinetic systems derived from these networks, and agent-based network-free simulation of the rules. In this work, compartmental and spatial modeling of rule-based models has been implemented within VCell. To enable rule-based deterministic and stochastic spatial simulations and network-free agent-based compartmental simulations, the BioNetGen and NFSim engines were each modified to support compartments. In the new rule-based formalism, every reactant and product pattern and every reaction rule are assigned locations. We also introduce the rule-based concept of molecular anchors. This assures that any species that has a molecule anchored to a predefined compartment will remain in this compartment. Importantly, in addition to formulation of compartmental models, this now permits VCell users to seamlessly connect reaction networks derived from rules to explicit geometries to automatically generate a system of reaction-diffusion equations. These may then be simulated using either the VCell partial differential equations deterministic solvers or the Smoldyn stochastic simulator. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

A Software Engine to Justify the Conclusions of an Expert System for Detecting Renal Obstruction on 99mTc-MAG3 Scans

PubMed Central

Garcia, Ernest V.; Taylor, Andrew; Manatunga, Daya; Folks, Russell

2013-01-01

The purposes of this study were to describe and evaluate a software engine to justify the conclusions reached by a renal expert system (RENEX) for assessing patients with suspected renal obstruction and to obtain from this evaluation new knowledge that can be incorporated into RENEX to attempt to improve diagnostic performance. Methods RENEX consists of 60 heuristic rules extracted from the rules used by a domain expert to generate the knowledge base and a forward-chaining inference engine to determine obstruction. The justification engine keeps track of the sequence of the rules that are instantiated to reach a conclusion. The interpreter can then request justification by clicking on the specific conclusion. The justification process then reports the English translation of all concatenated rules instantiated to reach that conclusion. The justification engine was evaluated with a prospective group of 60 patients (117 kidneys). After reviewing the standard renal mercaptoacetyltriglycine (MAG3) scans obtained before and after the administration of furosemide, a masked expert determined whether each kidney was obstructed, whether the results were equivocal, or whether the kidney was not obstructed and identified and ranked the main variables associated with each interpretation. Two parameters were then tabulated: the frequency with which the main variables associated with obstruction by the expert were also justified by RENEX and the frequency with which the justification rules provided by RENEX were deemed to be correct by the expert. Only when RENEX and the domain expert agreed on the diagnosis (87 kidneys) were the results used to test the justification. Results RENEX agreed with 91% (184/203) of the rules supplied by the expert for justifying the diagnosis. RENEX provided 103 additional rules justifying the diagnosis; the expert agreed that 102 (99%) were correct, although the rules were considered to be of secondary importance. Conclusion We have described and evaluated a software engine to justify the conclusions of RENEX for detecting renal obstruction with MAG3 renal scans obtained before and after the administration of furosemide. This tool is expected to increase physician confidence in the interpretations provided by RENEX and to assist physicians and trainees in gaining a higher level of expertise. PMID:17332625

A software engine to justify the conclusions of an expert system for detecting renal obstruction on 99mTc-MAG3 scans.

PubMed

Garcia, Ernest V; Taylor, Andrew; Manatunga, Daya; Folks, Russell

2007-03-01

The purposes of this study were to describe and evaluate a software engine to justify the conclusions reached by a renal expert system (RENEX) for assessing patients with suspected renal obstruction and to obtain from this evaluation new knowledge that can be incorporated into RENEX to attempt to improve diagnostic performance. RENEX consists of 60 heuristic rules extracted from the rules used by a domain expert to generate the knowledge base and a forward-chaining inference engine to determine obstruction. The justification engine keeps track of the sequence of the rules that are instantiated to reach a conclusion. The interpreter can then request justification by clicking on the specific conclusion. The justification process then reports the English translation of all concatenated rules instantiated to reach that conclusion. The justification engine was evaluated with a prospective group of 60 patients (117 kidneys). After reviewing the standard renal mercaptoacetyltriglycine (MAG3) scans obtained before and after the administration of furosemide, a masked expert determined whether each kidney was obstructed, whether the results were equivocal, or whether the kidney was not obstructed and identified and ranked the main variables associated with each interpretation. Two parameters were then tabulated: the frequency with which the main variables associated with obstruction by the expert were also justified by RENEX and the frequency with which the justification rules provided by RENEX were deemed to be correct by the expert. Only when RENEX and the domain expert agreed on the diagnosis (87 kidneys) were the results used to test the justification. RENEX agreed with 91% (184/203) of the rules supplied by the expert for justifying the diagnosis. RENEX provided 103 additional rules justifying the diagnosis; the expert agreed that 102 (99%) were correct, although the rules were considered to be of secondary importance. We have described and evaluated a software engine to justify the conclusions of RENEX for detecting renal obstruction with MAG3 renal scans obtained before and after the administration of furosemide. This tool is expected to increase physician confidence in the interpretations provided by RENEX and to assist physicians and trainees in gaining a higher level of expertise.

Development of Rules and Strategies: Balancing the Old and the New.

ERIC Educational Resources Information Center

Siegler, Robert S.; Chen, Zhe

2002-01-01

Considers how preceding articles by Jansen and van der Maas, and Halford et al., contribute to understanding of how rule use can be best assessed, how systematic rule use can be reconciled with variable rule use, when children begin to use rules, and how children generate new rules. Summarizes current understanding of development of knowledge…

Asperger's Syndrome: A Comparison of Clinical Diagnoses and Those Made According to the ICD-10 and DSM-IV

ERIC Educational Resources Information Center

Woodbury-Smith, Marc; Klin, Ami; Volkmar, Fred

2005-01-01

The diagnostic criteria for Asperger Syndrome (AS) according to ICD-10 and DSM-IV have been criticized as being too narrow in view of the rules of onset and precedence, whereby autism takes precedence over AS in a diagnostic hierarchy. In order to investigate this further, cases from the DSM-IV multicenter study who had been diagnosed clinically…

10 CFR 30.21 - Radioactive drug: Capsules containing carbon-14 urea for “in vivo” diagnostic use for humans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Radioactive drug: Capsules containing carbon-14 urea for âin vivoâ diagnostic use for humans. 30.21 Section 30.21 Energy NUCLEAR REGULATORY COMMISSION RULES OF GENERAL APPLICABILITY TO DOMESTIC LICENSING OF BYPRODUCT MATERIAL Exemptions § 30.21 Radioactive drug: Capsules containing carbon-14 urea for “in...

Prediction of the Chloride Resistance of Concrete Modified with High Calcium Fly Ash Using Machine Learning

PubMed Central

Marks, Michał; Glinicki, Michał A.; Gibas, Karolina

2015-01-01

The aim of the study was to generate rules for the prediction of the chloride resistance of concrete modified with high calcium fly ash using machine learning methods. The rapid chloride permeability test, according to the Nordtest Method Build 492, was used for determining the chloride ions’ penetration in concrete containing high calcium fly ash (HCFA) for partial replacement of Portland cement. The results of the performed tests were used as the training set to generate rules describing the relation between material composition and the chloride resistance. Multiple methods for rule generation were applied and compared. The rules generated by algorithm J48 from the Weka workbench provided the means for adequate classification of plain concretes and concretes modified with high calcium fly ash as materials of good, acceptable or unacceptable resistance to chloride penetration. PMID:28793740

[Quantitative measures for assessing the functional state of the human body during diagnostic procedure].

PubMed

Artemenko, M V

2008-01-01

Two approaches to calculation of the qualitative measures for assessing the functional state level of human body are considered. These approaches are based on image and fuzzy set recognition theories and are used to construct diagnostic decision rules. The first approach uses the data on deviation of detected parameters from those for healthy persons; the second approach analyzes the degree of deviation of detected parameters from the approximants characterizing the correlation differences between the parameters. A method for synthesis of decision rules and the results of blood count-based research for a number of diseases (hemophilia, thrombocytopathy, hypertension, arrhythmia, hepatic cirrhosis, trichophytia) are considered. An effect of a change in the functional link between the cholesterol content in blood and the relative rate of variation of AST and ALT enzymes in blood from direct proportional (healthy state) to inverse proportional (hepatic cirrhosis) is discussed. It is shown that analysis of correlation changes in detected parameters of the human body state during diagnostic process is more effective for application in decision support systems than the state space analysis.

Systematic Analysis of the Decision Rules of Traditional Chinese Medicine

PubMed Central

Bin-Rong, Ma; Xi-Yuan, Jiang; Su-Ming, Liso; Huai-ning, Zhu; Xiu-ru, Lin

1981-01-01

Chinese traditional medicine has evolved over many centuries, and has accumulated a body of observed relationships between symptoms, signs and prognoses, and the efficacy of alternative treatments and prescriptions. With the assistance of a computer-based clinical data base for recording the diagnostic and therapeutic practice of skilled practitioners of Chinese traditional medicine, a systematic program is being conducted to identify and define the clinical decision-making rules that underlie current practice.

Comparative analysis of expert and machine-learning methods for classification of body cavity effusions in companion animals.

PubMed

Hotz, Christine S; Templeton, Steven J; Christopher, Mary M

2005-03-01

A rule-based expert system using CLIPS programming language was created to classify body cavity effusions as transudates, modified transudates, exudates, chylous, and hemorrhagic effusions. The diagnostic accuracy of the rule-based system was compared with that produced by 2 machine-learning methods: Rosetta, a rough sets algorithm and RIPPER, a rule-induction method. Results of 508 body cavity fluid analyses (canine, feline, equine) obtained from the University of California-Davis Veterinary Medical Teaching Hospital computerized patient database were used to test CLIPS and to test and train RIPPER and Rosetta. The CLIPS system, using 17 rules, achieved an accuracy of 93.5% compared with pathologist consensus diagnoses. Rosetta accurately classified 91% of effusions by using 5,479 rules. RIPPER achieved the greatest accuracy (95.5%) using only 10 rules. When the original rules of the CLIPS application were replaced with those of RIPPER, the accuracy rates were identical. These results suggest that both rule-based expert systems and machine-learning methods hold promise for the preliminary classification of body fluids in the clinical laboratory.

76 FR 23502 - Fee-Generating Cases

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-27

... LEGAL SERVICES CORPORATION 45 CFR Part 1609 Fee-Generating Cases AGENCY: Legal Services Corporation. ACTION: Final rule. SUMMARY: This final rule amends the Legal Services Corporation's regulation... Assistant General Counsel, Office of Legal Affairs, Legal Services Corporation, 3333 K Street, NW...

Fact Sheet About the Hazardous Waste Generator Improvements Final Rule

EPA Pesticide Factsheets

October 28, 2016, EPA finalized a rule that revises the hazardous waste generator regulations by making them easier to understand and providing greater flexibility in how hazardous waste is managed to better fit today's business operations.

Intrusion Detection Systems with Live Knowledge System

DTIC Science & Technology

2016-05-31

Ripple -down Rule (RDR) to maintain the knowledge from human experts with knowledge base generated by the Induct RDR, which is a machine-learning based RDR...propose novel approach that uses Ripple -down Rule (RDR) to maintain the knowledge from human experts with knowledge base generated by the Induct RDR...detection model by applying Induct RDR approach. The proposed induct RDR ( Ripple Down Rules) approach allows to acquire the phishing detection

A decision support system and rule-based algorithm to augment the human interpretation of the 12-lead electrocardiogram.

PubMed

Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Guldenring, Daniel; Badilini, Fabio; Libretti, Guido; Peace, Aaron J; Leslie, Stephen J

The 12-lead Electrocardiogram (ECG) has been used to detect cardiac abnormalities in the same format for more than 70years. However, due to the complex nature of 12-lead ECG interpretation, there is a significant cognitive workload required from the interpreter. This complexity in ECG interpretation often leads to errors in diagnosis and subsequent treatment. We have previously reported on the development of an ECG interpretation support system designed to augment the human interpretation process. This computerised decision support system has been named 'Interactive Progressive based Interpretation' (IPI). In this study, a decision support algorithm was built into the IPI system to suggest potential diagnoses based on the interpreter's annotations of the 12-lead ECG. We hypothesise semi-automatic interpretation using a digital assistant can be an optimal man-machine model for ECG interpretation. To improve interpretation accuracy and reduce missed co-abnormalities. The Differential Diagnoses Algorithm (DDA) was developed using web technologies where diagnostic ECG criteria are defined in an open storage format, Javascript Object Notation (JSON), which is queried using a rule-based reasoning algorithm to suggest diagnoses. To test our hypothesis, a counterbalanced trial was designed where subjects interpreted ECGs using the conventional approach and using the IPI+DDA approach. A total of 375 interpretations were collected. The IPI+DDA approach was shown to improve diagnostic accuracy by 8.7% (although not statistically significant, p-value=0.1852), the IPI+DDA suggested the correct interpretation more often than the human interpreter in 7/10 cases (varying statistical significance). Human interpretation accuracy increased to 70% when seven suggestions were generated. Although results were not found to be statistically significant, we found; 1) our decision support tool increased the number of correct interpretations, 2) the DDA algorithm suggested the correct interpretation more often than humans, and 3) as many as 7 computerised diagnostic suggestions augmented human decision making in ECG interpretation. Statistical significance may be achieved by expanding sample size. Copyright © 2017 Elsevier Inc. All rights reserved.

Development and Evaluation of a Diagnostic Documentation Support System using Knowledge Processing

NASA Astrophysics Data System (ADS)

Makino, Kyoko; Hayakawa, Rumi; Terai, Koichi; Fukatsu, Hiroshi

In this paper, we will introduce a system which supports creating diagnostic reports. Diagnostic reports are documents by doctors of radiology describing the existence and nonexistence of abnormalities from the inspection images, such as CT and MRI, and summarize a patient's state and disease. Our system indicates insufficiencies in these reports created by younger doctors, by using knowledge processing based on a medical knowledge dictionary. These indications are not only clerical errors, but the system also analyzes the purpose of the inspection and determines whether a comparison with a former inspection is required, or whether there is any shortage in description. We verified our system by using actual data of 2,233 report pairs, a pair comprised of a report written by a younger doctor and a check result of the report by an experienced doctor. The results of the verification showed that the rules of string analysis for detecting clerical errors and sentence wordiness obtained a recall of over 90% and a precision of over 75%. Moreover, the rules based on a medical knowledge dictionary for detecting the lack of required comparison with a former inspection and the shortage in description for the inspection purpose obtained a recall of over 70%. From these results, we confirmed that our system contributes to the quality improvement of diagnostic reports. We expect that our system can comprehensively support diagnostic documentations by cooperating with the interface which refers to inspection images or past reports.

Ontology and medical diagnosis.

PubMed

Bertaud-Gounot, Valérie; Duvauferrier, Régis; Burgun, Anita

2012-03-01

Ontology and associated generic tools are appropriate for knowledge modeling and reasoning, but most of the time, disease definitions in existing description logic (DL) ontology are not sufficient to classify patient's characteristics under a particular disease because they do not formalize operational definitions of diseases (association of signs and symptoms=diagnostic criteria). The main objective of this study is to propose an ontological representation which takes into account the diagnostic criteria on which specific patient conditions may be classified under a specific disease. This method needs as a prerequisite a clear list of necessary and sufficient diagnostic criteria as defined for lots of diseases by learned societies. It does not include probability/uncertainty which Web Ontology Language (OWL 2.0) cannot handle. We illustrate it with spondyloarthritis (SpA). Ontology has been designed in Protégé 4.1 OWL-DL2.0. Several kinds of criteria were formalized: (1) mandatory criteria, (2) picking two criteria among several diagnostic criteria, (3) numeric criteria. Thirty real patient cases were successfully classified with the reasoner. This study shows that it is possible to represent operational definitions of diseases with OWL and successfully classify real patient cases. Representing diagnostic criteria as descriptive knowledge (instead of rules in Semantic Web Rule Language or Prolog) allows us to take advantage of tools already available for OWL. While we focused on Assessment of SpondyloArthritis international Society SpA criteria, we believe that many of the representation issues addressed here are relevant to using OWL-DL for operational definition of other diseases in ontology.

The risk of a second diagnostic window with 4th generation HIV assays: Two cases.

PubMed

Niederhauser, C; Ströhle, A; Stolz, M; Müller, F; Tinguely, C

2009-08-01

Despite the improved sensitivity of the 4th generation combined antigen/antibody HIV assays, detection of HIV in the early phase of an infection may still be ineffective. Description of two cases that highlight the existence of the "second diagnostic window phase" observed with commonly used sensitive 4th generation HIV assays. Samples were screened with different 4th generation HIV assays. HIV infection was confirmed with an HIV I/II antibody assay, a HIV-1 p24 antigen assay, the INNO-LIA HIV I/II Score Line immunoassay and HIV-1 PCR. In both investigated cases, the limitations of the 4th generation HIV assays within the second diagnostic window were apparent. The overall sensitivity of the commercial 4th generation HIV assays is currently higher than the 3rd generation HIV assays. Nevertheless, the rare occurrence of a second diagnostic window with 4th generation HIV assays strongly suggests that the following up testing algorithms need to be adjusted accordingly.

A probabilistic method to diagnose faults of air handling units

NASA Astrophysics Data System (ADS)

Dey, Debashis

Air handling unit (AHU) is one of the most extensively used equipment in large commercial buildings. This device is typically customized and lacks quality system integration which can result in hardwire failures and controller errors. Air handling unit Performance Assessment Rules (APAR) is a fault detection tool that uses a set of expert rules derived from mass and energy balances to detect faults in air handling units. APAR is computationally simple enough that it can be embedded in commercial building automation and control systems and relies only upon sensor data and control signals that are commonly available in these systems. Although APAR has many advantages over other methods, for example no training data required and easy to implement commercially, most of the time it is unable to provide the diagnosis of the faults. For instance, a fault on temperature sensor could be fixed bias, drifting bias, inappropriate location, complete failure. Also a fault in mixing box can be return and outdoor damper leak or stuck. In addition, when multiple rules are satisfied the list of faults increases. There is no proper way to have the correct diagnosis for rule based fault detection system. To overcome this limitation we proposed Bayesian Belief Network (BBN) as a diagnostic tool. BBN can be used to simulate diagnostic thinking of FDD experts through a probabilistic way. In this study we developed a new way to detect and diagnose faults in AHU through combining APAR rules and Bayesian Belief network. Bayesian Belief Network is used as a decision support tool for rule based expert system. BBN is highly capable to prioritize faults when multiple rules are satisfied simultaneously. Also it can get information from previous AHU operating conditions and maintenance records to provide proper diagnosis. The proposed model is validated with real time measured data of a campus building at University of Texas at San Antonio (UTSA).The results show that BBN is correctly able to prioritize faults which can be verified by manual investigation.

Applications of rule-induction in the derivation of quantitative structure-activity relationships.

PubMed

A-Razzak, M; Glen, R C

1992-08-01

Recently, methods have been developed in the field of Artificial Intelligence (AI), specifically in the expert systems area using rule-induction, designed to extract rules from data. We have applied these methods to the analysis of molecular series with the objective of generating rules which are predictive and reliable. The input to rule-induction consists of a number of examples with known outcomes (a training set) and the output is a tree-structured series of rules. Unlike most other analysis methods, the results of the analysis are in the form of simple statements which can be easily interpreted. These are readily applied to new data giving both a classification and a probability of correctness. Rule-induction has been applied to in-house generated and published QSAR datasets and the methodology, application and results of these analyses are discussed. The results imply that in some cases it would be advantageous to use rule-induction as a complementary technique in addition to conventional statistical and pattern-recognition methods.

Applications of rule-induction in the derivation of quantitative structure-activity relationships

NASA Astrophysics Data System (ADS)

A-Razzak, Mohammed; Glen, Robert C.

1992-08-01

Recently, methods have been developed in the field of Artificial Intelligence (AI), specifically in the expert systems area using rule-induction, designed to extract rules from data. We have applied these methods to the analysis of molecular series with the objective of generating rules which are predictive and reliable. The input to rule-induction consists of a number of examples with known outcomes (a training set) and the output is a tree-structured series of rules. Unlike most other analysis methods, the results of the analysis are in the form of simple statements which can be easily interpreted. These are readily applied to new data giving both a classification and a probability of correctness. Rule-induction has been applied to in-house generated and published QSAR datasets and the methodology, application and results of these analyses are discussed. The results imply that in some cases it would be advantageous to use rule-induction as a complementary technique in addition to conventional statistical and pattern-recognition methods.

Following the Rules.

PubMed

Katz, Anne

2016-05-01

I am getting better at following the rules as I grow older, although I still bristle at many of them. I was a typical rebellious teenager; no one understood me, David Bowie was my idol, and, one day, my generation was going to change the world. Now I really want people to understand me: David Bowie remains one of my favorite singers and, yes, my generation has changed the world, and not necessarily for the better. Growing up means that you have to make the rules, not just follow those set by others, and, at times, having rules makes a lot of sense.
.

Fact Sheet: 2015 Final Rule on the Disposal of Coal Combustion Residuals Generated by Electric Utilities

EPA Pesticide Factsheets

This fact sheet describes the final rule signed on December 19, 2014 establishing a comprehensive set of requirements for the disposal of coal combustion residuals generated by electric utilities in landfills and surface impoundments.

ECG Rhythm Analysis with Expert and Learner-Generated Schemas in Novice Learners

ERIC Educational Resources Information Center

Blissett, Sarah; Cavalcanti, Rodrigo; Sibbald, Matthew

2015-01-01

Although instruction using expert-generated schemas is associated with higher diagnostic performance, implementation is resource intensive. Learner-generated schemas are an alternative, but may be limited by increases in cognitive load. We compared expert- and learner-generated schemas for learning ECG rhythm interpretation on diagnostic accuracy,…

Clinical epidemiology.

PubMed

Martin, S W; Bonnett, B

1987-06-01

Rational clinical practice requires deductive particularization of diagnostic findings, prognoses, and therapeutic responses from groups of animals (herds) to the individual animal (herd) under consideration This process utilizes concepts, skills, and methods of epidemiology, as they relate to the study of the distribution and determinants of health and disease in populations, and casts them in a clinical perspective.We briefly outline diagnostic strategies and introduce a measure of agreement, called kappa, between clinical diagnoses. This statistic is useful not only as a measure of diagnostic accuracy, but also as a means of quantifying and understanding disagreement between diagnosticians. It is disconcerting to many, clinicians included, that given a general deficit of data on sensitivity and specificity, the level of agreement between many clinical diagnoses is only moderate at best with kappa values of 0.3 to 0.6.Sensitivity, specificity, pretest odds, and posttest probability of disease are defined and related to the interpretation of clinical findings and ancillary diagnostic test results. An understanding of these features and how they relate to ruling-in or ruling-out a diagnosis, or minimizzing diagnostic errors will greatly enhance the diagnostic accuracy of the practitioner, and reduce the frequency of clinical disagreement. The approach of running multiple tests on every patient is not only wasteful and expensive, it is unlikely to improve the ability of the clinician to establish the correct diagnosis.We conclude with a discussion of how to decide on the best therapy, a discussion which centers on, and outlines the key features of, the well designed clinical trial. Like a diagnosis, the results from a clinical trial may not always be definitive, nonetheless it is the best available method of gleaning information about treatment efficacy.

Steam Generator tube integrity -- US Nuclear Regulatory Commission perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Murphy, E.L.; Sullivan, E.J.

1997-02-01

In the US, the current regulatory framework was developed in the 1970s when general wall thinning was the dominant degradation mechanism; and, as a result of changes in the forms of degradation being observed and improvements in inspection and tube repair technology, the regulatory framework needs to be updated. Operating experience indicates that the current U.S. requirements should be more stringent in some areas, while in other areas they are overly conservative. To date, this situation has been dealt with on a plant-specific basis in the US. However, the NRC staff is now developing a proposed steam generator rule asmore » a generic framework for ensuring that the steam generator tubes are capable of performing their intended safety functions. This paper discusses the current U.S. regulatory framework for assuring steam generator (SG) tube integrity, the need to update this regulatory framework, the objectives of the new proposed rule, the US Nuclear Regulatory Commission (NRC) regulatory guide (RG) that will accompany the rule, how risk considerations affect the development of the new rule, and some outstanding issues relating to the rule that the NRC is still dealing with.« less

Approximating Optimal Behavioural Strategies Down to Rules-of-Thumb: Energy Reserve Changes in Pairs of Social Foragers

PubMed Central

Rands, Sean A.

2011-01-01

Functional explanations of behaviour often propose optimal strategies for organisms to follow. These ‘best’ strategies could be difficult to perform given biological constraints such as neural architecture and physiological constraints. Instead, simple heuristics or ‘rules-of-thumb’ that approximate these optimal strategies may instead be performed. From a modelling perspective, rules-of-thumb are also useful tools for considering how group behaviour is shaped by the behaviours of individuals. Using simple rules-of-thumb reduces the complexity of these models, but care needs to be taken to use rules that are biologically relevant. Here, we investigate the similarity between the outputs of a two-player dynamic foraging game (which generated optimal but complex solutions) and a computational simulation of the behaviours of the two members of a foraging pair, who instead followed a rule-of-thumb approximation of the game's output. The original game generated complex results, and we demonstrate here that the simulations following the much-simplified rules-of-thumb also generate complex results, suggesting that the rule-of-thumb was sufficient to make some of the model outcomes unpredictable. There was some agreement between both modelling techniques, but some differences arose – particularly when pair members were not identical in how they gained and lost energy. We argue that exploring how rules-of-thumb perform in comparison to their optimal counterparts is an important exercise for biologically validating the output of agent-based models of group behaviour. PMID:21765938

Approximating optimal behavioural strategies down to rules-of-thumb: energy reserve changes in pairs of social foragers.

PubMed

Rands, Sean A

2011-01-01

Functional explanations of behaviour often propose optimal strategies for organisms to follow. These 'best' strategies could be difficult to perform given biological constraints such as neural architecture and physiological constraints. Instead, simple heuristics or 'rules-of-thumb' that approximate these optimal strategies may instead be performed. From a modelling perspective, rules-of-thumb are also useful tools for considering how group behaviour is shaped by the behaviours of individuals. Using simple rules-of-thumb reduces the complexity of these models, but care needs to be taken to use rules that are biologically relevant. Here, we investigate the similarity between the outputs of a two-player dynamic foraging game (which generated optimal but complex solutions) and a computational simulation of the behaviours of the two members of a foraging pair, who instead followed a rule-of-thumb approximation of the game's output. The original game generated complex results, and we demonstrate here that the simulations following the much-simplified rules-of-thumb also generate complex results, suggesting that the rule-of-thumb was sufficient to make some of the model outcomes unpredictable. There was some agreement between both modelling techniques, but some differences arose - particularly when pair members were not identical in how they gained and lost energy. We argue that exploring how rules-of-thumb perform in comparison to their optimal counterparts is an important exercise for biologically validating the output of agent-based models of group behaviour.

[Thalassaemia diagnostics].

PubMed

Kusters, Elske; Kerkhoffs, Jean-Louis H; van Rossum, André P

2014-01-01

The thalassaemias are characterised by quantitative aberrations in the production of the globin chains that make up haemoglobin, and are a subgroup of the haemoglobinopathies. In this LabQuiz we show how thalassaemia carrier status can be indicated in the results of regular laboratory tests, and discuss the laboratory diagnostics that can confirm or rule out thalassaemia. In these two cases we will present a man of Moroccan descent, and two brothers of Filipino descent, all with anaemia and microcytosis. We show it is possible to differentiate between iron-deficiency anaemia and thalassaemia carrier status on the basis of a complete blood count and measurement of ferritin levels, and which laboratory diagnostics can be subsequently performed in order to confirm a suspicion of thalassaemia. The background section discusses the properties and pitfalls of routine laboratory diagnostics for the thalassaemias, and thalassaemia diagnostics in the Dutch newborn screening programme.

QA-driven Guidelines Generation for Bacteriotherapy

PubMed Central

Pasche, Emilie; Teodoro, Douglas; Gobeill, Julien; Ruch, Patrick; Lovis, Christian

2009-01-01

PURPOSE We propose a question-answering (QA) driven generation approach for automatic acquisition of structured rules that can be used in a knowledge authoring tool for antibiotic prescription guidelines management. METHODS: The rule generation is seen as a question-answering problem, where the parameters of the questions are known items of the rule (e.g. an infectious disease, caused by a given bacterium) and answers (e.g. some antibiotics) are obtained by a question-answering engine. RESULTS: When looking for a drug given a pathogen and a disease, top-precision of 0.55 is obtained by the combination of the Boolean engine (PubMed) and the relevance-driven engine (easyIR), which means that for more than half of our evaluation benchmark at least one of the recommended antibiotics was automatically acquired by the rule generation method. CONCLUSION: These results suggest that such an automatic text mining approach could provide a useful tool for guidelines management, by improving knowledge update and discovery. PMID:20351908

Binary translation using peephole translation rules

DOEpatents

Bansal, Sorav; Aiken, Alex

2010-05-04

An efficient binary translator uses peephole translation rules to directly translate executable code from one instruction set to another. In a preferred embodiment, the translation rules are generated using superoptimization techniques that enable the translator to automatically learn translation rules for translating code from the source to target instruction set architecture.

[An ultra-high-pressure liquid chromatography/linear ion trap-Orbitrap mass spectrometry method coupled with a diagnostic fragment ions-searching-based strategy for rapid identification and characterization of chemical components in Polygonum cuspidatum].

PubMed

Pan, Zhiran; Liang, Hailong; Liang, Chabhufi; Xu, Wen

2015-01-01

A method for qualitative analysis of constituents in Polygonum cuspidatum by ultra-high-pressure liquid chromatography coupled with linear ion trap-Orbitrap mass spectrometry (UHPLC-LTQ-Orbitrap MS) has been established. The methanol extract of Polygonum cuspidatumrn was separated on a Waters UPLC C18 column using acetonitrile-water (containing formic acid) eluting system and detected by LTQ-Orbitrap hybrid mass spectrometer in negative mode. The targeted components were further fragmented in LTQ and high accuracy data were acquired by Orbitrap MS. The summarized fragmentation pathways of typical reference components and a diagnostic fragment ions-searching-based strategy were used for detection and identification of the main phenolic components in Polygonum cuspidatum. Other clues such as nitrogen rule, even electron rule, degree of unsaturation rule and isotopic peak data were included for the structural elucidation as well. The whole analytical procedure was within 10 min and more than 30 components were identified or tentatively identified. This method is helpful for further phytochemical research and quality control on Polygonum cuspidatum and related preparations.

Toward fish and seafood traceability: anchovy species determination in fish products by molecular markers and support through a public domain database.

PubMed

Jérôme, Marc; Martinsohn, Jann Thorsten; Ortega, Delphine; Carreau, Philippe; Verrez-Bagnis, Véronique; Mouchel, Olivier

2008-05-28

Traceability in the fish food sector plays an increasingly important role for consumer protection and confidence building. This is reflected by the introduction of legislation and rules covering traceability on national and international levels. Although traceability through labeling is well established and supported by respective regulations, monitoring and enforcement of these rules are still hampered by the lack of efficient diagnostic tools. We describe protocols using a direct sequencing method based on 212-274-bp diagnostic sequences derived from species-specific mitochondria DNA cytochrome b, 16S rRNA, and cytochrome oxidase subunit I sequences which can efficiently be applied to unambiguously determine even closely related fish species in processed food products labeled "anchovy". Traceability of anchovy-labeled products is supported by the public online database AnchovyID ( http://anchovyid.jrc.ec.europa.eu), which provided data obtained during our study and tools for analytical purposes.

Reevaluating Muscle Biopsies in the Diagnosis of Pompe Disease: A Corroborative Report.

PubMed

Genge, Angela; Campbell, Natasha

2016-07-01

Previous reports suggest that although a diagnostic muscle biopsy can confirm the presence of Pompe disease, the absence of a definitive biopsy result does not rule out the diagnosis. In this study, we reviewed patients with a limb-girdle syndrome who demonstrated nonspecific abnormalities of muscle, without evidence of the classical changes of acid maltase deficiency. These patients were rescreened for Pompe disease using dried blood spot (DBS) testing. Twenty-seven patients provided blood samples for the DBS test. Four patients underwent subsequent genetic testing. Genetic analysis demonstrated that one patient tested positive for Pompe disease and one patient had one copy of a pathogenic variant. In conclusion, the ability of a diagnostic muscle biopsy to definitively rule out the presence of Pompe disease is limited. There is a role for a screening DBS in all patients presenting with a limb-girdle syndrome without a clear diagnosis.

Legionnaire's Disease: A Clinical Diagnostic Approach.

PubMed

Cunha, Burke A; Cunha, Cheston B

2017-03-01

Legionnaire's disease is a nonzoonotic atypical pneumonia caused by Legionella sp that occurs sporadically or in outbreaks. Legionnaire's disease pneumonia is accompanied by several extrapulmonary clinical and laboratory findings. Rather than testing all pneumonias for Legionnaire's disease, the clinical challenge is to recognize the diagnostic significance of Legionnaire's disease's. The pretest probability of Legionnaire's disease is increased if several characteristic extrapulmonary findings are present. Similarly, if certain key findings are absent, Legionnaire's disease may be eliminated from further diagnostic consideration. If characteristic clinical findings are present, then specific tests should be ordered to confirm or rule out Legionnaire's disease. Copyright © 2016 Elsevier Inc. All rights reserved.

Characteristics of knowledge content in a curated online evidence library.

PubMed

Varada, Sowmya; Lacson, Ronilda; Raja, Ali S; Ip, Ivan K; Schneider, Louise; Osterbur, David; Bain, Paul; Vetrano, Nicole; Cellini, Jacqueline; Mita, Carol; Coletti, Margaret; Whelan, Julia; Khorasani, Ramin

2018-05-01

To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.

Early-Onset Neonatal Sepsis: Still Room for Improvement in Procalcitonin Diagnostic Accuracy Studies

PubMed Central

Chiesa, Claudio; Pacifico, Lucia; Osborn, John F.; Bonci, Enea; Hofer, Nora; Resch, Bernhard

2015-01-01

Abstract To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative. EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS. We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies. We found 18 articles (1998–2014) fulfilling our eligibility criteria which were included in the final analysis. Overall, the results of our analysis showed that the quality of studies reporting diagnostic accuracy of PCT for EONS was suboptimal leaving ample room for improvement. Information on key elements of design, analysis, and interpretation of test accuracy were frequently missing. Authors should be aware of the STARD criteria before starting a study in this field. We welcome stricter adherence to this guideline. Well-reported studies with appropriate designs will provide more reliable information to guide decisions on the use and interpretations of PCT test results in the management of neonates with EONS. PMID:26222858

Definitions and outlook targeting x-ray exposure of patients in diagnostic imaging

NASA Astrophysics Data System (ADS)

Regulla, Dieter F.

2011-03-01

Computer tomography (CT) is vital and currently irreplaceable in diagnostic radiology. But CT operates with ionizing radiation which may cause cancer or non-cancer diseases in humans. The degree of radiation impact depends on the dose administered by an investigation. And this is the core issue: Even CT exams executed lege artis, administer doses to patients which by magnitude are far beyond the level of hitherto known doses of conventional film-screen techniques. Patients undergoing one or multiple CT examinations, digital angiographies or interventions will be exposed to effective doses between roughly several mSv and several 100 mSv depending on type and frequency of the diagnostic investigations. From the radiation protection point of view, there is therefore the worldwide problem of formulating firm rules for the control of these high-dose investigations, as dose limits can not be established for reasons of the medical benefit. This makes the difference compared with radiation protection for occupationally exposed persons. What remains is "software", namely "justification" and "optimization". Justification requires balancing the interests between the health benefit and the potential harm of an exam which has to be responsibly executed by the physician himself; therefore the radiologists' associations are in the duty to prepare practicable rules for justification. Optimization again needs a cooperative solution, and that is the establishment of reference doses for diagnostic examinations, to be checked by the technical service of the producers' companies. Experts and authorities have been aware of the high-dose dilemma in diagnostic imaging since long. It is time for the reflection of active solutions and their implementation into practice.

Railway Online Booking System Design and Implementation

NASA Astrophysics Data System (ADS)

Zongjiang, Wang

In this paper, we define rule usefulness and introduce one approach to evaluate the rule usefulness in rough sets. And we raise one method to get most useful rules. This method is easy and effective in applications of prisoners' reform. Comparing with the method to get most interesting rules, ours is direct and objective. Rule interestingness must consider the predefined knowledge on what kind of information is interesting. Our method greatly reduces the rule numbers generated and provides a measure of rule usefulness at the same time.

Notions of "Generation" in Rhetorical Studies.

ERIC Educational Resources Information Center

Young, Richard

A study of the meanings of "generation," a popular term in current rhetorical jargon, reveals important developments in the art and theory of rhetoric. As now used, it refers without clear distinction to rule-governed, heuristic, and trial-and-error procedures. The rule-governed procedures of transformation grammar are being employed to…

From data mining rules to medical logical modules and medical advices.

PubMed

Gomoi, Valentin; Vida, Mihaela; Robu, Raul; Stoicu-Tivadar, Vasile; Bernad, Elena; Lupşe, Oana

2013-01-01

Using data mining in collaboration with Clinical Decision Support Systems adds new knowledge as support for medical diagnosis. The current work presents a tool which translates data mining rules supporting generation of medical advices to Arden Syntax formalism. The developed system was tested with data related to 2326 births that took place in 2010 at the Bega Obstetrics - Gynaecology Hospital, Timişoara. Based on processing these data, 14 medical rules regarding the Apgar score were generated and then translated in Arden Syntax language.

DecisionMaker software and extracting fuzzy rules under uncertainty

NASA Technical Reports Server (NTRS)

Walker, Kevin B.

1992-01-01

Knowledge acquisition under uncertainty is examined. Theories proposed in deKorvin's paper 'Extracting Fuzzy Rules Under Uncertainty and Measuring Definability Using Rough Sets' are discussed as they relate to rule calculation algorithms. A data structure for holding an arbitrary number of data fields is described. Limitations of Pascal for loops in the generation of combinations are also discussed. Finally, recursive algorithms for generating all possible combination of attributes and for calculating the intersection of an arbitrary number of fuzzy sets are presented.

On the Universality and Non-Universality of Spiking Neural P Systems With Rules on Synapses.

PubMed

Song, Tao; Xu, Jinbang; Pan, Linqiang

2015-12-01

Spiking neural P systems with rules on synapses are a new variant of spiking neural P systems. In the systems, the neuron contains only spikes, while the spiking/forgetting rules are moved on the synapses. It was obtained that such system with 30 neurons (using extended spiking rules) or with 39 neurons (using standard spiking rules) is Turing universal. In this work, this number is improved to 6. Specifically, we construct a Turing universal spiking neural P system with rules on synapses having 6 neurons, which can generate any set of Turing computable natural numbers. As well, it is obtained that spiking neural P system with rules on synapses having less than two neurons are not Turing universal: i) such systems having one neuron can characterize the family of finite sets of natural numbers; ii) the family of sets of numbers generated by the systems having two neurons is included in the family of semi-linear sets of natural numbers.

Diagnostic accuracy of clinical dehydration scales in children.

PubMed

Falszewska, Anna; Dziechciarz, Piotr; Szajewska, Hania

2017-08-01

The aim of this study was to evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the World Health Organization (WHO) scale, and the Gorelick scale for dehydration assessment in children. A prospective, observational study was carried out between October 2014 and December 2016. Eligible participants were children aged 1 month to 5 years with acute diarrhea. After hospital admission, each patient's weight was recorded and the degree of dehydration based on three scales was assessed. The reference standard was the percentage weight change between the discharge and admission weights. The main outcomes were the sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Of 128 children enrolled in the study, complete data were available from 118 patients for analysis. Most of children presented with no or mild dehydration. Only the CDS showed limited value in confirming a diagnosis of dehydration ≥6% (positive LR 3.9, 95% CI 1.1 to 9.1), with no value in ruling it out (negative LR 0.6, 95% CI 0.2 to 0.99). In our cohort, the CDS was of limited diagnostic value in ruling in severe dehydration in children with acute gastroenteritis. The WHO and Gorelick scales were not helpful in the assessment of dehydration. What is Known : • Treatment of acute gastroenteritis (AGE) is based on assessing and correcting the degree of dehydration. • Several scales combining various signs and symptoms have been developed, including the Clinical Dehydration Scale (CDS), and the World Health Organization (WHO) scale, and the Gorelick scale. None of these scales is internationally accepted for best accuracy in diagnosing dehydration in children. What is New: • The CDS was of limited diagnostic value in ruling in severe dehydration in children with AGE. • The WHO and Gorelick scales were not helpful in the assessment of dehydration.

Photolithography diagnostic expert systems: a systematic approach to problem solving in a wafer fabrication facility

NASA Astrophysics Data System (ADS)

Weatherwax Scott, Caroline; Tsareff, Christopher R.

1990-06-01

One of the main goals of process engineering in the semiconductor industry is to improve wafer fabrication productivity and throughput. Engineers must work continuously toward this goal in addition to performing sustaining and development tasks. To accomplish these objectives, managers must make efficient use of engineering resources. One of the tools being used to improve efficiency is the diagnostic expert system. Expert systems are knowledge based computer programs designed to lead the user through the analysis and solution of a problem. Several photolithography diagnostic expert systems have been implemented at the Hughes Technology Center to provide a systematic approach to process problem solving. This systematic approach was achieved by documenting cause and effect analyses for a wide variety of processing problems. This knowledge was organized in the form of IF-THEN rules, a common structure for knowledge representation in expert system technology. These rules form the knowledge base of the expert system which is stored in the computer. The systems also include the problem solving methodology used by the expert when addressing a problem in his area of expertise. Operators now use the expert systems to solve many process problems without engineering assistance. The systems also facilitate the collection of appropriate data to assist engineering in solving unanticipated problems. Currently, several expert systems have been implemented to cover all aspects of the photolithography process. The systems, which have been in use for over a year, include wafer surface preparation (HMDS), photoresist coat and softbake, align and expose on a wafer stepper, and develop inspection. These systems are part of a plan to implement an expert system diagnostic environment throughout the wafer fabrication facility. In this paper, the systems' construction is described, including knowledge acquisition, rule construction, knowledge refinement, testing, and evaluation. The roles played by the process engineering expert and the knowledge engineer are discussed. The features of the systems are shown, particularly the interactive quality of the consultations and the ease of system use.

Rules in School. Strategies for Teachers Series.

ERIC Educational Resources Information Center

Brady, Kathryn; Forton, Mary Beth; Porter, Deborah; Wood, Chip

This book offers an approach for helping K-8 students become invested in creating and living by classroom rules. It provides techniques for: helping students articulate their hopes and dreams for school; involving students in generating classroom rules that grow out of their hopes and dreams; modeling, practicing, and role playing the rules; using…

38 CFR 3.371 - Presumptive service connection for tuberculous disease; wartime and service on or after January 1...

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Pulmonary tuberculosis. (1) Evidence of activity on comparative study of X-ray films showing pulmonary... effusion without obvious cause. Pleurisy with effusion with evidence of diagnostic studies ruling out...

38 CFR 3.371 - Presumptive service connection for tuberculous disease; wartime and service on or after January 1...

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Pulmonary tuberculosis. (1) Evidence of activity on comparative study of X-ray films showing pulmonary... effusion without obvious cause. Pleurisy with effusion with evidence of diagnostic studies ruling out...

38 CFR 3.371 - Presumptive service connection for tuberculous disease; wartime and service on or after January 1...

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Pulmonary tuberculosis. (1) Evidence of activity on comparative study of X-ray films showing pulmonary... effusion without obvious cause. Pleurisy with effusion with evidence of diagnostic studies ruling out...

38 CFR 3.371 - Presumptive service connection for tuberculous disease; wartime and service on or after January 1...

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Pulmonary tuberculosis. (1) Evidence of activity on comparative study of X-ray films showing pulmonary... effusion without obvious cause. Pleurisy with effusion with evidence of diagnostic studies ruling out...

38 CFR 3.371 - Presumptive service connection for tuberculous disease; wartime and service on or after January 1...

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Pulmonary tuberculosis. (1) Evidence of activity on comparative study of X-ray films showing pulmonary... effusion without obvious cause. Pleurisy with effusion with evidence of diagnostic studies ruling out...

Lesion size affects diagnostic performance of IOTA logistic regression models, IOTA simple rules and risk of malignancy index in discriminating between benign and malignant adnexal masses.

PubMed

Di Legge, A; Testa, A C; Ameye, L; Van Calster, B; Lissoni, A A; Leone, F P G; Savelli, L; Franchi, D; Czekierdowski, A; Trio, D; Van Holsbeke, C; Ferrazzi, E; Scambia, G; Timmerman, D; Valentin, L

2012-09-01

To estimate the ability to discriminate between benign and malignant adnexal masses of different size using: subjective assessment, two International Ovarian Tumor Analysis (IOTA) logistic regression models (LR1 and LR2), the IOTA simple rules and the risk of malignancy index (RMI). We used a multicenter IOTA database of 2445 patients with at least one adnexal mass, i.e. the database previously used to prospectively validate the diagnostic performance of LR1 and LR2. The masses were categorized into three subgroups according to their largest diameter: small tumors (diameter < 4 cm; n = 396), medium-sized tumors (diameter, 4-9.9 cm; n = 1457) and large tumors (diameter ≥ 10 cm, n = 592). Subjective assessment, LR1 and LR2, IOTA simple rules and the RMI were applied to each of the three groups. Sensitivity, specificity, positive and negative likelihood ratio (LR+, LR-), diagnostic odds ratio (DOR) and area under the receiver-operating characteristics curve (AUC) were used to describe diagnostic performance. A moving window technique was applied to estimate the effect of tumor size as a continuous variable on the AUC. The reference standard was the histological diagnosis of the surgically removed adnexal mass. The frequency of invasive malignancy was 10% in small tumors, 19% in medium-sized tumors and 40% in large tumors; 11% of the large tumors were borderline tumors vs 3% and 4%, respectively, of the small and medium-sized tumors. The type of benign histology also differed among the three subgroups. For all methods, sensitivity with regard to malignancy was lowest in small tumors (56-84% vs 67-93% in medium-sized tumors and 74-95% in large tumors) while specificity was lowest in large tumors (60-87%vs 83-95% in medium-sized tumors and 83-96% in small tumors ). The DOR and the AUC value were highest in medium-sized tumors and the AUC was largest in tumors with a largest diameter of 7-11 cm. Tumor size affects the performance of subjective assessment, LR1 and LR2, the IOTA simple rules and the RMI in discriminating correctly between benign and malignant adnexal masses. The likely explanation, at least in part, is the difference in histology among tumors of different size. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Effectiveness of real-time polymerase chain reaction assay for the detection of Mycobacterium tuberculosis in pathological samples: a systematic review and meta-analysis.

PubMed

Babafemi, Emmanuel O; Cherian, Benny P; Banting, Lee; Mills, Graham A; Ngianga, Kandala

2017-10-25

Rapid and accurate diagnosis of tuberculosis (TB) is key to manage the disease and to control and prevent its transmission. Many established diagnostic methods suffer from low sensitivity or delay of timely results and are inadequate for rapid detection of Mycobacterium tuberculosis (MTB) in pulmonary and extra-pulmonary clinical samples. This study examined whether a real-time polymerase chain reaction (RT-PCR) assay, with a turn-a-round time of 2 h, would prove effective for routine detection of MTB by clinical microbiology laboratories. A systematic literature search was performed for publications in any language on the detection of MTB in pathological samples by RT-PCR assay. The following sources were used MEDLINE via PubMed, EMBASE, BIOSIS Citation Index, Web of Science, SCOPUS, ISI Web of Knowledge and Cochrane Infectious Diseases Group Specialised Register, grey literature, World Health Organization and Centres for Disease Control and Prevention websites. Forty-six studies met set inclusion criteria. Generated pooled summary estimates (95% CIs) were calculated for overall accuracy and bivariate meta-regression model was used for meta-analysis. Summary estimates for pulmonary TB (31 studies) were as follows: sensitivity 0.82 (95% CI 0.81-0.83), specificity 0.99 (95% CI 0.99-0.99), positive likelihood ratio 43.00 (28.23-64.81), negative likelihood ratio 0.16 (0.12-0.20), diagnostic odds ratio 324.26 (95% CI 189.08-556.09) and area under curve 0.99. Summary estimates for extra-pulmonary TB (25 studies) were as follows: sensitivity 0.70 (95% CI 0.67-0.72), specificity 0.99 (95% CI 0.99-0.99), positive likelihood ratio 29.82 (17.86-49.78), negative likelihood ratio 0.33 (0.26-0.42), diagnostic odds ratio 125.20 (95% CI 65.75-238.36) and area under curve 0.96. RT-PCR assay demonstrated a high degree of sensitivity for pulmonary TB and good sensitivity for extra-pulmonary TB. It indicated a high degree of specificity for ruling in TB infection from sampling regimes. This was acceptable, but may better as a rule out add-on diagnostic test. RT-PCR assays demonstrate both a high degree of sensitivity in pulmonary samples and rapidity of detection of TB which is an important factor in achieving effective global control and for patient management in terms of initiating early and appropriate anti-tubercular therapy. PROSPERO CRD42015027534 .

Current challenges in diagnostic imaging of venous thromboembolism.

PubMed

Huisman, Menno V; Klok, Frederikus A

2015-01-01

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism. © 2015 by The American Society of Hematology. All rights reserved.

How Expert Clinicians Intuitively Recognize a Medical Diagnosis.

PubMed

Brush, John E; Sherbino, Jonathan; Norman, Geoffrey R

2017-06-01

Research has shown that expert clinicians make a medical diagnosis through a process of hypothesis generation and verification. Experts begin the diagnostic process by generating a list of diagnostic hypotheses using intuitive, nonanalytic reasoning. Analytic reasoning then allows the clinician to test and verify or reject each hypothesis, leading to a diagnostic conclusion. In this article, we focus on the initial step of hypothesis generation and review how expert clinicians use experiential knowledge to intuitively recognize a medical diagnosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Computer-aided diagnostic strategy selection.

PubMed

Greenes, R A

1986-03-01

Determination of the optimal diagnostic work-up strategy for the patient is becoming a major concern for the practicing physician. Overlap of the indications for various diagnostic procedures, differences in their invasiveness or risk, and high costs have made physicians aware of the need to consider the choice of procedure carefully, as well as its relation to management actions available. In this article, the author discusses research approaches that aim toward development of formal decision analytic methods to allow the physician to determine optimal strategy; clinical algorithms or rules as guides to physician decisions; improved measures for characterizing the performance of diagnostic tests; educational tools for increasing the familiarity of physicians with the concepts underlying these measures and analytic procedures; and computer-based aids for facilitating the employment of these resources in actual clinical practice.

Rules based process window OPC

NASA Astrophysics Data System (ADS)

O'Brien, Sean; Soper, Robert; Best, Shane; Mason, Mark

2008-03-01

As a preliminary step towards Model-Based Process Window OPC we have analyzed the impact of correcting post-OPC layouts using rules based methods. Image processing on the Brion Tachyon was used to identify sites where the OPC model/recipe failed to generate an acceptable solution. A set of rules for 65nm active and poly were generated by classifying these failure sites. The rules were based upon segment runlengths, figure spaces, and adjacent figure widths. 2.1 million sites for active were corrected in a small chip (comparing the pre and post rules based operations), and 59 million were found at poly. Tachyon analysis of the final reticle layout found weak margin sites distinct from those sites repaired by rules-based corrections. For the active layer more than 75% of the sites corrected by rules would have printed without a defect indicating that most rulesbased cleanups degrade the lithographic pattern. Some sites were missed by the rules based cleanups due to either bugs in the DRC software or gaps in the rules table. In the end dramatic changes to the reticle prevented catastrophic lithography errors, but this method is far too blunt. A more subtle model-based procedure is needed changing only those sites which have unsatisfactory lithographic margin.

A neural model of rule generation in inductive reasoning.

PubMed

Rasmussen, Daniel; Eliasmith, Chris

2011-01-01

Inductive reasoning is a fundamental and complex aspect of human intelligence. In particular, how do subjects, given a set of particular examples, generate general descriptions of the rules governing that set? We present a biologically plausible method for accomplishing this task and implement it in a spiking neuron model. We demonstrate the success of this model by applying it to the problem domain of Raven's Progressive Matrices, a widely used tool in the field of intelligence testing. The model is able to generate the rules necessary to correctly solve Raven's items, as well as recreate many of the experimental effects observed in human subjects. Copyright © 2011 Cognitive Science Society, Inc.

Evidence-based rules from family practice to inform family practice; the learning healthcare system case study on urinary tract infections.

PubMed

Soler, Jean K; Corrigan, Derek; Kazienko, Przemyslaw; Kajdanowicz, Tomasz; Danger, Roxana; Kulisiewicz, Marcin; Delaney, Brendan

2015-05-16

Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection" . The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis" . The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data.

Using next-generation sequencing to develop molecular diagnostics for Pseudoperonospora cubensis, the cucurbit downy mildew pathogen

USDA-ARS?s Scientific Manuscript database

Advances in Next Generation Sequencing (NGS) allow for rapid development of genomics resources needed to generate molecular diagnostics assays for infectious agents. NGS approaches are particularly helpful for organisms that cannot be cultured, such as the downy mildew pathogens, a group of biotrop...

Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation.

PubMed

Rodgers, M; Nixon, J; Hempel, S; Aho, T; Kelly, J; Neal, D; Duffy, S; Ritchie, G; Kleijnen, J; Westwood, M

2006-06-01

To determine the most effective diagnostic strategy for the investigation of microscopic and macroscopic haematuria in adults. Electronic databases from inception to October 2003, updated in August 2004. A systematic review was undertaken according to published guidelines. Decision analytic modelling was undertaken, based on the findings of the review, expert opinion and additional information from the literature, to assess the relative cost-effectiveness of plausible alternative tests that are part of diagnostic algorithms for haematuria. A total of 118 studies met the inclusion criteria. No studies that evaluated the effectiveness of diagnostic algorithms for haematuria or the effectiveness of screening for haematuria or investigating its underlying cause were identified. Eighteen out of 19 identified studies evaluated dipstick tests and data from these suggested that these are moderately useful in establishing the presence of, but cannot be used to rule out, haematuria. Six studies using haematuria as a test for the presence of a disease indicated that the detection of microhaematuria cannot alone be considered a useful test either to rule in or rule out the presence of a significant underlying pathology (urinary calculi or bladder cancer). Forty-eight of 80 studies addressed methods to localise the source of bleeding (renal or lower urinary tract). The methods and thresholds described in these studies varied greatly, precluding any estimate of a 'best performance' threshold that could be applied across patient groups. However, studies of red blood cell morphology that used a cut-off value of 80% dysmorphic cells for glomerular disease reported consistently high specificities (potentially useful in ruling in a renal cause for haematuria). The reported sensitivities were generally low. Twenty-eight studies included data on the accuracy of laboratory tests (tumour markers, cytology) for the diagnosis of bladder cancer. The majority of tumour marker studies evaluated nuclear matrix protein 22 or bladder tumour antigen. The sensitivity and specificity ranges suggested that neither of these would be useful either for diagnosing bladder cancer or for ruling out patients for further investigation (cystoscopy). However, the evidence remains sparse and the diagnostic accuracy estimates varied widely between studies. Fifteen studies evaluating urine cytology as a test for urinary tract malignancies were heterogeneous and poorly reported. The calculated specificity values were generally high, suggesting some possible utility in confirming malignancy. However, the evidence suggests that urine cytology has no application in ruling out malignancy or excluding patients from further investigation. Fifteen studies evaluated imaging techniques [computed tomography (CT), intravenous urography (IVU) or ultrasound scanning (US)] to detect the underlying cause of haematuria. The target condition and the reference standard varied greatly between these studies. The diagnostic accuracy data for several individual studies appeared promising but meaningful comparison of the available imaging technologies was impossible. Eight studies met the inclusion criteria but addressed different parts of the diagnostic chain (e.g. screening programmes, laboratory investigations, full urological work-up). No single study addressed the complete diagnostic process. The review also highlighted a number of methodological limitations of these studies, including their lack of generalisability to the UK context. Separate decision analytic models were therefore developed to progress estimation of the optimal strategy for the diagnostic management of haematuria. The economic model for the detection of microhaematuria found that immediate microscopy following a positive dipstick test would improve diagnostic efficiency as it eliminates the high number of false positives produced by dipstick testing. Strategies that use routine microscopy may be associated with high numbers of false results, but evidence was lacking regarding the accuracy of routine microscopy and estimates were adopted for the model. The model for imaging the upper urinary tract showed that US detects more tumours than IVU at one-third of the cost, and is also associated with fewer false results. For any cause of haematuria, CT was shown to have a mean incremental cost-effectiveness ratio of pounds sterling 9939 in comparison with the next best option, US. When US is followed up with CT for negative results with persistent haematuria, it dominates the initial use of CT alone, with a saving of pounds sterling 235,000 for the evaluation of 1000 patients. The model for investigation of the lower urinary tract showed that for low-risk patients the use of immediate cystoscopy could be avoided if cystoscopy were used for follow-up patients with a negative initial test using tumour markers and/or cytology, resulting in a saving of pounds sterling 483,000 for the evaluation of 1000 patients. The clinical and economic impact on delayed detection of both upper and lower urinary tract tumours through the use of follow-up testing should be evaluated in future studies. There are insufficient data currently available to derive an evidence-based algorithm of the diagnostic pathway for haematuria. A hypothetical algorithm based on the opinion and practice of clinical experts in the review team, other published algorithms and the results of economic modelling is presented in this report. This algorithm is presented, for comparative purposes, alongside current US and UK guidelines. The ideas contained in these algorithms and the specific questions outlined should form the basis of future research. Quality assessment of the diagnostic accuracy studies included in this review highlighted several areas of deficiency.

76 FR 62306 - Countermeasures Injury Compensation Program (CICP): Administrative Implementation, Final Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... respirators, Respiratory support devices, Ventilators, Anthrax, Smallpox, Botulism, Acute radiation syndrome...] and Relenza[supreg] when used for pandemic purposes; (5) smallpox countermeasures; (6) acute radiation syndrome countermeasures; (7) pandemic influenza diagnostics, personal respiratory devices, and respiratory...

Applying the Rule Space Model to Develop a Learning Progression for Thermochemistry

NASA Astrophysics Data System (ADS)

Chen, Fu; Zhang, Shanshan; Guo, Yanfang; Xin, Tao

2017-12-01

We used the Rule Space Model, a cognitive diagnostic model, to measure the learning progression for thermochemistry for senior high school students. We extracted five attributes and proposed their hierarchical relationships to model the construct of thermochemistry at four levels using a hypothesized learning progression. For this study, we developed 24 test items addressing the attributes of exothermic and endothermic reactions, chemical bonds and heat quantity change, reaction heat and enthalpy, thermochemical equations, and Hess's law. The test was administered to a sample base of 694 senior high school students taught in 3 schools across 2 cities. Results based on the Rule Space Model analysis indicated that (1) the test items developed by the Rule Space Model were of high psychometric quality for good analysis of difficulties, discriminations, reliabilities, and validities; (2) the Rule Space Model analysis classified the students into seven different attribute mastery patterns; and (3) the initial hypothesized learning progression was modified by the attribute mastery patterns and the learning paths to be more precise and detailed.

A Simple Computer-Aided Three-Dimensional Molecular Modeling for the Octant Rule

ERIC Educational Resources Information Center

Kang, Yinan; Kang, Fu-An

2011-01-01

The Moffitt-Woodward-Moscowitz-Klyne-Djerassi octant rule is one of the most successful empirical rules in organic chemistry. However, the lack of a simple effective modeling method for the octant rule in the past 50 years has posed constant difficulties for researchers, teachers, and students, particularly the young generations, to learn and…

Complex Problem Solving--More than Reasoning?

ERIC Educational Resources Information Center

Wustenberg, Sascha; Greiff, Samuel; Funke, Joachim

2012-01-01

This study investigates the internal structure and construct validity of Complex Problem Solving (CPS), which is measured by a "Multiple-Item-Approach." It is tested, if (a) three facets of CPS--"rule identification" (adequateness of strategies), "rule knowledge" (generated knowledge) and "rule application"…

Deriving adaptive operating rules of hydropower reservoirs using time-varying parameters generated by the EnKF

NASA Astrophysics Data System (ADS)

Feng, Maoyuan; Liu, Pan; Guo, Shenglian; Shi, Liangsheng; Deng, Chao; Ming, Bo

2017-08-01

Operating rules have been used widely to decide reservoir operations because of their capacity for coping with uncertain inflow. However, stationary operating rules lack adaptability; thus, under changing environmental conditions, they cause inefficient reservoir operation. This paper derives adaptive operating rules based on time-varying parameters generated using the ensemble Kalman filter (EnKF). A deterministic optimization model is established to obtain optimal water releases, which are further taken as observations of the reservoir simulation model. The EnKF is formulated to update the operating rules sequentially, providing a series of time-varying parameters. To identify the index that dominates the variations of the operating rules, three hydrologic factors are selected: the reservoir inflow, ratio of future inflow to current available water, and available water. Finally, adaptive operating rules are derived by fitting the time-varying parameters with the identified dominant hydrologic factor. China's Three Gorges Reservoir was selected as a case study. Results show that (1) the EnKF has the capability of capturing the variations of the operating rules, (2) reservoir inflow is the factor that dominates the variations of the operating rules, and (3) the derived adaptive operating rules are effective in improving hydropower benefits compared with stationary operating rules. The insightful findings of this study could be used to help adapt reservoir operations to mitigate the effects of changing environmental conditions.

A novel approach for incremental uncertainty rule generation from databases with missing values handling: application to dynamic medical databases.

PubMed

Konias, Sokratis; Chouvarda, Ioanna; Vlahavas, Ioannis; Maglaveras, Nicos

2005-09-01

Current approaches for mining association rules usually assume that the mining is performed in a static database, where the problem of missing attribute values does not practically exist. However, these assumptions are not preserved in some medical databases, like in a home care system. In this paper, a novel uncertainty rule algorithm is illustrated, namely URG-2 (Uncertainty Rule Generator), which addresses the problem of mining dynamic databases containing missing values. This algorithm requires only one pass from the initial dataset in order to generate the item set, while new metrics corresponding to the notion of Support and Confidence are used. URG-2 was evaluated over two medical databases, introducing randomly multiple missing values for each record's attribute (rate: 5-20% by 5% increments) in the initial dataset. Compared with the classical approach (records with missing values are ignored), the proposed algorithm was more robust in mining rules from datasets containing missing values. In all cases, the difference in preserving the initial rules ranged between 30% and 60% in favour of URG-2. Moreover, due to its incremental nature, URG-2 saved over 90% of the time required for thorough re-mining. Thus, the proposed algorithm can offer a preferable solution for mining in dynamic relational databases.

The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner.

PubMed

Sanfilippo, Paul G; Hewitt, Alex W; Mackey, David A

2017-04-01

To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

The INTELSAT VI SSTDMA network diagnostic system

NASA Astrophysics Data System (ADS)

Tamboli, Satish P.; Zhu, Xiaobo; Wilkins, Kim N.; Gupta, Ramesh K.

The system-level design of an expert-system-based, near-real-time diagnostic system for INTELSAT VI satellite-switched time-division multiple access (SSTDMA) network is described. The challenges of INTELSAT VI diagnostics are discussed, along with alternative approaches for network diagnostics and the rationale for choosing a method based on burst unique-word detection. The focal point of the diagnostic system is the diagnostic processor, which resides in the central control and monitoring facility known as the INTELSAT Operations Center TDMA Facility (IOCTF). As real-time information such as burst unique-word detection data, reference terminal status data, and satellite telemetry alarm data are received at the IOCTF, the diagnostic processor continuously monitors the data streams. When a burst status change is detected, a 'snapshot' of the real-time data is forwarded to the expert system. Receipt of the change causes a set of rules to be invoked which associate the traffic pattern with a set of probable causes. A user-friendly interface allows a graphical view of the burst time plan and provides the ability to browse through the knowledge bases.

Research on complex 3D tree modeling based on L-system

NASA Astrophysics Data System (ADS)

Gang, Chen; Bin, Chen; Yuming, Liu; Hui, Li

2018-03-01

L-system as a fractal iterative system could simulate complex geometric patterns. Based on the field observation data of trees and knowledge of forestry experts, this paper extracted modeling constraint rules and obtained an L-system rules set. Using the self-developed L-system modeling software the L-system rule set was parsed to generate complex tree 3d models.The results showed that the geometrical modeling method based on l-system could be used to describe the morphological structure of complex trees and generate 3D tree models.

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

PubMed

Weinberg, Douglas S; Scarcella, Nicholas R; Napora, Joshua K; Vallier, Heather A

2016-06-01

Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities of palpable dorsalis pedis or posterior tibial pulses, and the presence of an ankle-brachial index (ABI) of 0.9 or greater? A database at a Level I trauma center was queried for patients with evidence of knee dislocation, demographic information (age at the time of injury, sex, Injury Severity Score, BMI, mechanism of injury), and the presence of open injury were recorded. One-hundred forty-one patients underwent screening at initial presentation, of whom 26 (24%) underwent early vascular exploration based on an abnormal physical examination. One-hundred five (91%) of the remaining 115 patients were available at a minimum followup of 6 months (mean, 19 ± 10 months). In total, 31 unique patients were excluded, including 10 patients (7%) who were lost to followup before 6 months. Among the 110 patients who met inclusion criteria, the mean age and SD was 37 ± 13 years, and the Injury Severity Score was 15 ± 9. There were 71 males (65%). Logistic regression was used to determine independent correlates of vascular injury. The vascular examination was reviewed for the presence of a palpable pulse in the dorsalis pedis artery, the presence of a palpable pulse in the posterior tibial artery, and whether the ABI in the dorsalis pedis was 0.9 or greater. Contingency tables were generated to assess the sensitivity, specificity, and accuracy of physical examination maneuvers. The physical examination was collectively regarded as "normal" when both pulses were palpable and the ABI was 0.9 or greater. The initial physical examination as just described was considered the diagnostic test being evaluated in this study; "positive" tests were evaluated by and confirmed at vascular surgery, and 6 months clinical followup without symptoms or progressive signs of vascular injury confirmed the absence of injury in the remainder of the patients. Contingency tables were generated again to assess the sensitivity, specificity, and accuracy of the combined physical examination. Increased BMI (odds ratio [OR], 1.077; 95% CI, 1.008-1.155; p = 0.033) and open injuries (OR, 3.366; 95% CI, 1.008-11.420; p = 0.048) were associated with vascular injury. No single physical examination maneuver had a 100% sensitivity for ruling out vascular injury. A normal physical examination (palpable pulses and ABI ≥ 0.9) had 100% sensitivity for ruling out vascular injury. Increased BMI and the presence of open dislocation are associated with a greater risk for vascular injury after knee dislocation. The combination of a palpable dorsalis pedis and posterior tibial pulse combined with an ABI of 0.9 or greater was 100% sensitive for the detection of vascular injury based on clinical followup at 6 months. Level III, diagnostic study.

Knowledge From Pictures (KFP)

NASA Technical Reports Server (NTRS)

Truszkowski, Walt; Paterra, Frank; Bailin, Sidney

1993-01-01

The old maxim goes: 'A picture is worth a thousand words'. The objective of the research reported in this paper is to demonstrate this idea as it relates to the knowledge acquisition process and the automated development of an expert system's rule base. A prototype tool, the Knowledge From Pictures (KFP) tool, has been developed which configures an expert system's rule base by an automated analysis of and reasoning about a 'picture', i.e., a graphical representation of some target system to be supported by the diagnostic capabilities of the expert system under development. This rule base, when refined, could then be used by the expert system for target system monitoring and fault analysis in an operational setting. Most people, when faced with the problem of understanding the behavior of a complicated system, resort to the use of some picture or graphical representation of the system as an aid in thinking about it. This depiction provides a means of helping the individual to visualize the bahavior and dynamics of the system under study. An analysis of the picture augmented with the individual's background information, allows the problem solver to codify knowledge about the system. This knowledge can, in turn, be used to develop computer programs to automatically monitor the system's performance. The approach taken is this research was to mimic this knowledge acquisition paradigm. A prototype tool was developed which provides the user: (1) a mechanism for graphically representing sample system-configurations appropriate for the domain, and (2) a linguistic device for annotating the graphical representation with the behaviors and mutual influences of the components depicted in the graphic. The KFP tool, reasoning from the graphical depiction along with user-supplied annotations of component behaviors and inter-component influences, generates a rule base that could be used in automating the fault detection, isolation, and repair of the system.

Role of Big Data and Machine Learning in Diagnostic Decision Support in Radiology.

PubMed

Syeda-Mahmood, Tanveer

2018-03-01

The field of diagnostic decision support in radiology is undergoing rapid transformation with the availability of large amounts of patient data and the development of new artificial intelligence methods of machine learning such as deep learning. They hold the promise of providing imaging specialists with tools for improving the accuracy and efficiency of diagnosis and treatment. In this article, we will describe the growth of this field for radiology and outline general trends highlighting progress in the field of diagnostic decision support from the early days of rule-based expert systems to cognitive assistants of the modern era. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Clinical proteomics: Applications for prostate cancer biomarker discovery and detection.

PubMed

Petricoin, Emanuel F; Ornstein, David K; Liotta, Lance A

2004-01-01

The science of proteomics comprises much more than simply generating lists of proteins that change in expression as a cause of or consequence of pathophysiology. The goal of proteomics should be to characterize the information flow through the intercellular protein circuitry that communicates with the extracellular microenvironment and then ultimately to the serum/plasma macroenvironment. Serum proteomic pattern diagnostics is a new type of proteomic concept in which patterns of ion signatures generated from high dimensional mass spectrometry data are used as diagnostic classifiers. This recent approach has exciting potential for clinical utility of diagnostic patterns because low molecular weight metabolites, peptides, and protein fragments may have higher accuracy than traditional biomarkers of cancer detection. Intriguingly, we now have discovered that this diagnostic information exists in a bound state, complexed with circulating highly abundant carrier proteins. These diagnostic fragments may one day be harvested by circulating nanoparticles, designed to absorb, enrich, and amplify the repertoire of diagnostic biomarkers generated-even at the critical, initial stages of carcinogenesis. Copyright 2004 Elsevier Inc.

Validation of consensus panel diagnosis in dementia.

PubMed

Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

2010-12-01

The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

Rule Based Category Learning in Patients with Parkinson’s Disease

PubMed Central

Price, Amanda; Filoteo, J. Vincent; Maddox, W. Todd

2009-01-01

Measures of explicit rule-based category learning are commonly used in neuropsychological evaluation of individuals with Parkinson’s disease (PD) and the pattern of PD performance on these measures tends to be highly varied. We review the neuropsychological literature to clarify the manner in which PD affects the component processes of rule-based category learning and work to identify and resolve discrepancies within this literature. In particular, we address the manner in which PD and its common treatments affect the processes of rule generation, maintenance, shifting and selection. We then integrate the neuropsychological research with relevant neuroimaging and computational modeling evidence to clarify the neurobiological impact of PD on each process. Current evidence indicates that neurochemical changes associated with PD primarily disrupt rule shifting, and may disturb feedback-mediated learning processes that guide rule selection. Although surgical and pharmacological therapies remediate this deficit, it appears that the same treatments may contribute to impaired rule generation, maintenance and selection processes. These data emphasize the importance of distinguishing between the impact of PD and its common treatments when considering the neuropsychological profile of the disease. PMID:19428385

Generating Enthusiasm with Generative Phonology.

ERIC Educational Resources Information Center

Dickerson, Wayne B.

This paper attempts a systematic approach to the teaching of word stress in the ESL classroom. Stress assignment rules from Chomsky and Halle and from Ross are used to establish the SISL Principle (Stress Initial Strong Left), for final weak-syllable words. On the basis of spelling, this rule can be applied correctly to 95 out of 100 cases. (AM)

RELATIONSHIPS BETWEEN NITROGEN OXIDE EMISSIONS FROM ELECTRICAL GENERATING UNITS IN THE U.S. AND METEOROLOGY

EPA Science Inventory

Nitrogen oxide (NO_x) emissions from electrical generating units (EGUs) in the northeast US have declined dramatically during the past few years as a result of a series of air quality rules (RACT rule, Clean Air Act Amendments Title IV, and the NO_x SIP call)....

Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis.

PubMed

Décary, Simon; Feldman, Debbie; Frémont, Pierre; Pelletier, Jean-Pierre; Martel-Pelletier, Johanne; Fallaha, Michel; Pelletier, Bruno; Belzile, Sylvain; Sylvestre, Marie-Pierre; Vendittoli, Pascal-André; Desmeules, François

2018-05-21

The aim of the present study was to assess the validity of clusters combining history elements and physical examination tests to diagnose symptomatic knee osteoarthritis (SOA) compared with other knee disorders. This was a prospective diagnostic accuracy study, in which 279 consecutive patients consulting for a knee complaint were assessed. History elements and standardized physical examination tests were obtained independently by a physiotherapist and compared with an expert physician's composite diagnosis, including clinical examination and imaging. Recursive partitioning was used to develop diagnostic clusters for SOA. Diagnostic accuracy measures were calculated, including sensitivity, specificity, and positive and negative likelihood ratios (LR+/-), with associated 95% confidence intervals (CIs). A total of 129 patients had a diagnosis of SOA (46.2%). Most cases (76%) had combined tibiofemoral and patellofemoral knee OA and 63% had radiological Kellgren-Lawrence grades of 2 or 3. Different combinations of history elements and physical examination tests were used in clusters accurately to discriminate SOA from other knee disorders. These included age of patients, body mass index, presence of valgus/varus knee misalignment, palpable knee crepitus and limited passive knee extension. Two clusters to rule in SOA reached an LR+ of 13.6 (95% CI 6.5 to 28.4) and three clusters to rule out SOA reached an LR- of 0.11 (95% CI 0.06 to 0.20). Diagnostic clusters combining history elements and physical examination tests were able to support the differential diagnosis of SOA compared with various knee disorders without relying systematically on imaging. This could support primary care clinicians' role in the efficient management of these patients. Copyright © 2018 John Wiley & Sons, Ltd.

Diagnostic Performance of Wells Score Combined With Point-of-care Lung and Venous Ultrasound in Suspected Pulmonary Embolism.

PubMed

Nazerian, Peiman; Volpicelli, Giovanni; Gigli, Chiara; Becattini, Cecilia; Sferrazza Papa, Giuseppe Francesco; Grifoni, Stefano; Vanni, Simone

2017-03-01

Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated. We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators. Signs of deep venous thrombosis (DVT) at venous ultrasound and signs of pulmonary infarcts or alternative diagnoses at lung ultrasound were considered to recalculate two items of the Ws: signs and symptoms of DVT and alternative diagnosis less likely than PE. The diagnostic performances of the ultrasound-enhanced Ws (USWs) and Ws were then compared after confirmation of the final diagnosis. A total of 446 patients were studied. PE was confirmed in 125 patients (28%). USWs performed significantly better than Ws, with a sensitivity of 69.6% versus 57.6% and a specificity of 88.2% versus 68.2%. In combination with D-dimer, USWs showed an optimal failure rate (0.8%) and a significantly superior efficiency than Ws (32.3% vs. 27.2%). A strategy based on lung and venous ultrasound combined with D-dimer would allow to avoid CT pulmonary angiography in 50.5% of patients with suspected PE, compared to 27.2% when the rule without ultrasound is applied. A pretest risk stratification enhanced by ultrasound of lung and venous performs better than Ws in the early diagnostic process of PE. © 2016 by the Society for Academic Emergency Medicine.

Examining the Rule of Thumb of Not Using Multilevel Modeling: The "Design Effect Smaller than Two" Rule

ERIC Educational Resources Information Center

Lai, Mark H. C.; Kwok, Oi-man

2015-01-01

Educational researchers commonly use the rule of thumb of "design effect smaller than 2" as the justification of not accounting for the multilevel or clustered structure in their data. The rule, however, has not yet been systematically studied in previous research. In the present study, we generated data from three different models…

Negative and Positive Association Rules Mining from Text Using Frequent and Infrequent Itemsets

PubMed Central

Mahmood, Sajid; Shahbaz, Muhammad; Guergachi, Aziz

2014-01-01

Association rule mining research typically focuses on positive association rules (PARs), generated from frequently occurring itemsets. However, in recent years, there has been a significant research focused on finding interesting infrequent itemsets leading to the discovery of negative association rules (NARs). The discovery of infrequent itemsets is far more difficult than their counterparts, that is, frequent itemsets. These problems include infrequent itemsets discovery and generation of accurate NARs, and their huge number as compared with positive association rules. In medical science, for example, one is interested in factors which can either adjudicate the presence of a disease or write-off of its possibility. The vivid positive symptoms are often obvious; however, negative symptoms are subtler and more difficult to recognize and diagnose. In this paper, we propose an algorithm for discovering positive and negative association rules among frequent and infrequent itemsets. We identify associations among medications, symptoms, and laboratory results using state-of-the-art data mining technology. PMID:24955429

Natural frequencies facilitate diagnostic inferences of managers

PubMed Central

Hoffrage, Ulrich; Hafenbrädl, Sebastian; Bouquet, Cyril

2015-01-01

In Bayesian inference tasks, information about base rates as well as hit rate and false-alarm rate needs to be integrated according to Bayes’ rule after the result of a diagnostic test became known. Numerous studies have found that presenting information in a Bayesian inference task in terms of natural frequencies leads to better performance compared to variants with information presented in terms of probabilities or percentages. Natural frequencies are the tallies in a natural sample in which hit rate and false-alarm rate are not normalized with respect to base rates. The present research replicates the beneficial effect of natural frequencies with four tasks from the domain of management, and with management students as well as experienced executives as participants. The percentage of Bayesian responses was almost twice as high when information was presented in natural frequencies compared to a presentation in terms of percentages. In contrast to most tasks previously studied, the majority of numerical responses were lower than the Bayesian solutions. Having heard of Bayes’ rule prior to the study did not affect Bayesian performance. An implication of our work is that textbooks explaining Bayes’ rule should teach how to represent information in terms of natural frequencies instead of how to plug probabilities or percentages into a formula. PMID:26157397

[The drawbacks of diagnostic diligence].

PubMed

Giard, R W; Coebergh, J W

1998-10-03

More, earlier and better diagnostic work is being done nowadays, leasing to detection of abnormalities and preliminary stages that used to remain undetected; a large reservoir of subclinical disorders is found to exist. More intensive and sensitive diagnostic methods as a rule lead to higher disease prevalence figures, with the consequences of a seeming increase of disease risk, unnecessary further examinations, treatment and follow-up of individuals and overestimation of the effects of treatment. This may even start a vicious circle. More attention should be given to using diagnostic methods in such a way that the earlier and more frequent detection of disease actually profits the patient. The proof of this should be found in scientific (population) studies of the magnitude and severity of the burden of disease, the determinants of progression, the severity of abnormalities and diseases and the favourable effect of (early) treatment.

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis.

PubMed

Gans, Sarah L; Atema, Jasper J; van Dieren, Susan; Groot Koerkamp, Bas; Boermeester, Marja A

2015-07-01

Infectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge. A systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement. Twenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90% at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92-200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48-150): a pooled sensitivity of 86% (95% confidence interval (CI) 79-91%), specificity of 86% (95% CI 75-92%), and a positive predictive value of 64% (95% CI 49-77%). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001). Infectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on POD 3. This can aid patient selection for safe and early hospital discharge and prevent overuse of imaging.

A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study.

PubMed

Zuithoff, Nicolaas P A; Vergouwe, Yvonne; King, Michael; Nazareth, Irwin; Hak, Eelko; Moons, Karel G M; Geerlings, Mirjam I

2009-08-01

Major depressive disorder often remains unrecognized in primary care. Development of a clinical prediction rule using easily obtainable predictors for major depressive disorder in primary care patients. A total of 1046 subjects, aged 18-65 years, were included from seven large general practices in the center of The Netherlands. All subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. Major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Text Revision edition criteria was assessed with the Composite International Diagnostic Interview. Candidate predictors were gender, age, educational level, being single, number of presented complaints, presence of non-somatic complaints, whether a diagnosis was assigned, consultation rate in past 12 months, presentation of depressive complaints or prescription of antidepressants in past 12 months, number of life events in past 6 months and any history of depression. The first multivariable logistic regression model including only predictors that require no confronting depression-related questions had a reasonable degree of discrimination (area under the receiver operating characteristic curve or concordance-statistic (c-statistic) = 0.71; 95% Confidence Interval (CI): 0.67-0.76). Addition of three simple though more depression-related predictors, number of life events and history of depression, significantly increased the c-statistic to 0.80 (95% CI: 0.76-0.83). After transforming this second model to an easily to use risk score, the lowest risk category (sum score < 5) showed a 1% risk of depression, which increased to 49% in the highest category (sum score > or = 30). A clinical prediction rule allows GPs to identify patients-irrespective of their complaints-in whom diagnostic workup for major depressive disorder is indicated.

MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care.

PubMed

Monahan, Mark; Barton, Pelham; Taylor, Clare J; Roalfe, Andrea K; Hobbs, F D Richard; Cowie, Martin; Davis, Russell; Deeks, Jon; Mant, Jonathan; McCahon, Deborah; McDonagh, Theresa; Sutton, George; Tait, Lynda

2017-08-15

Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Design space exploration for early identification of yield limiting patterns

NASA Astrophysics Data System (ADS)

Li, Helen; Zou, Elain; Lee, Robben; Hong, Sid; Liu, Square; Wang, JinYan; Du, Chunshan; Zhang, Recco; Madkour, Kareem; Ali, Hussein; Hsu, Danny; Kabeel, Aliaa; ElManhawy, Wael; Kwan, Joe

2016-03-01

In order to resolve the causality dilemma of which comes first, accurate design rules or real designs, this paper presents a flow for exploration of the layout design space to early identify problematic patterns that will negatively affect the yield. A new random layout generating method called Layout Schema Generator (LSG) is reported in this paper, this method generates realistic design-like layouts without any design rule violation. Lithography simulation is then used on the generated layout to discover the potentially problematic patterns (hotspots). These hotspot patterns are further explored by randomly inducing feature and context variations to these identified hotspots through a flow called Hotspot variation Flow (HSV). Simulation is then performed on these expanded set of layout clips to further identify more problematic patterns. These patterns are then classified into design forbidden patterns that should be included in the design rule checker and legal patterns that need better handling in the RET recipes and processes.

Intrusion detection using secure signatures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, Trent Darnel; Haile, Jedediah

A method and device for intrusion detection using secure signatures comprising capturing network data. A search hash value, value employing at least one one-way function, is generated from the captured network data using a first hash function. The presence of a search hash value match in a secure signature table comprising search hash values and an encrypted rule is determined. After determining a search hash value match, a decryption key is generated from the captured network data using a second hash function, a hash function different form the first hash function. One or more of the encrypted rules of themore » secure signatures table having a hash value equal to the generated search hash value are then decrypted using the generated decryption key. The one or more decrypted secure signature rules are then processed for a match and one or more user notifications are deployed if a match is identified.« less

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews.

PubMed

Petersen, Tom; Laslett, Mark; Juhl, Carsten

2017-05-12

Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.

What is an ROC curve?

PubMed

Hoo, Zhe Hui; Candlish, Jane; Teare, Dawn

2017-06-01

The paper by Body et al is concerned with the evaluation of decision aids, which can be used to identify potential acute coronary syndromes (ACS) in the ED. The authors previously developed the Manchester Acute Coronary Syndromes model (MACS) decision aid, which uses several clinical variables and two biomarkers to 'rule in' and 'rule out' ACS. However, one of the two biomarkers (heart-type fatty acid bindingprotein, H-FABP) is not widely used so a revised decision aid has been developed (Troponin-only Manchester Acute Coronary Syndromes, T-MACS), which include a single biomarker hs-cTnT. In this issue, the authors show how they derive a revised decision aid and describe its performance in a number of independent diagnostic cohort studies. Decision aids (as well as other types of 'diagnostic tests') are often evaluated in terms of diagnostic testing parameters such as the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. In this article, we explain how the ROC analysis is conducted and why it is an essential step towards developing a test with the desirable levels of sensitivity and specificity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Diagnostic ion filtering to characterize ginseng saponins by rapid liquid chromatography with time-of-flight mass spectrometry.

PubMed

Qi, Lian-Wen; Wang, Huai-You; Zhang, Hui; Wang, Chong-Zhi; Li, Ping; Yuan, Chun-Su

2012-03-23

As one of the most commonly used medicinal plants, ginseng has been an attractive model herb for study. A wide range of analytical methods has been used to characterize its constituents. However, less effort has been devoted to the rare ginseng saponins, especially their isomers and sugar linkages. In this study, we used segmental monitoring and diagnostic ion filtering to characterize ginseng saponins by rapid liquid chromatography with time-of-flight mass spectrometry (LC-TOF-MS). By using selected diagnostic ions, specific groups of ginseng saponins were readily extracted from the complicated matrix. 20(R) and 20(S) stereo-saponins were differentiated using the peak abundance ratio of [M-H(2)O+H](+) to [M-2H(2)O+H](+). The fragmentation behavior of ginsenosides was first reported in negative ion mode by MS/MS with high-energy collision-induced dissociation, producing rules to determine sugar numbers, positions and linkages. Using the rules, we identified and compared the nontarget ginseng saponin profiling of raw and steamed American ginseng roots and berries. We characterized 70 saponins in the samples. Our strategy can be extended to screen and characterize other rare ginseng saponins and their metabolites. Copyright © 2012 Elsevier B.V. All rights reserved.

Enhancements to the Engine Data Interpretation System (EDIS)

NASA Technical Reports Server (NTRS)

Hofmann, Martin O.

1993-01-01

The Engine Data Interpretation System (EDIS) expert system project assists the data review personnel at NASA/MSFC in performing post-test data analysis and engine diagnosis of the Space Shuttle Main Engine (SSME). EDIS uses knowledge of the engine, its components, and simple thermodynamic principles instead of, and in addition to, heuristic rules gathered from the engine experts. EDIS reasons in cooperation with human experts, following roughly the pattern of logic exhibited by human experts. EDIS concentrates on steady-state static faults, such as small leaks, and component degradations, such as pump efficiencies. The objective of this contract was to complete the set of engine component models, integrate heuristic rules into EDIS, integrate the Power Balance Model into EDIS, and investigate modification of the qualitative reasoning mechanisms to allow 'fuzzy' value classification. The results of this contract is an operational version of EDIS. EDIS will become a module of the Post-Test Diagnostic System (PTDS) and will, in this context, provide system-level diagnostic capabilities which integrate component-specific findings provided by other modules.

Enhancements to the Engine Data Interpretation System (EDIS)

NASA Technical Reports Server (NTRS)

Hofmann, Martin O.

1993-01-01

The Engine Data Interpretation System (EDIS) expert system project assists the data review personnel at NASA/MSFC in performing post-test data analysis and engine diagnosis of the Space Shuttle Main Engine (SSME). EDIS uses knowledge of the engine, its components, and simple thermodynamic principles instead of, and in addition to, heuristic rules gathered from the engine experts. EDIS reasons in cooperation with human experts, following roughly the pattern of logic exhibited by human experts. EDIS concentrates on steady-state static faults, such as small leaks, and component degradations, such as pump efficiencies. The objective of this contract was to complete the set of engine component models, integrate heuristic rules into EDIS, integrate the Power Balance Model into EDIS, and investigate modification of the qualitative reasoning mechanisms to allow 'fuzzy' value classification. The result of this contract is an operational version of EDIS. EDIS will become a module of the Post-Test Diagnostic System (PTDS) and will, in this context, provide system-level diagnostic capabilities which integrate component-specific findings provided by other modules.

Guidelines in preparing computer-generated plots for NASA technical reports with the LaRC graphics output system

NASA Technical Reports Server (NTRS)

Taylor, N. L.

1983-01-01

To response to a need for improved computer-generated plots that are acceptable to the Langley publication process, the LaRC Graphics Output System has been modified to encompass the publication requirements, and a guideline has been established. This guideline deals only with the publication requirements of computer-generated plots. This report explains the capability that authors of NASA technical reports can use to obtain publication--quality computer-generated plots or the Langley publication process. The rules applied in developing this guideline and examples illustrating the rules are included.

NCEP Data Products

Science.gov Websites

Image of NCEP Logo WHERE AMERICA'S CLIMATE AND WEATHER SERVICES BEGIN Inventory of Data Products on Generated Products Image of horizontal rule Global Forecast System (GFS) GFS Ensemble Forecast System (GEFS of horizontal rule External Products Image of horizontal rule Canadian Ensemble Forecast System

Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability

PubMed Central

McGinn, Thomas; Jervis, Ramiro; Wisnivesky, Juan; Keitz, Sheri

2008-01-01

Background Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. Educational Objectives In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. Pilot Testing We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. Conclusion Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice. PMID:18491194

EPA Sets Rules on Hazardous Wastes.

ERIC Educational Resources Information Center

Smith, R. Jeffrey

1980-01-01

Announces the final rules published by the Environmental Protection Agency requiring that generators, transporters, and disposers of hazardous wastes report exactly where the wastes will be taken. (Author/SA)

An architecture for the development of real-time fault diagnosis systems using model-based reasoning

NASA Technical Reports Server (NTRS)

Hall, Gardiner A.; Schuetzle, James; Lavallee, David; Gupta, Uday

1992-01-01

Presented here is an architecture for implementing real-time telemetry based diagnostic systems using model-based reasoning. First, we describe Paragon, a knowledge acquisition tool for offline entry and validation of physical system models. Paragon provides domain experts with a structured editing capability to capture the physical component's structure, behavior, and causal relationships. We next describe the architecture of the run time diagnostic system. The diagnostic system, written entirely in Ada, uses the behavioral model developed offline by Paragon to simulate expected component states as reflected in the telemetry stream. The diagnostic algorithm traces causal relationships contained within the model to isolate system faults. Since the diagnostic process relies exclusively on the behavioral model and is implemented without the use of heuristic rules, it can be used to isolate unpredicted faults in a wide variety of systems. Finally, we discuss the implementation of a prototype system constructed using this technique for diagnosing faults in a science instrument. The prototype demonstrates the use of model-based reasoning to develop maintainable systems with greater diagnostic capabilities at a lower cost.

Male and Female Administrative Potential--Is There a Difference?

ERIC Educational Resources Information Center

Arons, Elizabeth Levin

1980-01-01

A diagnostic administrative style test administered to 98 candidates for administrative positions revealed no significant differences between men and women; the most frequent style for both was the "separated" style characterized by low task orientation, low relationship orientation, attention to rules, conscientiousness, and desire for…

The Addictive Personality Is the Behavior of the Addict.

ERIC Educational Resources Information Center

Nathan, Peter E.

1988-01-01

Childhood and adolescent antisocial behavior has been identified as a precursor of alcoholism. Research suggests that substantial numbers of abusers meet Diagnostic and Statistical Manual of Mental Disorders criteria for antisocial personality disorder and depression, behaviors symptomatic, respectively, of a disregard for society's rules and of…

Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis.

PubMed

Kelder, Johannes C; Cowie, Martin R; McDonagh, Theresa A; Hardman, Suzanna M C; Grobbee, Diederick E; Cost, Bernard; Hoes, Arno W

2011-06-01

Diagnosing early stages of heart failure with mild symptoms is difficult. B-type natriuretic peptide (BNP) has promising biochemical test characteristics, but its diagnostic yield on top of readily available diagnostic knowledge has not been sufficiently quantified in early stages of heart failure. To quantify the added diagnostic value of BNP for the diagnosis of heart failure in a population relevant to GPs and validate the findings in an independent primary care patient population. Individual patient data meta-analysis followed by external validation. The additional diagnostic yield of BNP above standard clinical information was compared with ECG and chest x-ray results. Derivation was performed on two existing datasets from Hillingdon (n=127) and Rotterdam (n=149) while the UK Natriuretic Peptide Study (n=306) served as validation dataset. Included were patients with suspected heart failure referred to a rapid-access diagnostic outpatient clinic. Case definition was according to the ESC guideline. Logistic regression was used to assess discrimination (with the c-statistic) and calibration. Of the 276 patients in the derivation set, 30.8% had heart failure. The clinical model (encompassing age, gender, known coronary artery disease, diabetes, orthopnoea, elevated jugular venous pressure, crackles, pitting oedema and S3 gallop) had a c-statistic of 0.79. Adding, respectively, chest x-ray results, ECG results or BNP to the clinical model increased the c-statistic to 0.84, 0.85 and 0.92. Neither ECG nor chest x-ray added significantly to the 'clinical plus BNP' model. All models had adequate calibration. The 'clinical plus BNP' diagnostic model performed well in an independent cohort with comparable inclusion criteria (c-statistic=0.91 and adequate calibration). Using separate cut-off values for 'ruling in' (typically implying referral for echocardiography) and for 'ruling out' heart failure--creating a grey zone--resulted in insufficient proportions of patients with a correct diagnosis. BNP has considerable diagnostic value in addition to signs and symptoms in patients suspected of heart failure in primary care. However, using BNP alone with the currently recommended cut-off levels is not sufficient to make a reliable diagnosis of heart failure.

Designing adaptive operating rules for a large multi-purpose reservoir

NASA Astrophysics Data System (ADS)

Geressu, Robel; Rougé, Charles; Harou, Julien

2017-04-01

Reservoirs whose live storage capacity is large compared with annual inflow have "memory", i.e., their storage levels contain information about past inflows and reservoir operations. Such "long-memory" reservoirs can be found in basins in dry regions such as the Nile River Basin in Africa, the Colorado River Basin in the US, or river basins in Western and Central Asia. There the effects of a dry year have the potential to impact reservoir levels and downstream releases for several subsequent years, prompting tensions in transboundary basins. Yet, current reservoir operation rules in those reservoirs do not reflect this by integrating past climate history and release decisions among the factors that influence operating decisions. This work proposes and demonstrates an adaptive reservoir operating rule that explicitly accounts for the recent history of release decisions, and not only current storage level and near-term inflow forecasts. This implies adding long-term (e.g., multiyear) objectives to the existing short-term (e.g., annual) ones. We apply these operating rules to the Grand Ethiopian Renaissance Dam, a large reservoir under construction on the Blue Nile River. Energy generation has to be balanced with the imperative of releasing enough water in low flow years (e.g., the minimum 1, 2 or 3 year cumulative flow) to avoid tensions with downstream countries, Sudan and Egypt. Maximizing the minimum multi-year releases could be of interest for the Nile problem to minimize the impact on performance of the large High Aswan Dam in Egypt. Objectives include maximizing the average and minimum annual energy generation and maximizing the minimum annual, two year and three year cumulative releases. The system model is tested using 30 stochastically generated streamflow series. One can then derive adaptive release rules depending on the value of one- and two-year total releases with respect to thresholds. Then, there are 3 sets of release rules for the reservoir depending on whether one or both thresholds are not met, vs. only one with a non-adaptive rule. Multi-objective evolutionary algorithms (MOEAs) are used to obtain the Pareto front, i.e., non-dominated adaptive and non-adaptive operating rule sets. Implementing adaptive rules is found to improve the trade-offs between energy generation criteria and minimum release targets. Compared with non-adaptive operations, an adaptive operating policy shows an increase of around 3 and 10 Billion cubic meters in the minimum 1 and 3-year cumulative releases for a given value of the same average annual energy generation.

Impact of flow routing on catchment area calculations, slope estimates, and numerical simulations of landscape development

NASA Astrophysics Data System (ADS)

Shelef, Eitan; Hilley, George E.

2013-12-01

Flow routing across real or modeled topography determines the modeled discharge and wetness index and thus plays a central role in predicting surface lowering rate, runoff generation, likelihood of slope failure, and transition from hillslope to channel forming processes. In this contribution, we compare commonly used flow-routing rules as well as a new routing rule, to commonly used benchmarks. We also compare results for different routing rules using Airborne Laser Swath Mapping (ALSM) topography to explore the impact of different flow-routing schemes on inferring the generation of saturation overland flow and the transition between hillslope to channel forming processes, as well as on location of saturation overland flow. Finally, we examined the impact of flow-routing and slope-calculation rules on modeled topography produced by Geomorphic Transport Law (GTL)-based simulations. We found that different rules produce substantive differences in the structure of the modeled topography and flow patterns over ALSM data. Our results highlight the impact of flow-routing and slope-calculation rules on modeled topography, as well as on calculated geomorphic metrics across real landscapes. As such, studies that use a variety of routing rules to analyze and simulate topography are necessary to determine those aspects that most strongly depend on a chosen routing rule.

High Level Rule Modeling Language for Airline Crew Pairing

NASA Astrophysics Data System (ADS)

Mutlu, Erdal; Birbil, Ş. Ilker; Bülbül, Kerem; Yenigün, Hüsnü

2011-09-01

The crew pairing problem is an airline optimization problem where a set of least costly pairings (consecutive flights to be flown by a single crew) that covers every flight in a given flight network is sought. A pairing is defined by using a very complex set of feasibility rules imposed by international and national regulatory agencies, and also by the airline itself. The cost of a pairing is also defined by using complicated rules. When an optimization engine generates a sequence of flights from a given flight network, it has to check all these feasibility rules to ensure whether the sequence forms a valid pairing. Likewise, the engine needs to calculate the cost of the pairing by using certain rules. However, the rules used for checking the feasibility and calculating the costs are usually not static. Furthermore, the airline companies carry out what-if-type analyses through testing several alternate scenarios in each planning period. Therefore, embedding the implementation of feasibility checking and cost calculation rules into the source code of the optimization engine is not a practical approach. In this work, a high level language called ARUS is introduced for describing the feasibility and cost calculation rules. A compiler for ARUS is also implemented in this work to generate a dynamic link library to be used by crew pairing optimization engines.

21 CFR 892.1760 - Diagnostic x-ray tube housing assembly.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Diagnostic x-ray tube housing assembly. 892.1760... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1760 Diagnostic x-ray tube housing assembly. (a) Identification. A diagnostic x-ray tube housing assembly is an x-ray generating tube encased...

21 CFR 892.1760 - Diagnostic x-ray tube housing assembly.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Diagnostic x-ray tube housing assembly. 892.1760... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1760 Diagnostic x-ray tube housing assembly. (a) Identification. A diagnostic x-ray tube housing assembly is an x-ray generating tube encased...

21 CFR 892.1760 - Diagnostic x-ray tube housing assembly.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Diagnostic x-ray tube housing assembly. 892.1760... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1760 Diagnostic x-ray tube housing assembly. (a) Identification. A diagnostic x-ray tube housing assembly is an x-ray generating tube encased...

21 CFR 892.1760 - Diagnostic x-ray tube housing assembly.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Diagnostic x-ray tube housing assembly. 892.1760... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1760 Diagnostic x-ray tube housing assembly. (a) Identification. A diagnostic x-ray tube housing assembly is an x-ray generating tube encased...

21 CFR 892.1760 - Diagnostic x-ray tube housing assembly.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Diagnostic x-ray tube housing assembly. 892.1760... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1760 Diagnostic x-ray tube housing assembly. (a) Identification. A diagnostic x-ray tube housing assembly is an x-ray generating tube encased...

Imaging in conjunction with physical therapy in management of a patient with history of thoracic tumour

PubMed Central

Rendeiro, Daniel G.; Deyle, Gail D.; Boissonnault, William G.

2015-01-01

Background: Physical therapy care for musculoskeletal conditions includes an ongoing process that systematically considers and prioritises diagnostic hypotheses. These diagnostic hypotheses include those that are typical for common musculoskeletal conditions, and must also include more rare conditions that would require care outside the scope of practice of the physical therapist. When additional screening is required, physical therapists collaborate with other providers or directly order the appropriate tests to rule out suspected pathology. Case Description: This article illustrates the use of musculoskeletal imaging ordered by a physical therapist to guide ongoing management of a patient with back pain and a history of cancer. Outcomes: The patient successfully returned to moderate-intensity sport activities after a course of physical therapy. Discussion: This case provides an example of how clinical diagnostic reasoning combined with clinical privileges to order musculoskeletal imaging can facilitate diagnostic accuracy in a timely and cost-efficient manner. PMID:26309382

Using economy of means to evolve transition rules within 2D cellular automata.

PubMed

Ripps, David L

2010-01-01

Running a cellular automaton (CA) on a rectangular lattice is a time-honored method for studying artificial life on a digital computer. Commonly, the researcher wishes to investigate some specific or general mode of behavior, say, the ability of a coherent pattern of points to glide within the lattice, or to generate copies of itself. This technique has a problem: how to design the transitions table-the set of distinct rules that specify the next content of a cell from its current content and that of its near neighbors. Often the table is painstakingly designed manually, rule by rule. The problem is exacerbated by the potentially vast number of individual rules that need be specified to cover all combinations of center and neighbors when there are several symbols in the alphabet of the CA. In this article a method is presented to have the set of rules evolve automatically while running the CA. The transition table is initially empty, with rules being added as the need arises. A novel principle drives the evolution: maximum economy of means-maximizing the reuse of rules introduced on previous cycles. This method may not be a panacea applicable to all CA studies. Nevertheless, it is sufficiently potent to evolve sets of rules and associated patterns of points that glide (periodically regenerate themselves at another location) and to generate gliding "children" that then "mate" by collision.

[SCAN system--semi-structured interview based on diagnostic criteria].

PubMed

Adamowski, Tomasz; Kiejna, Andrzej; Hadryś, Tomasz

2006-01-01

This paper presents the main features of contemporary diagnostic systems which are implemented into the SCAN--modern and semi-structured diagnostic interview. The concepts of further development of the classifications, rationale for operationalized diagnostic criteria and for the divisional approach to mental diagnoses will be in focus. The structure and components of SCAN ver. 2.1 (WHO), i.e. Present State Examination--10th edition, Item Group Checklist, Clinical History Schedule, Glossary of Definitions and computer software with the diagnostic algorithm: I-Shell, as well as rules for a reliable use of diagnostic rating scales, will be discussed within the scope of this paper. The materials and training sets necessary for the learning of proper use of the SCAN, especially training sets for SCAN Training Centers and the Reference Manual--a form of guidebook for SCAN shall be introduced. Finally the paper will present evidence that SCAN is an instrument feasible in different cultural settings. Reliability and validity data of SCAN will also be dealt with indicating that SCAN could be widely used in research studies as well as in everyday clinical practice facilitating more detailed diagnostic approach to a patient.

Resolving Task Rule Incongruence during Task Switching by Competitor Rule Suppression

ERIC Educational Resources Information Center

Meiran, Nachshon; Hsieh, Shulan; Dimov, Eduard

2010-01-01

Task switching requires maintaining readiness to execute any task of a given set of tasks. However, when tasks switch, the readiness to execute the now-irrelevant task generates interference, as seen in the task rule incongruence effect. Overcoming such interference requires fine-tuned inhibition that impairs task readiness only minimally. In an…

Impact of Rule Accuracy on Productivity and Rumor in an Organizational Analog

ERIC Educational Resources Information Center

Smith, Gregory S.; Houmanfar, Ramona; Denny, Melany

2012-01-01

This study examined the effects of inaccurate rules on generation of rumor among participants and their productivity in an organizational analog setting. Dyads of participants were given an explicit rule that described a contingency (i.e., number of points earned for correct responses). Experiments 1 and 2 utilized quasirandom and counterbalanced…

Design technology co-optimization for 14/10nm metal1 double patterning layer

NASA Astrophysics Data System (ADS)

Duan, Yingli; Su, Xiaojing; Chen, Ying; Su, Yajuan; Shao, Feng; Zhang, Recco; Lei, Junjiang; Wei, Yayi

2016-03-01

Design and technology co-optimization (DTCO) can satisfy the needs of the design, generate robust design rule, and avoid unfriendly patterns at the early stage of design to ensure a high level of manufacturability of the product by the technical capability of the present process. The DTCO methodology in this paper includes design rule translation, layout analysis, model validation, hotspots classification and design rule optimization mainly. The correlation of the DTCO and double patterning (DPT) can optimize the related design rule and generate friendlier layout which meets the requirement of the 14/10nm technology node. The experiment demonstrates the methodology of DPT-compliant DTCO which is applied to a metal1 layer from the 14/10nm node. The DTCO workflow proposed in our job is an efficient solution for optimizing the design rules for 14/10 nm tech node Metal1 layer. And the paper also discussed and did the verification about how to tune the design rule of the U-shape and L-shape structures in a DPT-aware metal layer.

Rule-based simulation models

NASA Technical Reports Server (NTRS)

Nieten, Joseph L.; Seraphine, Kathleen M.

1991-01-01

Procedural modeling systems, rule based modeling systems, and a method for converting a procedural model to a rule based model are described. Simulation models are used to represent real time engineering systems. A real time system can be represented by a set of equations or functions connected so that they perform in the same manner as the actual system. Most modeling system languages are based on FORTRAN or some other procedural language. Therefore, they must be enhanced with a reaction capability. Rule based systems are reactive by definition. Once the engineering system has been decomposed into a set of calculations using only basic algebraic unary operations, a knowledge network of calculations and functions can be constructed. The knowledge network required by a rule based system can be generated by a knowledge acquisition tool or a source level compiler. The compiler would take an existing model source file, a syntax template, and a symbol table and generate the knowledge network. Thus, existing procedural models can be translated and executed by a rule based system. Neural models can be provide the high capacity data manipulation required by the most complex real time models.

Periprosthetic infection: where do we stand with regard to Gram stain?

PubMed

Ghanem, Elie; Ketonis, Constantinos; Restrepo, Camilo; Joshi, Ashish; Barrack, Robert; Parvizi, Javad

2009-02-01

One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution. A positive gram stain was defined as the visualization of bacterial cells or "many neutrophils" (> 5 per high-power field) in the smear. The sensitivity, specificity, and predictive values of each individual diagnostic arm of Gram stain were determined. Combinations were performed in series, which required both tests to be positive to confirm infection, and also in parallel, which necessitated both tests to be negative to rule out infection. The presence of organisms and "many" neutrophils on a Gram smear had high specificity (98-100%) and positive predictive value (89-100%) in both THA and TKA. The sensitivities (30-50%) and negative predictive values (70-79%) of the 2 tests were low for both joint types. When the 2 tests were combined in series, the specificity and positive predictive value were absolute (100%). The sensitivity and the negative predictive value improved for both THA and TKA (43-64% and 82%, respectively). Although the 2 diagnostic arms of Gram staining can be combined to achieve improved negative predictive value (82%), Gram stain continues to have little value in ruling out PPI. With the advances in the field of molecular biology, novel diagnostic modalities need to be designed that can replace these traditional and poor tests.

A diagnostic prototype of the potable water subsystem of the Space Station Freedom ECLSS

NASA Technical Reports Server (NTRS)

Lukefahr, Brenda D.; Rochowiak, Daniel M.; Benson, Brian L.; Rogers, John S.; Mckee, James W.

1989-01-01

In analyzing the baseline Environmental Control and Life Support System (ECLSS) command and control architecture, various processes are found which would be enhanced by the use of knowledge based system methods of implementation. The most suitable process for prototyping using rule based methods are documented, while domain knowledge resources and other practical considerations are examined. Requirements for a prototype rule based software system are documented. These requirements reflect Space Station Freedom ECLSS software and hardware development efforts, and knowledge based system requirements. A quick prototype knowledge based system environment is researched and developed.

Automation based on knowledge modeling theory and its applications in engine diagnostic systems using Space Shuttle Main Engine vibrational data. M.S. Thesis

NASA Technical Reports Server (NTRS)

Kim, Jonnathan H.

1995-01-01

Humans can perform many complicated tasks without explicit rules. This inherent and advantageous capability becomes a hurdle when a task is to be automated. Modern computers and numerical calculations require explicit rules and discrete numerical values. In order to bridge the gap between human knowledge and automating tools, a knowledge model is proposed. Knowledge modeling techniques are discussed and utilized to automate a labor and time intensive task of detecting anomalous bearing wear patterns in the Space Shuttle Main Engine (SSME) High Pressure Oxygen Turbopump (HPOTP).

PO-07 - Excluding pulmonary embolism in cancer patients using the Wells rule and age-adjusted D-dimer testing: an individual patient data meta-analysis.

PubMed

van Es, N; van der Hulle, T; van Es, J; den Exter, P L; Douma, R A; Goekoop, R J; Mos, I C M; Garcia, J G; Kamphuisen, P W; Huisman, M V; Klok, F A; Büller, H R; Bossuyt, P M

2016-04-01

Among patients with clinically suspected pulmonary embolism (PE), imaging and anticoagulant treatment can be safely withheld in approximately one-third of patients based on the combination of a "PE unlikely" Wells score and a D-dimer below the age-adjusted threshold. The clinical utility of this diagnostic approach in cancer patients is less clear. To evaluate the efficiency and failure rate of the original and simplified Wells rules in combination with age-adjusted D-dimer testing in patients with active cancer. Individual patient data were used from 6 large prospective studies in which the diagnostic management of PE was guided by the original Wells rule and D-dimer testing. Study physicians classified patients as having active cancer if they had new, recurrent, or progressive cancer (excluding basal-cell or squamous-cell skin carcinoma), or cancer requiring treatment in the last 6 months. We evaluated the dichotomous Wells rule and its simplified version (Table). The efficiency of the algorithm was defined as the proportion of patients with a "PE unlikely" Wells score and a negative age-adjusted D-dimer, defined by a D-dimer below the threshold of a patient's age times 10 μg/L in patients aged ≥51 years. A diagnostic failure was defined as a patient with a "PE unlikely" Wells score and negative age-adjusted D-dimer who had symptomatic venous thromboembolism during 3 months follow-up. A one-stage random effects meta-analysis was performed to estimate the efficiency and failure. The dataset comprised 938 patients with active cancer with a mean age of 63 years. The most frequent cancer types were breast (13%), gastrointestinal tract (11%), and lung (8%). The type of cancer was not specified in 42%. The pooled PE prevalence was 29% (95% CI 25-32). PE could be excluded in 122 patients based on a "PE unlikely" Wells score and a negative age-adjusted D-dimer (efficiency 13%; 95% CI 11-15). Two of 122 patients were diagnosed with non-fatal symptomatic venous thromboembolism during follow-up (failure rate 1.5%; 95% CI 0.13-14.8). The simplified Wells score in combination with a negative age-adjusted D-dimer had an efficiency of 3.9% (95% CI 2.0-7.6) and a failure rate of 2.4% (95% CI 0.3-15). Among cancer patients with clinically suspected PE, imaging and anticoagulant treatment can be withheld in 1 out of every 8 patients by the original Wells rule and age-adjusted D-dimer testing. The simplified Wells rule was neither efficient nor safe in this population. © 2016 Elsevier Ltd. All rights reserved.

MATS E-Reporting Final Action

EPA Pesticide Factsheets

This page describes the interim final rule that will allow owners or operators of electric generating units to submit to EPA electronic emissions and compliance reports for the Mercury and Air Toxics rule.

Towards Verification of Operational Procedures Using Auto-Generated Diagnostic Trees

NASA Technical Reports Server (NTRS)

Kurtoglu, Tolga; Lutz, Robyn; Patterson-Hine, Ann

2009-01-01

The design, development, and operation of complex space, lunar and planetary exploration systems require the development of general procedures that describe a detailed set of instructions capturing how mission tasks are performed. For both crewed and uncrewed NASA systems, mission safety and the accomplishment of the scientific mission objectives are highly dependent on the correctness of procedures. In this paper, we describe how to use the auto-generated diagnostic trees from existing diagnostic models to improve the verification of standard operating procedures. Specifically, we introduce a systematic method, namely the Diagnostic Tree for Verification (DTV), developed with the goal of leveraging the information contained within auto-generated diagnostic trees in order to check the correctness of procedures, to streamline the procedures in terms of reducing the number of steps or use of resources in them, and to propose alternative procedural steps adaptive to changing operational conditions. The application of the DTV method to a spacecraft electrical power system shows the feasibility of the approach and its range of capabilities

Molecular Diagnosis and Biomarker Identification on SELDI proteomics data by ADTBoost method.

PubMed

Wang, Lu-Yong; Chakraborty, Amit; Comaniciu, Dorin

2005-01-01

Clinical proteomics is an emerging field that will have great impact on molecular diagnosis, identification of disease biomarkers, drug discovery and clinical trials in the post-genomic era. Protein profiling in tissues and fluids in disease and pathological control and other proteomics techniques will play an important role in molecular diagnosis with therapeutics and personalized healthcare. We introduced a new robust diagnostic method based on ADTboost algorithm, a novel algorithm in proteomics data analysis to improve classification accuracy. It generates classification rules, which are often smaller and easier to interpret. This method often gives most discriminative features, which can be utilized as biomarkers for diagnostic purpose. Also, it has a nice feature of providing a measure of prediction confidence. We carried out this method in amyotrophic lateral sclerosis (ALS) disease data acquired by surface enhanced laser-desorption/ionization-time-of-flight mass spectrometry (SELDI-TOF MS) experiments. Our method is shown to have outstanding prediction capacity through the cross-validation, ROC analysis results and comparative study. Our molecular diagnosis method provides an efficient way to distinguish ALS disease from neurological controls. The results are expressed in a simple and straightforward alternating decision tree format or conditional format. We identified most discriminative peaks in proteomic data, which can be utilized as biomarkers for diagnosis. It will have broad application in molecular diagnosis through proteomics data analysis and personalized medicine in this post-genomic era.

75 FR 45769 - Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Ambulatory...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... 2010 OPPS/ASC final rule, we estimated that pass-through spending for both drugs and biologicals and... pass through drugs and non-implantable biologicals, and device categories and the proportion of... and implantable biologicals), ``policy packaged'' drugs (diagnostic radiopharmaceuticals and contrast...

21 CFR 886.1655 - Ophthalmic Fresnel prism.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ophthalmic Fresnel prism. 886.1655 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1655 Ophthalmic Fresnel prism. (a) Identification. An ophthalmic Fresnel prism is a device that is a thin plastic sheet with embossed rulings which...

21 CFR 886.1655 - Ophthalmic Fresnel prism.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ophthalmic Fresnel prism. 886.1655 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1655 Ophthalmic Fresnel prism. (a) Identification. An ophthalmic Fresnel prism is a device that is a thin plastic sheet with embossed rulings which...

21 CFR 886.1655 - Ophthalmic Fresnel prism.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ophthalmic Fresnel prism. 886.1655 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1655 Ophthalmic Fresnel prism. (a) Identification. An ophthalmic Fresnel prism is a device that is a thin plastic sheet with embossed rulings which...

21 CFR 886.1655 - Ophthalmic Fresnel prism.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ophthalmic Fresnel prism. 886.1655 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1655 Ophthalmic Fresnel prism. (a) Identification. An ophthalmic Fresnel prism is a device that is a thin plastic sheet with embossed rulings which...

21 CFR 886.1655 - Ophthalmic Fresnel prism.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ophthalmic Fresnel prism. 886.1655 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1655 Ophthalmic Fresnel prism. (a) Identification. An ophthalmic Fresnel prism is a device that is a thin plastic sheet with embossed rulings which...

Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium.

ERIC Educational Resources Information Center

Gintner, Gary G.

1995-01-01

Examines three common disorders, dementia, depression, and delirium, which can be particularly difficult to diagnose in older adults. Presents three aspects that are helpful in making a decision: age-related differences, medical issues that need to be ruled out, and assessment methods particularly useful in the diagnostic process. (JPS)

Digamma diagnostics for the mixed-phase generation at NICA

NASA Astrophysics Data System (ADS)

Kukulin, V. I.; Platonova, M. N.

2017-03-01

A novel type of diagnostics for dense and/or hot nuclear matter produced in heavy-ion collisions at NICA and similar future colliders (FAIR, etc.) is suggested. The diagnostics is based on an assumption (confirmed in many experiments worldwide) about intensive generation of light scalar mesons (σ) the consequent decay of which produces γγ pairs with the mass and width dependent upon density and temperature of the fireball produced in the collision process. Thus, measurements of the absolute yield, mass and width of the γγ signal carry valuable information about the state of fireball generated during the high-energy nuclear collision.

C code generation from Petri-net-based logic controller specification

NASA Astrophysics Data System (ADS)

Grobelny, Michał; Grobelna, Iwona; Karatkevich, Andrei

2017-08-01

The article focuses on programming of logic controllers. It is important that a programming code of a logic controller is executed flawlessly according to the primary specification. In the presented approach we generate C code for an AVR microcontroller from a rule-based logical model of a control process derived from a control interpreted Petri net. The same logical model is also used for formal verification of the specification by means of the model checking technique. The proposed rule-based logical model and formal rules of transformation ensure that the obtained implementation is consistent with the already verified specification. The approach is validated by practical experiments.

A business model for diagnostic startups-a business model for a new generation of diagnostics companies.

PubMed

Kurtzman, Gary

2005-10-01

Venture capital has tended to shy away from diagnostics companies, whose products are not predicated on the blockbuster model of pharmaceuticals. But several new diagnostics companies are developing products that hold immense potential to improve healthcare delivery. Here's why venture investors should take another look at the diagnostics area.

Real-Time Diagnosis of Faults Using a Bank of Kalman Filters

NASA Technical Reports Server (NTRS)

Kobayashi, Takahisa; Simon, Donald L.

2006-01-01

A new robust method of automated real-time diagnosis of faults in an aircraft engine or a similar complex system involves the use of a bank of Kalman filters. In order to be highly reliable, a diagnostic system must be designed to account for the numerous failure conditions that an aircraft engine may encounter in operation. The method achieves this objective though the utilization of multiple Kalman filters, each of which is uniquely designed based on a specific failure hypothesis. A fault-detection-and-isolation (FDI) system, developed based on this method, is able to isolate faults in sensors and actuators while detecting component faults (abrupt degradation in engine component performance). By affording a capability for real-time identification of minor faults before they grow into major ones, the method promises to enhance safety and reduce operating costs. The robustness of this method is further enhanced by incorporating information regarding the aging condition of an engine. In general, real-time fault diagnostic methods use the nominal performance of a "healthy" new engine as a reference condition in the diagnostic process. Such an approach does not account for gradual changes in performance associated with aging of an otherwise healthy engine. By incorporating information on gradual, aging-related changes, the new method makes it possible to retain at least some of the sensitivity and accuracy needed to detect incipient faults while preventing false alarms that could result from erroneous interpretation of symptoms of aging as symptoms of failures. The figure schematically depicts an FDI system according to the new method. The FDI system is integrated with an engine, from which it accepts two sets of input signals: sensor readings and actuator commands. Two main parts of the FDI system are a bank of Kalman filters and a subsystem that implements FDI decision rules. Each Kalman filter is designed to detect a specific sensor or actuator fault. When a sensor or actuator fault occurs, large estimation errors are generated by all filters except the one using the correct hypothesis. By monitoring the residual output of each filter, the specific fault that has occurred can be detected and isolated on the basis of the decision rules. A set of parameters that indicate the performance of the engine components is estimated by the "correct" Kalman filter for use in detecting component faults. To reduce the loss of diagnostic accuracy and sensitivity in the face of aging, the FDI system accepts information from a steady-state-condition-monitoring system. This information is used to update the Kalman filters and a data bank of trim values representative of the current aging condition.

Adaptive Critic-based Neurofuzzy Controller for the Steam Generator Water Level

NASA Astrophysics Data System (ADS)

Fakhrazari, Amin; Boroushaki, Mehrdad

2008-06-01

In this paper, an adaptive critic-based neurofuzzy controller is presented for water level regulation of nuclear steam generators. The problem has been of great concern for many years as the steam generator is a highly nonlinear system showing inverse response dynamics especially at low operating power levels. Fuzzy critic-based learning is a reinforcement learning method based on dynamic programming. The only information available for the critic agent is the system feedback which is interpreted as the last action the controller has performed in the previous state. The signal produced by the critic agent is used alongside the backpropagation of error algorithm to tune online conclusion parts of the fuzzy inference rules. The critic agent here has a proportional-derivative structure and the fuzzy rule base has nine rules. The proposed controller shows satisfactory transient responses, disturbance rejection and robustness to model uncertainty. Its simple design procedure and structure, nominates it as one of the suitable controller designs for the steam generator water level control in nuclear power plant industry.

The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study.

PubMed

Rodrigues, Mark A; Samarasekera, Neshika; Lerpiniere, Christine; Humphreys, Catherine; McCarron, Mark O; White, Philip M; Nicoll, James A R; Sudlow, Cathie L M; Cordonnier, Charlotte; Wardlaw, Joanna M; Smith, Colin; Al-Shahi Salman, Rustam

2018-03-01

Identification of lobar spontaneous intracerebral haemorrhage associated with cerebral amyloid angiopathy (CAA) is important because it is associated with a higher risk of recurrent intracerebral haemorrhage than arteriolosclerosis-associated intracerebral haemorrhage. We aimed to develop a prediction model for the identification of CAA-associated lobar intracerebral haemorrhage using CT features and genotype. We identified adults with first-ever intracerebral haemorrhage diagnosed by CT, who died and underwent research autopsy as part of the Lothian IntraCerebral Haemorrhage, Pathology, Imaging and Neurological Outcome (LINCHPIN) study, a prospective, population-based, inception cohort. We determined APOE genotype and radiologists rated CT imaging appearances. Radiologists were not aware of clinical, genetic, and histopathological features. A neuropathologist rated brain tissue for small vessel diseases, including CAA, and was masked to clinical, radiographic, and genetic features. We used CT and APOE genotype data in a logistic regression model, which we internally validated using bootstrapping, to predict the risk of CAA-associated lobar intracerebral haemorrhage, derive diagnostic criteria, and estimate diagnostic accuracy. Among 110 adults (median age 83 years [IQR 76-87], 49 [45%] men) included in the LINCHPIN study between June 1, 2010 and Feb 10, 2016, intracerebral haemorrhage was lobar in 62 (56%) participants, deep in 41 (37%), and infratentorial in seven (6%). Of the 62 participants with lobar intracerebral haemorrhage, 36 (58%) were associated with moderate or severe CAA compared with 26 (42%) that were associated with absent or mild CAA, and were independently associated with subarachnoid haemorrhage (32 [89%] of 36 vs 11 [42%] of 26; p=0·014), intracerebral haemorrhage with finger-like projections (14 [39%] of 36 vs 0; p=0·043), and APOE ɛ4 possession (18 [50%] of 36 vs 2 [8%] of 26; p=0·0020). A prediction model for CAA-associated lobar intracerebral haemorrhage using these three variables had excellent discrimination (c statistic 0·92, 95% CI 0·86-0·98), confirmed by internal validation. For the rule-out criteria, neither subarachnoid haemorrhage nor APOE ɛ4 possession had 100% sensitivity (95% CI 88-100). For the rule-in criteria, subarachnoid haemorrhage and either APOE ɛ4 possession or finger-like projections had 96% specificity (95% CI 78-100). The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage. UK Medical Research Council, The Stroke Association, and The Wellcome Trust. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Small business development for molecular diagnostics.

PubMed

Anagostou, Anthanasia; Liotta, Lance A

2012-01-01

Molecular profiling, which is the application of molecular diagnostics technology to tissue and blood -specimens, is an integral element in the new era of molecular medicine and individualized therapy. Molecular diagnostics is a fertile ground for small business development because it can generate products that meet immediate demands in the health-care sector: (a) Detection of disease risk, or early-stage disease, with a higher specificity and sensitivity compared to previous testing methods, and (b) "Companion diagnostics" for stratifying patients to receive a treatment choice optimized to their individual disease. This chapter reviews the promise and challenges of business development in this field. Guidelines are provided for the creation of a business model and the generation of a marketing plan around a candidate molecular diagnostic product. Steps to commercialization are outlined using existing molecular diagnostics companies as learning examples.

Clinical Utility of Risk Models to Refer Patients with Adnexal Masses to Specialized Oncology Care: Multicenter External Validation Using Decision Curve Analysis.

PubMed

Wynants, Laure; Timmerman, Dirk; Verbakel, Jan Y; Testa, Antonia; Savelli, Luca; Fischerova, Daniela; Franchi, Dorella; Van Holsbeke, Caroline; Epstein, Elisabeth; Froyman, Wouter; Guerriero, Stefano; Rossi, Alberto; Fruscio, Robert; Leone, Francesco Pg; Bourne, Tom; Valentin, Lil; Van Calster, Ben

2017-09-01

Purpose: To evaluate the utility of preoperative diagnostic models for ovarian cancer based on ultrasound and/or biomarkers for referring patients to specialized oncology care. The investigated models were RMI, ROMA, and 3 models from the International Ovarian Tumor Analysis (IOTA) group [LR2, ADNEX, and the Simple Rules risk score (SRRisk)]. Experimental Design: A secondary analysis of prospectively collected data from 2 cross-sectional cohort studies was performed to externally validate diagnostic models. A total of 2,763 patients (2,403 in dataset 1 and 360 in dataset 2) from 18 centers (11 oncology centers and 7 nononcology hospitals) in 6 countries participated. Excised tissue was histologically classified as benign or malignant. The clinical utility of the preoperative diagnostic models was assessed with net benefit (NB) at a range of risk thresholds (5%-50% risk of malignancy) to refer patients to specialized oncology care. We visualized results with decision curves and generated bootstrap confidence intervals. Results: The prevalence of malignancy was 41% in dataset 1 and 40% in dataset 2. For thresholds up to 10% to 15%, RMI and ROMA had a lower NB than referring all patients. SRRisks and ADNEX demonstrated the highest NB. At a threshold of 20%, the NBs of ADNEX, SRrisks, and RMI were 0.348, 0.350, and 0.270, respectively. Results by menopausal status and type of center (oncology vs. nononcology) were similar. Conclusions: All tested IOTA methods, especially ADNEX and SRRisks, are clinically more useful than RMI and ROMA to select patients with adnexal masses for specialized oncology care. Clin Cancer Res; 23(17); 5082-90. ©2017 AACR . ©2017 American Association for Cancer Research.

Rule extraction from minimal neural networks for credit card screening.

PubMed

Setiono, Rudy; Baesens, Bart; Mues, Christophe

2011-08-01

While feedforward neural networks have been widely accepted as effective tools for solving classification problems, the issue of finding the best network architecture remains unresolved, particularly so in real-world problem settings. We address this issue in the context of credit card screening, where it is important to not only find a neural network with good predictive performance but also one that facilitates a clear explanation of how it produces its predictions. We show that minimal neural networks with as few as one hidden unit provide good predictive accuracy, while having the added advantage of making it easier to generate concise and comprehensible classification rules for the user. To further reduce model size, a novel approach is suggested in which network connections from the input units to this hidden unit are removed by a very straightaway pruning procedure. In terms of predictive accuracy, both the minimized neural networks and the rule sets generated from them are shown to compare favorably with other neural network based classifiers. The rules generated from the minimized neural networks are concise and thus easier to validate in a real-life setting.

"Smart inhibition": electrophysiological evidence for the suppression of conflict-generating task rules during task switching.

PubMed

Meiran, Nachshon; Hsieh, Shulan; Chang, Chi-Chih

2011-09-01

A major challenge for task switching is maintaining a balance between high task readiness and effectively ignoring irrelevant task rules. This calls for finely tuned inhibition that targets only the source of interference without adversely influencing other task-related representations. The authors show that irrelevant task rules generating response conflict are inhibited, causing their inefficient execution on the next trial (indicating the presence of competitor rule suppression[CRS];Meiran, Hsieh, & Dimov, Journal of Experimental Psychology: Learning, Memory and Cognition, 36, 992-1002, 2010). To determine whether CRS influences task rules, rather than target stimuli or responses, the authors focused on the processing of the task cue before the target stimulus was presented and before the response could be chosen. As was predicted, CRS was found in the event-related potentials in two time windows during task cue processing. It was also found in three time windows after target presentation. Source localization analyses suggest the involvement of the right dorsal prefrontal cortex in all five time windows.

Non-lightlike ruled surfaces with constant curvatures in Minkowski 3-space

NASA Astrophysics Data System (ADS)

Ali, Ahmad Tawfik

We study the non-lightlike ruled surfaces in Minkowski 3-space with non-lightlike base curve c(s) =∫(αt + βn + γb)ds, where t, n, b are the tangent, principal normal and binormal vectors of an arbitrary timelike curve Γ(s). Some important results of flat, minimal, II-minimal and II-flat non-lightlike ruled surfaces are studied. Finally, the following interesting theorem is proved: the only non-zero constant mean curvature (CMC) non-lightlike ruled surface is developable timelike ruled surface generated by binormal vector.

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis.

PubMed

Benabbas, Roshanak; Hanna, Mark; Shah, Jay; Sinert, Richard

2017-05-01

Acute appendicitis (AA) is the most common surgical emergency in children. Accurate and timely diagnosis is crucial but challenging due to atypical presentations and the inherent difficulty of obtaining a reliable history and physical examination in younger children. The aim of this study was to determine the utility of history, physical examination, laboratory tests, Pediatric Appendicitis Score (PAS) and Emergency Department Point-of-Care Ultrasound (ED-POCUS) in the diagnosis of AA in ED pediatric patients. We performed a systematic review and meta-analysis and used a test-treatment threshold model to identify diagnostic findings that could rule in/out AA and obviate the need for further imaging studies, specifically computed tomography (CT) scan, magnetic resonance imaging (MRI), and radiology department ultrasound (RUS). We searched PubMed, EMBASE, and SCOPUS up to October 2016 for studies on ED pediatric patients with abdominal pain. Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality and applicability of included studies. Positive and negative likelihood ratios (LR+ and LR-) for diagnostic modalities were calculated and when appropriate data was pooled using Meta-DiSc. Based on the available literature on the test characteristics of different imaging modalities and applying the Pauker-Kassirer method we developed a test-treatment threshold model. Twenty-one studies were included encompassing 8,605 patients with weighted AA prevalence of 39.2%. Studies had variable quality using the QUADAS-2 tool with most studies at high risk of partial verification bias. We divided studies based on their inclusion criteria into two groups of "undifferentiated abdominal pain" and abdominal pain "suspected of AA." In patients with undifferentiated abdominal pain, history of "pain migration to right lower quadrant (RLQ)" (LR+ = 4.81, 95% confidence interval [CI] = 3.59-6.44) and presence of "cough/hop pain" in the physical examination (LR+ = 7.64, 95% CI = 5.94-9.83) were most strongly associated with AA. In patients suspected of AA none of the history or laboratory findings were strongly associated with AA. Rovsing's sign was the physical examination finding most strongly associated with AA (LR+ = 3.52, 95% CI = 2.65-4.68). Among different PAS cutoff points, PAS ≥ 9 (LR+ = 5.26, 95% CI = 3.34-8.29) was most associated with AA. None of the history, physical examination, laboratory tests findings, or PAS alone could rule in or rule out AA in patients with undifferentiated abdominal pain or those suspected of AA. ED-POCUS had LR+ of 9.24 (95% CI = 6.24-13.28) and LR- of 0.17 (95% CI = 0.09-0.30). Using our test-treatment threshold model, positive ED-POCUS could rule in AA without the use of CT and MRI, but negative ED-POCUS could not rule out AA. Presence of AA is more likely in patients with undifferentiated abdominal pain migrating to the RLQ or when cough/hop pain is present in the physical examination. Once AA is suspected, no single history, physical examination, laboratory finding, or score attained on PAS can eliminate the need for imaging studies. Operating characteristics of ED-POCUS are similar to those reported for RUS in literature for diagnosis of AA. In ED patients suspected of AA, a positive ED-POCUS is diagnostic and obviates the need for CT or MRI while negative ED-POCUS is not enough to rule out AA. © 2017 by the Society for Academic Emergency Medicine.

An Interactive Decision Support System for Scheduling Fighter Pilot Training

DTIC Science & Technology

2002-03-26

Deitel , H.M. and Deitel , P.J. C: How to Program , 2nd ed., Prentice Hall, 1994. 8. Deitel , H.M. and Deitel , P.J. How to Program Java...Visual Basic Programming language, the Excel tool is modified in several ways. Scheduling Dispatch rules are implemented to automatically generate... programming language, the Excel tool was modified in several ways. Scheduling dispatch rules are implemented to automatically generate

Automated knowledge generation

NASA Technical Reports Server (NTRS)

Myler, Harley R.; Gonzalez, Avelino J.

1988-01-01

The general objectives of the NASA/UCF Automated Knowledge Generation Project were the development of an intelligent software system that could access CAD design data bases, interpret them, and generate a diagnostic knowledge base in the form of a system model. The initial area of concentration is in the diagnosis of the process control system using the Knowledge-based Autonomous Test Engineer (KATE) diagnostic system. A secondary objective was the study of general problems of automated knowledge generation. A prototype was developed, based on object-oriented language (Flavors).

microRNA Expression Profiling: Technologies, Insights, and Prospects.

PubMed

Roden, Christine; Mastriano, Stephen; Wang, Nayi; Lu, Jun

2015-01-01

Since the early days of microRNA (miRNA) research, miRNA expression profiling technologies have provided important tools toward both better understanding of the biological functions of miRNAs and using miRNA expression as potential diagnostics. Multiple technologies, such as microarrays, next-generation sequencing, bead-based detection system, single-molecule measurements, and quantitative RT-PCR, have enabled accurate quantification of miRNAs and the subsequent derivation of key insights into diverse biological processes. As a class of ~22 nt long small noncoding RNAs, miRNAs present unique challenges in expression profiling that require careful experimental design and data analyses. We will particularly discuss how normalization and the presence of miRNA isoforms can impact data interpretation. We will present one example in which the consideration in data normalization has provided insights that helped to establish the global miRNA expression as a tumor suppressor. Finally, we discuss two future prospects of using miRNA profiling technologies to understand single cell variability and derive new rules for the functions of miRNA isoforms.

Synthesis and characterization of attosecond light vortices in the extreme ultraviolet

PubMed Central

Géneaux, R.; Camper, A.; Auguste, T.; Gobert, O.; Caillat, J.; Taïeb, R.; Ruchon, T.

2016-01-01

Infrared and visible light beams carrying orbital angular momentum (OAM) are currently thoroughly studied for their extremely broad applicative prospects, among which are quantum information, micromachining and diagnostic tools. Here we extend these prospects, presenting a comprehensive study for the synthesis and full characterization of optical vortices carrying OAM in the extreme ultraviolet (XUV) domain. We confirm the upconversion rules of a femtosecond infrared helically phased beam into its high-order harmonics, showing that each harmonic order carries the total number of OAM units absorbed in the process up to very high orders (57). This allows us to synthesize and characterize helically shaped XUV trains of attosecond pulses. To demonstrate a typical use of these new XUV light beams, we show our ability to generate and control, through photoionization, attosecond electron beams carrying OAM. These breakthroughs pave the route for the study of a series of fundamental phenomena and the development of new ultrafast diagnosis tools using either photonic or electronic vortices. PMID:27573787

Synthesis and characterization of attosecond light vortices in the extreme ultraviolet

DOE PAGES

Géneaux, R.; Camper, A.; Auguste, T.; ...

2016-08-30

Infrared and visible light beams carrying orbital angular momentum (OAM) are currently thoroughly studied for their extremely broad applicative prospects, among which are quantum information, micromachining and diagnostic tools. Here we extend these prospects, presenting a comprehensive study for the synthesis and full characterization of optical vortices carrying OAM in the extreme ultraviolet (XUV) domain. We confirm the upconversion rules of a femtosecond infrared helically phased beam into its high-order harmonics, showing that each harmonic order carries the total number of OAM units absorbed in the process up to very high orders (57). This allows us to synthesize and characterizemore » helically shaped XUV trains of attosecond pulses. To demonstrate a typical use of these new XUV light beams, we show our ability to generate and control, through photoionization, attosecond electron beams carrying OAM. Furthermore, these breakthroughs pave the route for the study of a series of fundamental phenomena and the development of new ultrafast diagnosis tools using either photonic or electronic vortices.« less

Breakthrough Invasive Mold Infections in the Hematology Patient: Current Concepts and Future Directions.

PubMed

Lionakis, Michail S; Lewis, Russell E; Kontoyiannis, Dimitrios P

2018-05-31

Although the widespread use of mold-active agents (especially the new-generation of triazoles) has resulted in reductions of documented invasive mold infections (IMIs) in patients with hematological malignancies and allogeneic hematopoietic stem cell transplantation (HSCT), a subset of such patients still develop breakthrough IMIs (bIMIs). There are no data from prospective randomized clinical trials to guide therapeutic decisions in the different scenarios of bIMIs. In this viewpoint, we present the current status of our understanding of the clinical, diagnostic and treatment challenges of bIMIs in high-risk adult patients with hematological cancer and/or HSCT receiving mold-active antifungals and outline common clinical scenarios. As a rule, managing bIMIs demands an individualized treatment plan that takes into account the host, including co-morbidities, certainty of diagnosis and site of bIMIs, local epidemiology, considerations for fungal resistance, and antifungal pharmacological properties. Finally, we highlight areas that require future investigation in this complex area of clinical mycology.

75 FR 12321 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-15

...-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule Change by New York Stock Exchange LLC To Adopt a Reservation Fee for Next Generation Trading Floor Booth Space March 8... Rule 19b-4 thereunder,\\3\\ notice is hereby given that on March 4, 2010, New York Stock Exchange LLC...

40 CFR Appendix A to Part 55 - Listing of State and Local Requirements Incorporated by Reference Into Part 55, by State

Code of Federal Regulations, 2011 CFR

2011-07-01

... Prohibitions (Revised 12/6/76) Rule 405 Nitrogen Oxides Emission Standards, Limitations and Prohibitions... (Adopted 7/12/94) Rule 427 Marine Tanker Loading (Adopted 4/26/95) Rule 429 Oxides of Nitrogen and Carbon... Nitrogen from Industrial, Institutional, Commercial Boilers, Steam Generators, and Process Heaters (Adopted...

Aqui y Alla (Here and There) Information-Based Learning Corridors between Tennessee and Puerto Rico: The Five Golden Rules in Intercultural Education

ERIC Educational Resources Information Center

Mehra, Bharat; Allard, Suzie; Qayyum, M. Asim; Barclay-McLaughlin, Gina

2008-01-01

This article proposes five information-based Golden Rules in intercultural education that represent a holistic approach to creating learning corridors across geographically dispersed academic communities. The Golden Rules are generated through qualitative analysis, grounded theory application, reflective practice, and critical research to…

French Regulatory practice and experience feedback on steam generator tube integrity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sandon, G.

1997-02-01

This paper summarizes the way the French Safety Authority applies regulatory rules and practices to the problem of steam generator tube cracking in French PWR reactors. There are 54 reactors providing 80% of French electrical consumption. The Safety Authority closely monitors the performance of tubes in steam generators, and requires application of a program which deals with problems prior to the actual development of leakage. The actual rules regarding such performance are flexible, responding to the overall performance of operating steam generators. In addition there is an inservice inspection service to examine tubes during shutdown, and to monitor steam generatorsmore » for leakage during operation, with guidelines for when generators must be pulled off line.« less

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

PubMed

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population.

PubMed

Ellenbogen, Amy L; Rice, Amy L; Vyas, Pranav

2017-09-01

A recent multicenter prospective Canadian study presented prospective evidence supporting the Low Risk Ankle Rules (LRAR) as a means of reducing the number of ankle radiographs ordered for children presenting with an ankle injury while maintaining nearly 100% sensitivity. This is in contrast to a previous prospective study which showed that this rule yielded only 87% sensitivity. It is important to further investigate the LRAR and compare them with the already validated Ottawa Ankle Rules (OAR) to potentially curb healthcare costs and decrease unnecessary radiation exposure without compromising diagnostic accuracy. We conducted a retrospective chart review of 980 qualifying patients ages 12months to 18years presenting with ankle injury to a commonly staffed 310 bed children's hospital and auxiliary site pediatric emergency department. There were 28 high-risk fractures identified. The Ottawa Ankle Rules had a sensitivity of 100% (95% CI 87.7-100), specificity of 33.1% (95% CI 30.1-36.2), and would have reduced the number of ankle radiographs ordered by 32.1%. The Low Risk Ankle Rules had a sensitivity of 85.7% (95% CI 85.7-96), specificity of 64.9% (95% CI 61.8-68), and would have reduced the number of ankle radiographs ordered by 63.1%. The latter rule missed 4 high-risk fractures. The Low Risk Ankle Rules may not be sensitive enough for use in Pediatric Emergency Departments, while the Ottawa Ankle Rules again demonstrated 100% sensitivity. Further research on ways to implement the Ottawa Ankle Rules and maximize its ability to decrease wait times, healthcare costs, and improve patient satisfaction are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

A Business Model for Diagnostic Startups-A Business Model for a New Generation Of Diagnostics Companies

PubMed Central

Kurtzman, Gary

2005-01-01

Venture capital has tended to shy away from diagnostics companies, whose products are not predicated on the blockbuster model of pharmaceuticals. But several new diagnostics companies are developing products that hold immense potential to improve healthcare delivery. Here’s why venture investors should take another look at the diagnostics area. PMID:23424311

Plenoptic Imaging for Three-Dimensional Particle Field Diagnostics.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guildenbecher, Daniel Robert; Hall, Elise Munz

2017-06-01

Plenoptic imaging is a promising emerging technology for single-camera, 3D diagnostics of particle fields. In this work, recent developments towards quantitative measurements of particle size, positions, and velocities are discussed. First, the technique is proven viable with measurements of the particle field generated by the impact of a water drop on a thin film of water. Next, well cont rolled experiments are used to verify diagnostic uncertainty. Finally, an example is presented of 3D plenoptic imaging of a laboratory scale, explosively generated fragment field.

RuleMonkey: software for stochastic simulation of rule-based models

PubMed Central

2010-01-01

Background The system-level dynamics of many molecular interactions, particularly protein-protein interactions, can be conveniently represented using reaction rules, which can be specified using model-specification languages, such as the BioNetGen language (BNGL). A set of rules implicitly defines a (bio)chemical reaction network. The reaction network implied by a set of rules is often very large, and as a result, generation of the network implied by rules tends to be computationally expensive. Moreover, the cost of many commonly used methods for simulating network dynamics is a function of network size. Together these factors have limited application of the rule-based modeling approach. Recently, several methods for simulating rule-based models have been developed that avoid the expensive step of network generation. The cost of these "network-free" simulation methods is independent of the number of reactions implied by rules. Software implementing such methods is now needed for the simulation and analysis of rule-based models of biochemical systems. Results Here, we present a software tool called RuleMonkey, which implements a network-free method for simulation of rule-based models that is similar to Gillespie's method. The method is suitable for rule-based models that can be encoded in BNGL, including models with rules that have global application conditions, such as rules for intramolecular association reactions. In addition, the method is rejection free, unlike other network-free methods that introduce null events, i.e., steps in the simulation procedure that do not change the state of the reaction system being simulated. We verify that RuleMonkey produces correct simulation results, and we compare its performance against DYNSTOC, another BNGL-compliant tool for network-free simulation of rule-based models. We also compare RuleMonkey against problem-specific codes implementing network-free simulation methods. Conclusions RuleMonkey enables the simulation of rule-based models for which the underlying reaction networks are large. It is typically faster than DYNSTOC for benchmark problems that we have examined. RuleMonkey is freely available as a stand-alone application http://public.tgen.org/rulemonkey. It is also available as a simulation engine within GetBonNie, a web-based environment for building, analyzing and sharing rule-based models. PMID:20673321

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pin, F.G.

Sensor-based operation of autonomous robots in unstructured and/or outdoor environments has revealed to be an extremely challenging problem, mainly because of the difficulties encountered when attempting to represent the many uncertainties which are always present in the real world. These uncertainties are primarily due to sensor imprecisions and unpredictability of the environment, i.e., lack of full knowledge of the environment characteristics and dynamics. An approach. which we have named the {open_quotes}Fuzzy Behaviorist Approach{close_quotes} (FBA) is proposed in an attempt to remedy some of these difficulties. This approach is based on the representation of the system`s uncertainties using Fuzzy Set Theory-basedmore » approximations and on the representation of the reasoning and control schemes as sets of elemental behaviors. Using the FBA, a formalism for rule base development and an automated generator of fuzzy rules have been developed. This automated system can automatically construct the set of membership functions corresponding to fuzzy behaviors. Once these have been expressed in qualitative terms by the user. The system also checks for completeness of the rule base and for non-redundancy of the rules (which has traditionally been a major hurdle in rule base development). Two major conceptual features, the suppression and inhibition mechanisms which allow to express a dominance between behaviors are discussed in detail. Some experimental results obtained with the automated fuzzy, rule generator applied to the domain of sensor-based navigation in aprion unknown environments. using one of our autonomous test-bed robots as well as a real car in outdoor environments, are then reviewed and discussed to illustrate the feasibility of large-scale automatic fuzzy rule generation using the {open_quotes}Fuzzy Behaviorist{close_quotes} concepts.« less

How to make stripes: deciphering the transition from non-periodic to periodic patterns in Drosophila segmentation

PubMed Central

Schroeder, Mark D.; Greer, Christina; Gaul, Ulrike

2011-01-01

The generation of metameric body plans is a key process in development. In Drosophila segmentation, periodicity is established rapidly through the complex transcriptional regulation of the pair-rule genes. The ‘primary’ pair-rule genes generate their 7-stripe expression through stripe-specific cis-regulatory elements controlled by the preceding non-periodic maternal and gap gene patterns, whereas ‘secondary’ pair-rule genes are thought to rely on 7-stripe elements that read off the already periodic primary pair-rule patterns. Using a combination of computational and experimental approaches, we have conducted a comprehensive systems-level examination of the regulatory architecture underlying pair-rule stripe formation. We find that runt (run), fushi tarazu (ftz) and odd skipped (odd) establish most of their pattern through stripe-specific elements, arguing for a reclassification of ftz and odd as primary pair-rule genes. In the case of run, we observe long-range cis-regulation across multiple intervening genes. The 7-stripe elements of run, ftz and odd are active concurrently with the stripe-specific elements, indicating that maternal/gap-mediated control and pair-rule gene cross-regulation are closely integrated. Stripe-specific elements fall into three distinct classes based on their principal repressive gap factor input; stripe positions along the gap gradients correlate with the strength of predicted input. The prevalence of cis-elements that generate two stripes and their genomic organization suggest that single-stripe elements arose by splitting and subfunctionalization of ancestral dual-stripe elements. Overall, our study provides a greatly improved understanding of how periodic patterns are established in the Drosophila embryo. PMID:21693522

Medical Area Body Network. Final rule.

PubMed

2012-09-11

This document expands the Commission's Medical Device Radiocommunications Service (MedRadio) rules to permit the development of new Medical Body Area Network (MBAN) devices in the 2360-2400 MHz band. The MBAN technology will provide a flexible platform for the wireless networking of multiple body transmitters used for the purpose of measuring and recording physiological parameters and other patient information or for performing diagnostic or therapeutic functions, primarily in health care facilities. This platform will enhance patient safety, care and comfort by reducing the need to physically connect sensors to essential monitoring equipment by cables and wires. This decision is the latest in a series of actions to expand the spectrum available for wireless medical use. The Commission finds that the risk of increased interference is minimal and is greatly outweighed by the benefits of the MBAN rules.

Induction for Radiology Patients

NASA Astrophysics Data System (ADS)

Yıldırım, Pınar; Tolun, Mehmet R.

This paper represents the implementation of an inductive learning algorithm for patients of Radiology Department in Hacettepe University hospitals to discover the relationship between patient demographics information and time that patients spend during a specific radiology exam. ILA has been used for the implementation which generates rules and the results are evaluated by evaluation metrics. According to generated rules, some patients in different age groups or birthplaces may spend more time for the same radiology exam than the others.

Knowledge-based reasoning in the Paladin tactical decision generation system

NASA Technical Reports Server (NTRS)

Chappell, Alan R.

1993-01-01

A real-time tactical decision generation system for air combat engagements, Paladin, has been developed. A pilot's job in air combat includes tasks that are largely symbolic. These symbolic tasks are generally performed through the application of experience and training (i.e. knowledge) gathered over years of flying a fighter aircraft. Two such tasks, situation assessment and throttle control, are identified and broken out in Paladin to be handled by specialized knowledge based systems. Knowledge pertaining to these tasks is encoded into rule-bases to provide the foundation for decisions. Paladin uses a custom built inference engine and a partitioned rule-base structure to give these symbolic results in real-time. This paper provides an overview of knowledge-based reasoning systems as a subset of rule-based systems. The knowledge used by Paladin in generating results as well as the system design for real-time execution is discussed.

Failure detection system design methodology. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Chow, E. Y.

1980-01-01

The design of a failure detection and identification system consists of designing a robust residual generation process and a high performance decision making process. The design of these two processes are examined separately. Residual generation is based on analytical redundancy. Redundancy relations that are insensitive to modelling errors and noise effects are important for designing robust residual generation processes. The characterization of the concept of analytical redundancy in terms of a generalized parity space provides a framework in which a systematic approach to the determination of robust redundancy relations are developed. The Bayesian approach is adopted for the design of high performance decision processes. The FDI decision problem is formulated as a Bayes sequential decision problem. Since the optimal decision rule is incomputable, a methodology for designing suboptimal rules is proposed. A numerical algorithm is developed to facilitate the design and performance evaluation of suboptimal rules.

The “Silent Dog” Method: Analyzing the Impact of Self-Generated Rules When Teaching Different Computer Chains to Boys with Autism

PubMed Central

Arntzen, Erik; Halstadtro, Lill-Beathe; Halstadtro, Monica

2009-01-01

The purpose of the study was to extend the literature on verbal self-regulation by using the “silent dog” method to evaluate the role of verbal regulation over nonverbal behavior in 2 individuals with autism. Participants were required to talk-aloud while performing functional computer tasks.Then the effects of distracters with increasing demands on target behavior were evaluated as well as whether self-talk emitted by Participant 1 could be used to alter Participant 2's performance. Results suggest that participants' tasks seemed to be under control of self-instructions, and the rules generated from Participants 1's self-talk were effective in teaching computer skills to Participant 2. The silent dog method was useful in evaluating the possible role of self-generated rules in teaching computer skills to participants with autism. PMID:22477428

The "silent dog" method: analyzing the impact of self-generated rules when teaching different computer chains to boys with autism.

PubMed

Arntzen, Erik; Halstadtro, Lill-Beathe; Halstadtro, Monica

2009-01-01

The purpose of the study was to extend the literature on verbal self-regulation by using the "silent dog" method to evaluate the role of verbal regulation over nonverbal behavior in 2 individuals with autism. Participants were required to talk-aloud while performing functional computer tasks.Then the effects of distracters with increasing demands on target behavior were evaluated as well as whether self-talk emitted by Participant 1 could be used to alter Participant 2's performance. Results suggest that participants' tasks seemed to be under control of self-instructions, and the rules generated from Participants 1's self-talk were effective in teaching computer skills to Participant 2. The silent dog method was useful in evaluating the possible role of self-generated rules in teaching computer skills to participants with autism.

Sonographic Diagnosis of Tubal Cancer with IOTA Simple Rules Plus Pattern Recognition

PubMed Central

Tongsong, Theera; Wanapirak, Chanane; Tantipalakorn, Charuwan; Tinnangwattana, Dangcheewan

2017-01-01

Objective: To evaluate diagnostic performance of IOTA simple rules plus pattern recognition in predicting tubal cancer. Methods: Secondary analysis was performed on prospective database of our IOTA project. The patients recruited in the project were those who were scheduled for pelvic surgery due to adnexal masses. The patients underwent ultrasound examinations within 24 hours before surgery. On ultrasound examination, the masses were evaluated using the well-established IOTA simple rules plus pattern recognition (sausage-shaped appearance, incomplete septum, visible ipsilateral ovaries) to predict tubal cancer. The gold standard diagnosis was based on histological findings or operative findings. Results: A total of 482 patients, including 15 cases of tubal cancer, were evaluated by ultrasound preoperatively. The IOTA simple rules plus pattern recognition gave a sensitivity of 86.7% (13 in 15) and specificity of 97.4%. Sausage-shaped appearance was identified in nearly all cases (14 in 15). Incomplete septa and normal ovaries could be identified in 33.3% and 40%, respectively. Conclusion: IOTA simple rules plus pattern recognition is relatively effective in predicting tubal cancer. Thus, we propose the simple scheme in diagnosis of tubal cancer as follows. First of all, the adnexal masses are evaluated with IOTA simple rules. If the B-rules could be applied, tubal cancer is reliably excluded. If the M-rules could be applied or the result is inconclusive, careful delineation of the mass with pattern recognition should be performed. PMID:29172273

Sonographic Diagnosis of Tubal Cancer with IOTA Simple Rules Plus Pattern Recognition

PubMed

Tongsong, Theera; Wanapirak, Chanane; Tantipalakorn, Charuwan; Tinnangwattana, Dangcheewan

2017-11-26

Objective: To evaluate diagnostic performance of IOTA simple rules plus pattern recognition in predicting tubal cancer. Methods: Secondary analysis was performed on prospective database of our IOTA project. The patients recruited in the project were those who were scheduled for pelvic surgery due to adnexal masses. The patients underwent ultrasound examinations within 24 hours before surgery. On ultrasound examination, the masses were evaluated using the well-established IOTA simple rules plus pattern recognition (sausage-shaped appearance, incomplete septum, visible ipsilateral ovaries) to predict tubal cancer. The gold standard diagnosis was based on histological findings or operative findings. Results: A total of 482 patients, including 15 cases of tubal cancer, were evaluated by ultrasound preoperatively. The IOTA simple rules plus pattern recognition gave a sensitivity of 86.7% (13 in 15) and specificity of 97.4%. Sausage-shaped appearance was identified in nearly all cases (14 in 15). Incomplete septa and normal ovaries could be identified in 33.3% and 40%, respectively. Conclusion: IOTA simple rules plus pattern recognition is relatively effective in predicting tubal cancer. Thus, we propose the simple scheme in diagnosis of tubal cancer as follows. First of all, the adnexal masses are evaluated with IOTA simple rules. If the B-rules could be applied, tubal cancer is reliably excluded. If the M-rules could be applied or the result is inconclusive, careful delineation of the mass with pattern recognition should be performed. Creative Commons Attribution License

78 FR 5346 - Approval and Promulgation of Air Quality Implementation Plans; Massachusetts and New Hampshire...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

...-FRL-9754-7] Approval and Promulgation of Air Quality Implementation Plans; Massachusetts and New... (EPA). ACTION: Proposed rule. SUMMARY: EPA is proposing to approve State Implementation Plan (SIP... repair network for an on-board diagnostic (OBD2) testing program for model year 1996 and newer vehicles...

Group Comparisons of Mathematics Performance from a Cognitive Diagnostic Perspective

ERIC Educational Resources Information Center

Chen, Yi-Hsin; Ferron, John M.; Thompson, Marilyn S.; Gorin, Joanna S.; Tatsuoka, Kikumi K.

2010-01-01

Traditional comparisons of test score means identify group differences in broad academic areas, but fail to provide substantive description of how the groups differ on the specific cognitive attributes required for success in the academic area. The rule space method (RSM) allows for group comparisons at the cognitive attribute level, which…

The spinal cord and its roots according to Galen.

PubMed

Viale, Giuseppe L

2004-06-01

Galen's methodological approach to medicine anticipated modern rules. His experiments on the spinal cord contributed greatly to our knowledge of this structure by reporting the variegated pattern of neurological impairment after sectioning at different levels. His approach to injuries of the spinal roots and peripheral nerves documents both diagnostic skill and intellectual honesty.

75 FR 76004 - Agency Information Collection Activities OMB Responses

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... without change. EPA ICR Number 1975.08; NESHAP for Stationary Reciprocating Internal Combustion Engines... Motor Vehicles (Proposed Rule); in 40 CFR parts 85, 86 and 600; OMB filed comment on 11/12/2010. EPA ICR... Duty Engines and Vehicles Equipped with On-Board Diagnostics (PR for Alt Fuel Conversion of Heavy-duty...

26 CFR 26.2642-3 - Special rule for charitable lead annuity trusts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Special rule for charitable lead annuity trusts. 26.2642-3 Section 26.2642-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES GENERATION-SKIPPING TRANSFER TAX REGULATIONS UNDER THE TAX REFORM ACT OF 1986 § 26.2642-3 Special rule for...

[Myocardial infarction. New universal definition and its implementation in clinical practice].

PubMed

Vafaie, M; Katus, H A

2013-12-01

The third version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. The diagnosis of acute myocardial infarction (AMI) should only be made in a clinical setting consistent with acute myocardial ischaemia when evidence of myocardial necrosis is present. The diagnostic criteria for MI are fulfilled when a rise and/or fall of cardiac biomarkers (preferentially troponins) occurs with at least one value above the 99th percentile of the upper reference limit. In addition, there should be symptoms of ischaemia, new changes in electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormality, or the identification of an intracoronary thrombus by angiography or autopsy. This revised definition updates previous versions by including changes to diagnostic ECG criteria, placing a higher emphasis on cardiac imaging, modifying the criteria for subtypes of MI and implementing high sensitivity cardiac troponin (cTn) assays. A guideline-based algorithm for management of patients with suspected acute coronary syndrome allowing "early rule-in" and "rule-out" of non-STEMI with high sensitivity cTn assays is also presented.

Communication skills in diagnostic pathology.

PubMed

Lehr, Hans-Anton; Bosman, Fred T

2016-01-01

Communication is an essential element of good medical practice also in pathology. In contrast to technical or diagnostic skills, communication skills are not easy to define, teach, or assess. Rules almost do not exist. In this paper, which has a rather personal character and cannot be taken as a set of guidelines, important aspects of communication in pathology are explored. This includes what should be communicated to the pathologist on the pathology request form, communication between pathologists during internal (interpathologist) consultation, communication around frozen section diagnoses, modalities of communication of a final diagnosis, with whom and how critical and unexpected findings should be communicated, (in-)adequate routes of communication for pathology diagnoses, who will (or might) receive pathology reports, and what should be communicated and how in case of an error or a technical problem. An earlier more formal description of what the responsibilities are of a pathologist as communicator and as collaborator in a medical team is added in separate tables. The intention of the paper is to stimulate reflection and discussion rather than to formulate strict rules.

Hamilton's rule and the causes of social evolution

PubMed Central

Bourke, Andrew F. G.

2014-01-01

Hamilton's rule is a central theorem of inclusive fitness (kin selection) theory and predicts that social behaviour evolves under specific combinations of relatedness, benefit and cost. This review provides evidence for Hamilton's rule by presenting novel syntheses of results from two kinds of study in diverse taxa, including cooperatively breeding birds and mammals and eusocial insects. These are, first, studies that empirically parametrize Hamilton's rule in natural populations and, second, comparative phylogenetic analyses of the genetic, life-history and ecological correlates of sociality. Studies parametrizing Hamilton's rule are not rare and demonstrate quantitatively that (i) altruism (net loss of direct fitness) occurs even when sociality is facultative, (ii) in most cases, altruism is under positive selection via indirect fitness benefits that exceed direct fitness costs and (iii) social behaviour commonly generates indirect benefits by enhancing the productivity or survivorship of kin. Comparative phylogenetic analyses show that cooperative breeding and eusociality are promoted by (i) high relatedness and monogamy and, potentially, by (ii) life-history factors facilitating family structure and high benefits of helping and (iii) ecological factors generating low costs of social behaviour. Overall, the focal studies strongly confirm the predictions of Hamilton's rule regarding conditions for social evolution and their causes. PMID:24686934

Hamilton's rule and the causes of social evolution.

PubMed

Bourke, Andrew F G

2014-05-19

Hamilton's rule is a central theorem of inclusive fitness (kin selection) theory and predicts that social behaviour evolves under specific combinations of relatedness, benefit and cost. This review provides evidence for Hamilton's rule by presenting novel syntheses of results from two kinds of study in diverse taxa, including cooperatively breeding birds and mammals and eusocial insects. These are, first, studies that empirically parametrize Hamilton's rule in natural populations and, second, comparative phylogenetic analyses of the genetic, life-history and ecological correlates of sociality. Studies parametrizing Hamilton's rule are not rare and demonstrate quantitatively that (i) altruism (net loss of direct fitness) occurs even when sociality is facultative, (ii) in most cases, altruism is under positive selection via indirect fitness benefits that exceed direct fitness costs and (iii) social behaviour commonly generates indirect benefits by enhancing the productivity or survivorship of kin. Comparative phylogenetic analyses show that cooperative breeding and eusociality are promoted by (i) high relatedness and monogamy and, potentially, by (ii) life-history factors facilitating family structure and high benefits of helping and (iii) ecological factors generating low costs of social behaviour. Overall, the focal studies strongly confirm the predictions of Hamilton's rule regarding conditions for social evolution and their causes.

Diagnostic Performance of (18)F-Fluorodeoxyglucose in 162 Small Pulmonary Nodules Incidentally Detected in Subjects Without a History of Malignancy.

PubMed

Calcagni, Maria Lucia; Taralli, Silvia; Cardillo, Giuseppe; Graziano, Paolo; Ialongo, Pasquale; Mattoli, Maria Vittoria; Di Franco, Davide; Caldarella, Carmelo; Carleo, Francesco; Indovina, Luca; Giordano, Alessandro

2016-04-01

Solitary pulmonary nodule (SPN) still represents a diagnostic challenge. The aim of our study was to evaluate the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography in one of the largest samples of small SPNs, incidentally detected in subjects without a history of malignancy (nonscreening population) and undetermined at computed tomography. One-hundred and sixty-two small (>0.8 to 1.5 cm) and, for comparison, 206 large nodules (>1.5 to 3 cm) were retrospectively evaluated. Diagnostic performance of (18)F-fluorodeoxyglucose visual analysis, receiver-operating characteristic (ROC) analysis for maximum standardized uptake value (SUVmax), and Bayesian analysis were assessed using histology or radiological follow-up as a golden standard. In 162 small nodules, (18)F-fluorodeoxyglucose visual and ROC analyses (SUVmax = 1.3) provided 72.6% and 77.4% sensitivity and 88.0% and 82.0% specificity, respectively. The prevalence of malignancy was 38%; Bayesian analysis provided 78.8% positive and 16.0% negative posttest probabilities of malignancy. In 206 large nodules (18)F-fluorodeoxyglucose visual and ROC analyses (SUVmax = 1.9) provided 89.5% and 85.1% sensitivity and 70.8% and 79.2% specificity, respectively. The prevalence of malignancy was 65%; Bayesian analysis provided 85.0% positive and 21.6% negative posttest probabilities of malignancy. In both groups, malignant nodules had a significant higher SUVmax (p < 0.0001) than benign nodules. Only in the small group, malignant nodules were significantly larger (p = 0.0054) than benign ones. (18)F-fluorodeoxyglucose can be clinically relevant to rule in and rule out malignancy in undetermined small SPNs, incidentally detected in nonscreening population with intermediate pretest probability of malignancy, as well as in larger ones. Visual analysis can be considered an optimal diagnostic criterion, adequately detecting a wide range of malignant nodules with different metabolic activity. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Prehospital lung ultrasound for the diagnosis of cardiogenic pulmonary oedema: a pilot study.

PubMed

Laursen, Christian B; Hänselmann, Anja; Posth, Stefan; Mikkelsen, Søren; Videbæk, Lars; Berg, Henrik

2016-08-02

An improved prehospital diagnostic accuracy of cardiogenic pulmonary oedema could potentially improve initial treatment, triage, and outcome. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema. A prospective observational study was conducted in a prehospital setting. Patients were included if the physician based prehospital mobile emergency care unit was activated and one or more of the following two were present: respiratory rate >30/min., oxygen saturation <90 %. Exclusion criteria were: age <18 years, permanent mental disability or PLUS causing a delay in life-saving treatment or transportation. Following clinical assessment PLUS was performed and presence or absence of interstitial syndrome was registered. Audit by three physicians using predefined diagnostic criteria for cardiogenic pulmonary oedema was used as gold standard. A total of 40 patients were included in the study. Feasibility of PLUS was 100 % and median time used was 3 min. The gold standard diagnosed 18 (45.0 %) patients with cardiogenic pulmonary oedema. The diagnostic accuracy of PLUS for the diagnosis of cardiogenic pulmonary oedema was: sensitivity 94.4 % (95 % confidence interval (CI) 72.7-99.9 %), specificity 77.3 % (95 % CI 54.6-92.2 %), positive predictive value 77.3 % (95 % CI 54.6-92.2 %), negative predictive value 94.4 % (95 % CI 72.7-99.9 %). The sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies. Performed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients with respiratory failure. Due to its diagnostic accuracy, PLUS may have potential as a prehospital tool, especially to rule out cardiogenic pulmonary oedema.

Fecal immunochemical test for predicting mucosal healing in ulcerative colitis patients: A systematic review and meta-analysis.

PubMed

Dai, Cong; Jiang, Min; Sun, Ming-Jun; Cao, Qin

2018-05-01

Fecal immunochemical test (FIT) is a promising marker for assessment of inflammatory bowel disease activity. However, the utility of FIT for predicting mucosal healing (MH) of ulcerative colitis (UC) patients has yet to be clearly demonstrated. The objective of our study was to perform a diagnostic test accuracy test meta-analysis evaluating the diagnostic accuracy of FIT in predicting MH of UC patients. We systematically searched the databases from inception to November 2017 that evaluated MH in UC. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Six studies comprising 625 UC patients were included in the meta-analysis. The pooled sensitivity and specificity values for predicting MH in UC were 0.77 (95% confidence interval [CI], 0.72-0.81) and 0.81 (95% CI, 0.76-0.85), respectively. The FIT level had a high rule-in value (positive likelihood ratio, 3.79; 95% CI, 2.85-5.03) and a moderate rule-out value (negative likelihood ratio, 0.26; 95% CI, 0.16-0.43) for predicting MH in UC. The results of the receiver operating characteristic curve analysis (area under the curve, 0.88; standard error of the mean, 0.02) and diagnostic odds ratio (18.08; 95% CI, 9.57-34.13) also revealed improved discrimination for identifying MH in UC with FIT concentration. Our meta-analysis has found that FIT is a simple, reliable non-invasive marker for predicting MH in UC patients. © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

PubMed

Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

2012-05-15

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

Mental disorders in battered women: an empirical study.

PubMed

Gleason, W J

1993-01-01

Prevalence of mental disorders in 62 battered women receiving services from a Florida battered woman agency was identified by means of a structured interview, the Diagnostic Interview Schedule. Of the total sample of battered women, 30 were in a shelter operated by the agency and 32 were living in their own homes and receiving assistance from the agency. Resultant diagnoses met diagnostic criteria developed in the Diagnostic and Statistical Manual (3rd. ed.) of the American Psychiatric Association. The Diagnostic Interview Schedule is a 263 item structured interview used in the National Institute of Mental Health Epidemiological Catchment Area program carried out in the early 1980s. The Diagnostic Interview Schedule permits the use of 10,953 females in the epidemiological study as a comparison group of normal women. Scoring of the interviews was done by a computer diagnostic program with absolute decision rules. Extremely high prevalence was found for psychosexual dysfunction, major depression, post traumatic stress disorder, generalized anxiety disorder, and obsessive compulsive disorder. These diagnoses appear to reflect the major components of the battered woman syndrome developed by Lenore Walker and the study approximates Walker's request for improved methodology in the research into the psychology of the battered woman.

Laser speckle and skin cancer: skin roughness assessment

NASA Astrophysics Data System (ADS)

Lee, Tim K.; Tchvialeva, Lioudmila; Zeng, Haishan; McLean, David I.; Lui, Harvey

2009-10-01

Incidence of skin cancer has been increasing rapidly since the last few decades. Non-invasive optical diagnostic tools may improve the diagnostic accuracy. In this paper, skin structure, skin cancer statistics and subtypes of skin cancer are briefly reviewed. Among the subtypes, malignant melanoma is the most aggressive and dangerous; early detection dramatically improves the prognosis. Therefore, a non-invasive diagnostic tool for malignant melanoma is especially needed. In addition, in order for the diagnostic tool to be useful, it must be able to differentiate melanoma from common skin conditions such as seborrheic keratosis, a benign skin disease that resembles melanoma according to the well known clinical-assessment ABCD rule. The key diagnostic feature between these two diseases is surface roughness. Based on laser speckle contrast, our research team has recently developed a portable, optical, non-invasive, in-vivo diagnostic device for quantifying skin surface roughness. The methodology of our technique is described in details. Examining the preliminary data collected in a pilot clinical study for the prototype, we found that there was a difference in roughness between melanoma and seborrheic keratosis. In fact, there was a perfect cutoff value for the two diseases based on our initial data.

Scalability of a Methodology for Generating Technical Trading Rules with GAPs Based on Risk-Return Adjustment and Incremental Training

NASA Astrophysics Data System (ADS)

de La Cal, E. A.; Fernández, E. M.; Quiroga, R.; Villar, J. R.; Sedano, J.

In previous works a methodology was defined, based on the design of a genetic algorithm GAP and an incremental training technique adapted to the learning of series of stock market values. The GAP technique consists in a fusion of GP and GA. The GAP algorithm implements the automatic search for crisp trading rules taking as objectives of the training both the optimization of the return obtained and the minimization of the assumed risk. Applying the proposed methodology, rules have been obtained for a period of eight years of the S&P500 index. The achieved adjustment of the relation return-risk has generated rules with returns very superior in the testing period to those obtained applying habitual methodologies and even clearly superior to Buy&Hold. This work probes that the proposed methodology is valid for different assets in a different market than previous work.

Optical Generation of Fuzzy-Based Rules

NASA Astrophysics Data System (ADS)

Gur, Eran; Mendlovic, David; Zalevsky, Zeev

2002-08-01

In the last third of the 20th century, fuzzy logic has risen from a mathematical concept to an applicable approach in soft computing. Today, fuzzy logic is used in control systems for various applications, such as washing machines, train-brake systems, automobile automatic gear, and so forth. The approach of optical implementation of fuzzy inferencing was given by the authors in previous papers, giving an extra emphasis to applications with two dominant inputs. In this paper the authors introduce a real-time optical rule generator for the dual-input fuzzy-inference engine. The paper briefly goes over the dual-input optical implementation of fuzzy-logic inferencing. Then, the concept of constructing a set of rules from given data is discussed. Next, the authors show ways to implement this procedure optically. The discussion is accompanied by an example that illustrates the transformation from raw data into fuzzy set rules.

Bibliography of Soviet Laser Developments, Number 58, March-April 1982.

DTIC Science & Technology

1983-05-01

generation and diagnostics . DD IA7 1473 EOITION OF I NOV A OSOLETE UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE (When Does Entered) Introduction...10 C. He-Kr............................................. 10 iv 2. Molecular Beam and lIon a. C02...104 K. Plasma Generation and Diagnostics ....................... 105 III. MONOGRAPHS, BOOKS, CONFERENCE PROCEEDINGS................... 113

Logic Learning Machine creates explicit and stable rules stratifying neuroblastoma patients

PubMed Central

2013-01-01

Background Neuroblastoma is the most common pediatric solid tumor. About fifty percent of high risk patients die despite treatment making the exploration of new and more effective strategies for improving stratification mandatory. Hypoxia is a condition of low oxygen tension occurring in poorly vascularized areas of the tumor associated with poor prognosis. We had previously defined a robust gene expression signature measuring the hypoxic component of neuroblastoma tumors (NB-hypo) which is a molecular risk factor. We wanted to develop a prognostic classifier of neuroblastoma patients' outcome blending existing knowledge on clinical and molecular risk factors with the prognostic NB-hypo signature. Furthermore, we were interested in classifiers outputting explicit rules that could be easily translated into the clinical setting. Results Shadow Clustering (SC) technique, which leads to final models called Logic Learning Machine (LLM), exhibits a good accuracy and promises to fulfill the aims of the work. We utilized this algorithm to classify NB-patients on the bases of the following risk factors: Age at diagnosis, INSS stage, MYCN amplification and NB-hypo. The algorithm generated explicit classification rules in good agreement with existing clinical knowledge. Through an iterative procedure we identified and removed from the dataset those examples which caused instability in the rules. This workflow generated a stable classifier very accurate in predicting good and poor outcome patients. The good performance of the classifier was validated in an independent dataset. NB-hypo was an important component of the rules with a strength similar to that of tumor staging. Conclusions The novelty of our work is to identify stability, explicit rules and blending of molecular and clinical risk factors as the key features to generate classification rules for NB patients to be conveyed to the clinic and to be used to design new therapies. We derived, through LLM, a set of four stable rules identifying a new class of poor outcome patients that could benefit from new therapies potentially targeting tumor hypoxia or its consequences. PMID:23815266

Logic Learning Machine creates explicit and stable rules stratifying neuroblastoma patients.

PubMed

Cangelosi, Davide; Blengio, Fabiola; Versteeg, Rogier; Eggert, Angelika; Garaventa, Alberto; Gambini, Claudio; Conte, Massimo; Eva, Alessandra; Muselli, Marco; Varesio, Luigi

2013-01-01

Neuroblastoma is the most common pediatric solid tumor. About fifty percent of high risk patients die despite treatment making the exploration of new and more effective strategies for improving stratification mandatory. Hypoxia is a condition of low oxygen tension occurring in poorly vascularized areas of the tumor associated with poor prognosis. We had previously defined a robust gene expression signature measuring the hypoxic component of neuroblastoma tumors (NB-hypo) which is a molecular risk factor. We wanted to develop a prognostic classifier of neuroblastoma patients' outcome blending existing knowledge on clinical and molecular risk factors with the prognostic NB-hypo signature. Furthermore, we were interested in classifiers outputting explicit rules that could be easily translated into the clinical setting. Shadow Clustering (SC) technique, which leads to final models called Logic Learning Machine (LLM), exhibits a good accuracy and promises to fulfill the aims of the work. We utilized this algorithm to classify NB-patients on the bases of the following risk factors: Age at diagnosis, INSS stage, MYCN amplification and NB-hypo. The algorithm generated explicit classification rules in good agreement with existing clinical knowledge. Through an iterative procedure we identified and removed from the dataset those examples which caused instability in the rules. This workflow generated a stable classifier very accurate in predicting good and poor outcome patients. The good performance of the classifier was validated in an independent dataset. NB-hypo was an important component of the rules with a strength similar to that of tumor staging. The novelty of our work is to identify stability, explicit rules and blending of molecular and clinical risk factors as the key features to generate classification rules for NB patients to be conveyed to the clinic and to be used to design new therapies. We derived, through LLM, a set of four stable rules identifying a new class of poor outcome patients that could benefit from new therapies potentially targeting tumor hypoxia or its consequences.

Precision medicine for cancer with next-generation functional diagnostics.

PubMed

Friedman, Adam A; Letai, Anthony; Fisher, David E; Flaherty, Keith T

2015-12-01

Precision medicine is about matching the right drugs to the right patients. Although this approach is technology agnostic, in cancer there is a tendency to make precision medicine synonymous with genomics. However, genome-based cancer therapeutic matching is limited by incomplete biological understanding of the relationship between phenotype and cancer genotype. This limitation can be addressed by functional testing of live patient tumour cells exposed to potential therapies. Recently, several 'next-generation' functional diagnostic technologies have been reported, including novel methods for tumour manipulation, molecularly precise assays of tumour responses and device-based in situ approaches; these address the limitations of the older generation of chemosensitivity tests. The promise of these new technologies suggests a future diagnostic strategy that integrates functional testing with next-generation sequencing and immunoprofiling to precisely match combination therapies to individual cancer patients.

The Buffer Diagnostic Prototype: A fault isolation application using CLIPS

NASA Technical Reports Server (NTRS)

Porter, Ken

1994-01-01

This paper describes problem domain characteristics and development experiences from using CLIPS 6.0 in a proof-of-concept troubleshooting application called the Buffer Diagnostic Prototype. The problem domain is a large digital communications subsystems called the real-time network (RTN), which was designed to upgrade the launch processing system used for shuttle support at KSC. The RTN enables up to 255 computers to share 50,000 data points with millisecond response times. The RTN's extensive built-in test capability but lack of any automatic fault isolation capability presents a unique opportunity for a diagnostic expert system application. The Buffer Diagnostic Prototype addresses RTN diagnosis with a multiple strategy approach. A novel technique called 'faulty causality' employs inexact qualitative models to process test results. Experimental knowledge provides a capability to recognize symptom-fault associations. The implementation utilizes rule-based and procedural programming techniques, including a goal-directed control structure and simple text-based generic user interface that may be reusable for other rapid prototyping applications. Although limited in scope, this project demonstrates a diagnostic approach that may be adapted to troubleshoot a broad range of equipment.

A report on the Academic Emergency Medicine 2015 consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization".

PubMed

Gunn, Martin L; Marin, Jennifer R; Mills, Angela M; Chong, Suzanne T; Froemming, Adam T; Johnson, Jamlik O; Kumaravel, Manickam; Sodickson, Aaron D

2016-08-01

In May 2015, the Academic Emergency Medicine consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization" was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use.

Periprosthetic infection: where do we stand with regard to Gram stain?

PubMed Central

Ghanem, Elie; Ketonis, Constantinos; Restrepo, Camilo; Joshi, Ashish; Barrack, Robert

2009-01-01

Background and purpose One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution. Materials and methods A positive gram stain was defined as the visualization of bacterial cells or “many neutrophils” (> 5 per high-power field) in the smear. The sensitivity, specificity, and predictive values of each individual diagnostic arm of Gram stain were determined. Combinations were performed in series, which required both tests to be positive to confirm infection, and also in parallel, which necessitated both tests to be negative to rule out infection. Results The presence of organisms and “many” neutrophils on a Gram smear had high specificity (98–100%) and positive predictive value (89–100%) in both THA and TKA. The sensitivities (30–50%) and negative predictive values (70–79%) of the 2 tests were low for both joint types. When the 2 tests were combined in series, the specificity and positive predictive value were absolute (100%). The sensitivity and the negative predictive value improved for both THA and TKA (43–64% and 82%, respectively). Interpretation Although the 2 diagnostic arms of Gram staining can be combined to achieve improved negative predictive value (82%), Gram stain continues to have little value in ruling out PPI. With the advances in the field of molecular biology, novel diagnostic modalities need to be designed that can replace these traditional and poor tests. PMID:19297787

Impact of delay in clinical presentation on the diagnostic management and prognosis of patients with suspected pulmonary embolism.

PubMed

den Exter, Paul L; van Es, Josien; Erkens, Petra M G; van Roosmalen, Mark J G; van den Hoven, Pim; Hovens, Marcel M C; Kamphuisen, Pieter W; Klok, Frederikus A; Huisman, Menno V

2013-06-15

The nonspecific clinical presentation of pulmonary embolism (PE) frequently leads to delay in its diagnosis. This study aimed to assess the impact of delay in presentation on the diagnostic management and clinical outcome of patients with suspected PE. In 4,044 consecutive patients with suspected PE, patients presenting more than 7 days from the onset of symptoms were contrasted with those presenting within 7 days as regards the safety of excluding PE on the basis of a clinical decision rule combined with D-dimer testing. Patients were followed for 3 months to assess the rates of recurrent venous thromboembolism and mortality. A delayed presentation (presentation >7 d) was present in 754 (18.6%) of the patients. The failure rate of an unlikely clinical probability and normal D-dimer test was 0.5% (95% confidence interval [CI], 0.01-2.7) for patients with and 0.5% (95% CI, 0.2-1.2) for those without diagnostic delay. D-dimer testing yielded a sensitivity of 99% (95% CI, 96-99%) and 98% (95% CI, 97-99%) in these groups, respectively. Patients with PE with diagnostic delay more frequently had centrally located PE (41% vs. 26%; P < 0.001). The cumulative rates of recurrent venous thromboembolism (4.6% vs. 2.7%; P = 0.14) and mortality (7.6% vs. 6.6%; P = 0.31) were not different for patients with and without delayed presentation. PE can be safely excluded based on a clinical decision rule and D-dimer testing in patients with a delayed clinical presentation. A delayed presentation for patients who survived acute PE was associated with a more central PE location, although this did not affect the clinical outcome at 3 months.

Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection.

PubMed

Nazerian, Peiman; Morello, Fulvio; Vanni, Simone; Bono, Alessia; Castelli, Matteo; Forno, Daniela; Gigli, Chiara; Soardo, Flavia; Carbone, Federica; Lupia, Enrico; Grifoni, Stefano

2014-07-15

Acute aortic dissection (AD) represents a diagnostic conundrum. Validated algorithms are particularly needed to identify patients where AD could be ruled out without aortic imaging. We evaluated the diagnostic accuracy of a strategy combining the aortic dissection detection (ADD) risk score with D-dimer, a sensitive biomarker of AD. Patients from two clinical centers with suspected AD were prospectively enrolled in a registry, from January 2008 to March 2013. The ADD risk score was calculated by retrospective blinded chart review. For D-dimer, a cutoff of 500 ng/ml was applied. AD was diagnosed in 233 of 1035 (22.5%) patients. The ADD risk score was 0 in 322 (31.1%), 1 in 508 (49.1%) and >1 in 205 (19.8%) patients. The sensitivity and the failure rate of D-dimer were 100% and 0% in patients with ADD score 0, versus 97.5% (95% CI 91.4-99.6%) and 4.2% (95% CI 0.7-12.5%) in patients with ADD risk score >1. In patients with ADD risk score ≤ 1, the sensitivity and the failure rate of D-dimer were 98.7% (95% CI 95.3-99.8%) and 0.8% (95% CI 0.1-2.6%). The diagnostic efficiency of D-dimer in patients with ADD risk score 0 and ≤ 1 was 8.9% (95% CI 7.2-10.7%) and 23.6% (95% CI 21.1-26.2%) respectively. In a large cohort of patients with suspected AD, the presence of ADD risk score 0 or ≤ 1 combined with a negative D-dimer accurately and efficiently ruled out AD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Improved DNA hybridization parameters by Twisted Intercalating Nucleic Acid (TINA).

PubMed

Schneider, Uffe Vest

2012-01-01

This thesis establishes oligonucleotide design rules and applications of a novel group of DNA stabilizing molecules collectively called Twisted Intercalating Nucleic Acid - TINA. Three peer-reviewed publications form the basis for the thesis. One publication describes an improved and rapid method for determination of DNA melting points and two publications describe the effects of positioning TINA molecules in parallel triplex helix and antiparallel duplex helix forming DNA structures. The third publication establishes that TINA molecules containing oligonucleotides improve an antiparallel duplex hybridization based capture assay's analytical sensitivity compared to conventionel DNA oligonucleotides. Clinical microbiology is traditionally based on pathogenic microorganisms' culture and serological tests. The introduction of DNA target amplification methods like PCR has improved the analytical sensitivity and total turn around time involved in clinical diagnostics of infections. Due to the relatively weak hybridization between the two strands of double stranded DNA, a number of nucleic acid stabilizing molecules have been developed to improve the sensitivity of DNA based diagnostics through superior binding properties. A short introduction is given to Watson-Crick and Hoogsteen based DNA binding and the derived DNA structures. A number of other nucleic acid stabilizing molecules are described. The stabilizing effect of TINA molecules on different DNA structures is discussed and considered in relation to other nucleic acid stabilizing molecules and in relation to future use of TINA containing oligonucleotides in clinical diagnostics and therapy. In conclusion, design of TINA modified oligonucleotides for antiparallel duplex helixes and parallel triplex helixes follows simple purpose dependent rules. TINA molecules are well suited for improving multiplex PCR assays and can be used as part of novel technologies. Future research should test whether combinations of TINA molecules and other nucleic acid stabilizing molecules can increase analytical sensitivity whilst maintaining nucleobase mismatch discrimination in triplex helix based diagnostic assays.

Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care.

PubMed

Bruins Slot, M H E; Rutten, F H; van der Heijden, G J M G; Doevendans, P A; Mast, E G; Bredero, A C; van der Spoel, O P; Glatz, J F C; Hoes, A W

2013-09-30

To determine the diagnostic accuracy of a rapid heart-type fatty acid-binding protein (H-FABP) test in patients suspected of acute coronary syndrome (ACS) in primary care. General practitioners included 298 patients suspected of ACS. In all patients, whether referred to hospital or not, ECG and cardiac biomarker testing was performed. ACS was determined in accordance with international guidelines. Multivariate analysis was used to determine the value of H-FABP in addition to clinical findings. Mean patient age was 66 years (SD 14), 52% was female and 66 patients (22%) were diagnosed with ACS. The H-FABP bedside test was performed within 24h (median 3.1, IQR 1.5 to 7.1) after symptom onset. The positive predictive value (PPV) of H-FABP was 65% (95% confidence interval (CI) 50-78). The negative predictive value (NPV) was 85% (95% CI 80-88). Sensitivity was 39% (29-51%) and specificity 94% (90-96%). Within 6h after symptom onset, the PPV was 72% (55-84) and the NPV was 83% (77-88), sensitivity 43% (31-57%) and specificity 94% (89-97%). Adding the H-FABP test to a diagnostic model for ACS led to an increase in the area under the receiver operating curve from 0.66 (95% CI 0.58-0.73) to 0.75 (95% CI 0.68-0.82). The H-FABP rapid test provides modest additional diagnostic certainty in primary care. It cannot be used to safely exclude rule out ACS. The test can only be used safely in patients otherwise NOT referred to hospital by the GP, as an extra precaution not to miss ACS ('rule in'). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Oppositional Defiant Disorder: prevalence based on parent and teacher ratings of Malaysian primary school children.

PubMed

Gomez, Rapson; Hafetz, Nina; Gomez, Rashika Miranjani

2013-08-01

This study examined the prevalence rate of Oppositional Defiant Disorder (ODD) in Malaysian primary school children. In all 934 Malaysian parents and teachers completed ratings of their children using a scale comprising DSM-IV-TR ODD symptoms. Results showed rates of 3.10%, 3.85%, 7.49% and 0.64% for parent, teacher, parent or teacher ("or-rule"), and parent and teacher ("and-rule") ratings, respectively. When the functional impairment criterion was not considered, the rate reported by parents was higher at 13.28%. The theoretical, diagnostic and cultural implications of the findings are discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

The development of causal reasoning.

PubMed

Kuhn, Deanna

2012-05-01

How do inference rules for causal learning themselves change developmentally? A model of the development of causal reasoning must address this question, as well as specify the inference rules. Here, the evidence for developmental changes in processes of causal reasoning is reviewed, with the distinction made between diagnostic causal inference and causal prediction. Also addressed is the paradox of a causal reasoning literature that highlights the competencies of young children and the proneness to error among adults. WIREs Cogn Sci 2012, 3:327-335. doi: 10.1002/wcs.1160 For further resources related to this article, please visit the WIREs website. Copyright © 2012 John Wiley & Sons, Ltd.

The Goldwater Rule: Perspectives From, and Implications for, Psychological Science.

PubMed

Lilienfeld, Scott O; Miller, Joshua D; Lynam, Donald R

2018-01-01

When, if ever, should psychological scientists be permitted to offer professional opinions concerning the mental health of public figures they have never directly examined? This contentious question, which attracted widespread public attention during the 1964 U.S. presidential election involving Barry Goldwater, received renewed scrutiny during and after the 2016 U.S. presidential campaign, when many mental health professionals raised pointed questions concerning the psychiatric status of Donald Trump. Although the Goldwater Rule prohibits psychiatrists from offering diagnostic opinions on individuals they have never examined, no comparable rule exists for psychologists. We contend that, owing largely to the Goldwater Rule's origins in psychiatry, a substantial body of psychological research on assessment and clinical judgment, including work on the questionable validity of unstructured interviews, the psychology of cognitive biases, and the validity of informant reports and of L (lifetime) data, has been overlooked in discussions of its merits. We conclude that although the Goldwater Rule may have been defensible several decades ago, it is outdated and premised on dubious scientific assumptions. We further contend that there are select cases in which psychological scientists with suitable expertise may harbor a "duty to inform," allowing them to offer informed opinions concerning public figures' mental health with appropriate caveats.

Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department.

PubMed

Bahrmann, Philipp; Bahrmann, Anke; Breithardt, Ole-A; Daniel, Werner G; Christ, Michael; Sieber, Cornel C; Bertsch, Thomas

2013-06-01

Identifying older patients with non-ST- elevation myocardial infarction (NSTEMI) within the very large proportion with elevated high-sensitive cardiac troponin T (hs-cTnT) is a diagnostic challenge because they often present without clear symptoms or electrocardiographic features of acute coronary syndrome to the emergency department (ED). We prospectively investigated the diagnostic and prognostic performance of copeptin ultra-sensitive (copeptin-us) and hs-cTnT compared to hs-cTnT alone for NSTEMI at prespecified cut-offs in unselected older patients. We consecutively enrolled 306 non-surgical patients ≥70 years presenting to the ED. In addition to clinical examination, copeptin-us and hs-cTnT were measured at admission. Two cardiologists independently adjudicated the final diagnosis of NSTEMI after reviewing all available data. All patients were followed up for cardiovascular-related death within the following 12 months. NSTEMI was diagnosed in 38 (12%) patients (age 81±6 years). The combination of copeptin-us ≥14 pmol/L and hs-cTnT ≥0.014 µg/L compared to hs-cTnT ≥0.014 µg/L alone had a positive predictive value of 21% vs. 19% to rule in NSTEMI. The combination of copeptin-us <14 pmol/L and hs-cTnT <0.014 µg/L compared to hs-cTnT <0.014 µg/L alone had a negative predictive value of 100% vs. 99% to rule out NSTEMI. Hs-cTnT ≥0.014 µg/L alone was significantly associated with outcome. When copeptin-us ≥14 pmol/L was added, the net reclassification improvement for outcome was not significant (p=0.809). In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

Automated diagnosis of coronary artery disease based on data mining and fuzzy modeling.

PubMed

Tsipouras, Markos G; Exarchos, Themis P; Fotiadis, Dimitrios I; Kotsia, Anna P; Vakalis, Konstantinos V; Naka, Katerina K; Michalis, Lampros K

2008-07-01

A fuzzy rule-based decision support system (DSS) is presented for the diagnosis of coronary artery disease (CAD). The system is automatically generated from an initial annotated dataset, using a four stage methodology: 1) induction of a decision tree from the data; 2) extraction of a set of rules from the decision tree, in disjunctive normal form and formulation of a crisp model; 3) transformation of the crisp set of rules into a fuzzy model; and 4) optimization of the parameters of the fuzzy model. The dataset used for the DSS generation and evaluation consists of 199 subjects, each one characterized by 19 features, including demographic and history data, as well as laboratory examinations. Tenfold cross validation is employed, and the average sensitivity and specificity obtained is 62% and 54%, respectively, using the set of rules extracted from the decision tree (first and second stages), while the average sensitivity and specificity increase to 80% and 65%, respectively, when the fuzzification and optimization stages are used. The system offers several advantages since it is automatically generated, it provides CAD diagnosis based on easily and noninvasively acquired features, and is able to provide interpretation for the decisions made.

Generative rules of Drosophila locomotor behavior as a candidate homology across phyla.

PubMed

Gomez-Marin, Alex; Oron, Efrat; Gakamsky, Anna; Dan Valente; Benjamini, Yoav; Golani, Ilan

2016-06-08

The discovery of shared behavioral processes across phyla is a significant step in the establishment of a comparative study of behavior. We use immobility as an origin and reference for the measurement of fly locomotor behavior; speed, walking direction and trunk orientation as the degrees of freedom shaping this behavior; and cocaine as the parameter inducing progressive transitions in and out of immobility. We characterize and quantify the generative rules that shape Drosophila locomotor behavior, bringing about a gradual buildup of kinematic degrees of freedom during the transition from immobility to normal behavior, and the opposite narrowing down into immobility. Transitions into immobility unfold via sequential enhancement and then elimination of translation, curvature and finally rotation. Transitions out of immobility unfold by progressive addition of these degrees of freedom in the opposite order. The same generative rules have been found in vertebrate locomotor behavior in several contexts (pharmacological manipulations, ontogeny, social interactions) involving transitions in-and-out of immobility. Recent claims for deep homology between arthropod central complex and vertebrate basal ganglia provide an opportunity to examine whether the rules we report also share common descent. Our approach prompts the discovery of behavioral homologies, contributing to the elusive problem of behavioral evolution.

78 FR 32385 - Exelon Generation Company, LLC; CER Generation II, LLC; Constellation Mystic Power, LLC...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL13-64-000] Exelon Generation Company, LLC; CER Generation II, LLC; Constellation Mystic Power, LLC; Constellation NewEnergy...) Rules of Practice and Procedure, 18 CFR 385.207, Exelon Generation Company, LLC, CER Generation II, LLC...

Next-Generation Undersea Warfare and Undersea Distributed Networked Systems

DTIC Science & Technology

2007-01-31

Probability of false alarm R5 Redeployment, refueling, repositioning, replacement, and recovery ROE Rules of engagement RSTA Reconnaissance, surveillance...and decision aids) at a given point, considering mission, tasks, rules of engagement (ROE), objectives, and other appropriate factors. " Manning within...trajectories are important and must occur concurrently; they must, however, be governed by different rule sets.21 II Mission Capability Centric .•UDNS

Interpretation of diagnostic data: 3. How to do it with a simple table (part B).

PubMed

1983-10-01

The following guidelines are useful if you want to "do it with a simple table" (Table IV): First, identify the sensitivity and specificity of the sign, symptom or diagnostic test you plan to use. Many are already in the literature, and subspecialists should either know them for their field or be able to track them down for you. Depending on whether you are considering a sign, a symptom or a diagnostic laboratory test, you will want to track down a clinical subspecialist, a radiologist, a pathologist and so on. Start your table with a total of 1000 patients, as shown in location (a + b + c + d) of panel A. Using the information you have about the patient before you apply the diagnostic test, estimate the patient's pretest likelihood (prevalence or prior probability) of the target disorder -- let's say 10%. Take this proportion of the total (100) and place it in location (a + c); the remaining 900 patients go in location (b + d) (panel B). Multiply (a + c) (100) by the sensitivity of the diagnostic test (let's say 83%) and place the result (83) in cell a and the difference (17) in cell c; similarly, multiply (b + d) (900) by the specificity of the diagnostic test (let's say 91%) and place the result (819) in cell d and the difference (81) in cell b (panel C). If (a + b) and (c + d) do not add up to 1000, you will know you have made a mistake. You can now calculate the positive predictive value, a/(a + b), and the negative predictive value, d/(c + d), as shown in panel D. You have now reached a level of understanding a fair bit beyond the rule-in/rule-out strategy discussed in part 1 of our series. Furthermore, you can already do more than most clinicians, so you may want to stop here, at least for a while. On the other hand, you may want to go further and learn how to handle slightly more complex tables with multiple cut-off points. In the next article you will find more powerful ways to take advantage of the degree of positivity and negativity of diagnostic test results.

[S3 guidelines on diagnostics and treatment of cervical cancer: Demands on pathology].

PubMed

Horn, L-C; Beckmann, M W; Follmann, M; Koch, M C; Mallmann, P; Marnitz, S; Schmidt, D

2015-11-01

Between 2011 and the end of 2014 the former consensus S2k guidelines for the diagnostics and treatment of cervical cancer were updated and upgraded to S3 level, methodologically based on the regulations of the German Cancer Society (DKG). The present article summarizes the relevant aspects for the sectioning, histopathological workup, diagnostics and reporting for the pathology of invasive cancer of the uterine cervix. The recommendations are based on the most recent World Health Organization (WHO) and TNM classification systems and consider the needs of the clinician for appropriate surgical and radiotherapeutic treatment of patients. Detailed processing rules of colposcopy-guided diagnostic biopsies, conization and trachelectomy as well as for radical hysterectomy specimens and lymph node resection (including sentinel lymph node resection) are given. In the guidelines deep stromal invasion in macroinvasive cervical cancer is defined for the first time as tumor infiltration of > 66% of the cervical stromal wall. Furthermore, morphological prognostic factors for microinvasive and macroinvasive cervical cancer are summarized.

Artificial neural networks in mammography interpretation and diagnostic decision making.

PubMed

Ayer, Turgay; Chen, Qiushi; Burnside, Elizabeth S

2013-01-01

Screening mammography is the most effective means for early detection of breast cancer. Although general rules for discriminating malignant and benign lesions exist, radiologists are unable to perfectly detect and classify all lesions as malignant and benign, for many reasons which include, but are not limited to, overlap of features that distinguish malignancy, difficulty in estimating disease risk, and variability in recommended management. When predictive variables are numerous and interact, ad hoc decision making strategies based on experience and memory may lead to systematic errors and variability in practice. The integration of computer models to help radiologists increase the accuracy of mammography examinations in diagnostic decision making has gained increasing attention in the last two decades. In this study, we provide an overview of one of the most commonly used models, artificial neural networks (ANNs), in mammography interpretation and diagnostic decision making and discuss important features in mammography interpretation. We conclude by discussing several common limitations of existing research on ANN-based detection and diagnostic models and provide possible future research directions.

Women-specific mental disorders in DSM-V: are we failing again?

PubMed

Wittchen, Hans-Ulrich

2010-02-01

Despite a wealth of studies on differences regarding the biobehavioral and social-psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the "current rules of game" used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems.

A novel modification of the Turing test for artificial intelligence and robotics in healthcare.

PubMed

Ashrafian, Hutan; Darzi, Ara; Athanasiou, Thanos

2015-03-01

The increasing demands of delivering higher quality global healthcare has resulted in a corresponding expansion in the development of computer-based and robotic healthcare tools that rely on artificially intelligent technologies. The Turing test was designed to assess artificial intelligence (AI) in computer technology. It remains an important qualitative tool for testing the next generation of medical diagnostics and medical robotics. Development of quantifiable diagnostic accuracy meta-analytical evaluative techniques for the Turing test paradigm. Modification of the Turing test to offer quantifiable diagnostic precision and statistical effect-size robustness in the assessment of AI for computer-based and robotic healthcare technologies. Modification of the Turing test to offer robust diagnostic scores for AI can contribute to enhancing and refining the next generation of digital diagnostic technologies and healthcare robotics. Copyright © 2014 John Wiley & Sons, Ltd.

Multicentre external validation of IOTA prediction models and RMI by operators with varied training

PubMed Central

Sayasneh, A; Wynants, L; Preisler, J; Kaijser, J; Johnson, S; Stalder, C; Husicka, R; Abdallah, Y; Raslan, F; Drought, A; Smith, A A; Ghaem-Maghami, S; Epstein, E; Van Calster, B; Timmerman, D; Bourne, T

2013-01-01

Background: Correct characterisation of ovarian tumours is critical to optimise patient care. The purpose of this study is to evaluate the diagnostic performance of the International Ovarian Tumour Analysis (IOTA) logistic regression model (LR2), ultrasound Simple Rules (SR), the Risk of Malignancy Index (RMI) and subjective assessment (SA) for preoperative characterisation of adnexal masses, when ultrasonography is performed by examiners with different background training and experience. Methods: A 2-year prospective multicentre cross-sectional study. Thirty-five level II ultrasound examiners contributed in three UK hospitals. Transvaginal ultrasonography was performed using a standardised approach. The final outcome was the surgical findings and histological diagnosis. To characterise the adnexal masses, the six-variable prediction model (LR2) with a cutoff of 0.1, the RMI with cutoff of 200, ten SR (five rules for malignancy and five rules for benignity) and SA were applied. The area under the curves (AUCs) for performance of LR2 and RMI were calculated. Diagnostic performance measures for all models assessed were sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−), and the diagnostic odds ratio (DOR). Results: Nine-hundred and sixty-two women with adnexal masses underwent transvaginal ultrasonography, whereas 255 had surgery. Prevalence of malignancy was 29% (49 primary invasive epithelial ovarian cancers, 18 borderline ovarian tumours, and 7 metastatic tumours). The AUCs for LR2 and RMI for all masses were 0.94 (95% confidence interval (CI): 0.89–0.97) and 0.90 (95% CI: 0.83–0.94), respectively. In premenopausal women, LR2−RMI difference was 0.09 (95% CI: 0.03–0.15) compared with −0.02 (95% CI: −0.08 to 0.04) in postmenopausal women. For all masses, the DORs for LR2, RMI, SR+SA (using SA when SR inapplicable), SR+MA (assuming malignancy when SR inapplicable), and SA were 62 (95% CI: 27–142), 43 (95% CI: 19–97), 109 (95% CI: 44–274), 66 (95% CI: 27–158), and 70 (95% CI: 30–163), respectively. Conclusion: Overall, the test performance of IOTA prediction models and rules as well as the RMI was maintained in examiners with varying levels of training and experience. PMID:23674083

Disruptive Influences on Research in Academic Pathology Departments: Proposed Changes to the Common Rule Governing Informed Consent for Research Use of Biospecimens and to Rules Governing Return of Research Results.

PubMed

Sobel, Mark E; Dreyfus, Jennifer C

2017-01-01

Academic pathology departments will be dramatically affected by proposed United States federal government regulatory initiatives. Pathology research will be substantially altered if proposed changes to the Common Rule (Code of Federal Regulations: Protection of Human Subjects title 45 CFR 46) and regulations governing the return of individual research results are approved and finalized, even more so now that the Precision Medicine initiative has been launched. Together, these changes are disruptive influences on academic pathology research as we know it, straining limited resources and compromising advances in diagnostic and academic pathology. Academic research pathologists will be challenged over the coming years and must demonstrate leadership to ensure the continued availability of and the ethical use of research pathology specimens. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Logical Differential Prediction Bayes Net, improving breast cancer diagnosis for older women.

PubMed

Nassif, Houssam; Wu, Yirong; Page, David; Burnside, Elizabeth

2012-01-01

Overdiagnosis is a phenomenon in which screening identities cancer which may not go on to cause symptoms or death. Women over 65 who develop breast cancer bear the heaviest burden of overdiagnosis. This work introduces novel machine learning algorithms to improve diagnostic accuracy of breast cancer in aging populations. At the same time, we aim at minimizing unnecessary invasive procedures (thus decreasing false positives) and concomitantly addressing overdiagnosis. We develop a novel algorithm. Logical Differential Prediction Bayes Net (LDP-BN), that calculates the risk of breast disease based on mammography findings. LDP-BN uses Inductive Logic Programming (ILP) to learn relational rules, selects older-specific differentially predictive rules, and incorporates them into a Bayes Net, significantly improving its performance. In addition, LDP-BN offers valuable insight into the classification process, revealing novel older-specific rules that link mass presence to invasive, and calcification presence and lack of detectable mass to DCIS.

Estimating irrigation water demand using an improved method and optimizing reservoir operation for water supply and hydropower generation: a case study of the Xinfengjiang reservoir in southern China

USGS Publications Warehouse

Wu, Yiping; Chen, Ji

2013-01-01

The ever-increasing demand for water due to growth of population and socioeconomic development in the past several decades has posed a worldwide threat to water supply security and to the environmental health of rivers. This study aims to derive reservoir operating rules through establishing a multi-objective optimization model for the Xinfengjiang (XFJ) reservoir in the East River Basin in southern China to minimize water supply deficit and maximize hydropower generation. Additionally, to enhance the estimation of irrigation water demand from the downstream agricultural area of the XFJ reservoir, a conventional method for calculating crop water demand is improved using hydrological model simulation results. Although the optimal reservoir operating rules are derived for the XFJ reservoir with three priority scenarios (water supply only, hydropower generation only, and equal priority), the river environmental health is set as the basic demand no matter which scenario is adopted. The results show that the new rules derived under the three scenarios can improve the reservoir operation for both water supply and hydropower generation when comparing to the historical performance. Moreover, these alternative reservoir operating policies provide the flexibility for the reservoir authority to choose the most appropriate one. Although changing the current operating rules may influence its hydropower-oriented functions, the new rules can be significant to cope with the increasingly prominent water shortage and degradation in the aquatic environment. Overall, our results and methods (improved estimation of irrigation water demand and formulation of the reservoir optimization model) can be useful for local watershed managers and valuable for other researchers worldwide.

Hypothetical Scenario Generator for Fault-Tolerant Diagnosis

NASA Technical Reports Server (NTRS)

James, Mark

2007-01-01

The Hypothetical Scenario Generator for Fault-tolerant Diagnostics (HSG) is an algorithm being developed in conjunction with other components of artificial- intelligence systems for automated diagnosis and prognosis of faults in spacecraft, aircraft, and other complex engineering systems. By incorporating prognostic capabilities along with advanced diagnostic capabilities, these developments hold promise to increase the safety and affordability of the affected engineering systems by making it possible to obtain timely and accurate information on the statuses of the systems and predicting impending failures well in advance. The HSG is a specific instance of a hypothetical- scenario generator that implements an innovative approach for performing diagnostic reasoning when data are missing. The special purpose served by the HSG is to (1) look for all possible ways in which the present state of the engineering system can be mapped with respect to a given model and (2) generate a prioritized set of future possible states and the scenarios of which they are parts.

Semi-automatic generation of medical tele-expert opinion for primary care physician.

PubMed

Biermann, E; Rihl, J; Schenker, M; Standl, E

2003-01-01

A computer-based system has been developed for the generation of medical expert opinions on the insulin-resistance syndrome, based on clinical data obtained from primary care physicians. An expert opinion for each patient was generated by using a decision tree for entering individual text modules and by adding optional free text. The expert opinions were returned by e-mail, telefax or by ordinary mail. 1389 primary care physician sent anonymous data sets and requested expert opinions for a total of 3768 patients. Through the set up of a rule-based system an automation of the generation of the expert opinions could be achieved and the generation time dropped from initially 40 minutes to less than 5 minutes at the end. By using predefined text modules and a rule based system, a large number of medical expert opinions can be generated with relatively few additional resources.

Assess and Predict Automatic Generation Control Performances for Thermal Power Generation Units Based on Modeling Techniques

NASA Astrophysics Data System (ADS)

Zhao, Yan; Yang, Zijiang; Gao, Song; Liu, Jinbiao

2018-02-01

Automatic generation control(AGC) is a key technology to maintain real time power generation and load balance, and to ensure the quality of power supply. Power grids require each power generation unit to have a satisfactory AGC performance, being specified in two detailed rules. The two rules provide a set of indices to measure the AGC performance of power generation unit. However, the commonly-used method to calculate these indices is based on particular data samples from AGC responses and will lead to incorrect results in practice. This paper proposes a new method to estimate the AGC performance indices via system identification techniques. In addition, a nonlinear regression model between performance indices and load command is built in order to predict the AGC performance indices. The effectiveness of the proposed method is validated through industrial case studies.

Phenobarbital-responsive sialadenosis in dogs: case series.

PubMed

Alcoverro, Emili; Tabar, Maria Dolores; Lloret, Albert; Roura, Xavier; Pastor, Josep; Planellas, Marta

2014-12-01

Phenobarbital-responsive sialadenosis (PRS) is a rare idiopathic disease in dogs. Vomiting, retching, and gulping with bilateral enlargement of the submandibular salivary glands are the more frequent clinical signs. A thorough diagnostic examination must be performed to rule out the most important systemic etiologies involved with chronic vomiting, as there is no specific test to diagnose PRS. Diagnosis is confirmed clinically by a rapid and dramatic improvement of clinical signs after instauration of phenobarbital treatment. The aim of this article is to describe the clinical presentation, diagnostic findings, and outcome of a case series of 4 dogs with presumptive PRS. Copyright © 2015 Elsevier Inc. All rights reserved.

Methodology for automating software systems

NASA Technical Reports Server (NTRS)

Moseley, Warren

1990-01-01

Applying ITS technology to the shuttle diagnostics would not require the rigor of the Petri Net representation, however it is important in providing the animated simulated portion of the interface and the demands placed on the system to support the training aspects to have a homogeneous and consistent underlying knowledge representation. By keeping the diagnostic rule base, the hardware description, the software description, user profiles, desired behavioral knowledge, and the user interface in the same notation, it is possible to reason about the all of the properties of petri nets, on any selected portion of the simulation. This reasoning provides foundation for utilization of intelligent tutoring systems technology.

An evidential reasoning extension to quantitative model-based failure diagnosis

NASA Technical Reports Server (NTRS)

Gertler, Janos J.; Anderson, Kenneth C.

1992-01-01

The detection and diagnosis of failures in physical systems characterized by continuous-time operation are studied. A quantitative diagnostic methodology has been developed that utilizes the mathematical model of the physical system. On the basis of the latter, diagnostic models are derived each of which comprises a set of orthogonal parity equations. To improve the robustness of the algorithm, several models may be used in parallel, providing potentially incomplete and/or conflicting inferences. Dempster's rule of combination is used to integrate evidence from the different models. The basic probability measures are assigned utilizing quantitative information extracted from the mathematical model and from online computation performed therewith.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hurlbut, D. J.; Haase, S.; Brinkman, G.

Pursuant to the Clean Air Act, the U.S. Environmental Protection Agency (EPA) announced in 2009 its intent to issue rules for controlling emissions from Navajo Generating Station that could affect visibility at the Grand Canyon and at several other national parks and wilderness areas. The final rule will conform to what EPA determines is the best available retrofit technology (BART) for the control of haze-causing air pollutants, especially nitrogen oxides. While EPA is ultimately responsible for setting Navajo Generating Station's BART standards in its final rule, it will be the U.S. Department of the Interior's responsibility to manage compliance andmore » the related impacts. This study aims to assist both Interior and EPA by providing an objective assessment of issues relating to the power sector.« less

Kinetic Monte Carlo Method for Rule-based Modeling of Biochemical Networks

PubMed Central

Yang, Jin; Monine, Michael I.; Faeder, James R.; Hlavacek, William S.

2009-01-01

We present a kinetic Monte Carlo method for simulating chemical transformations specified by reaction rules, which can be viewed as generators of chemical reactions, or equivalently, definitions of reaction classes. A rule identifies the molecular components involved in a transformation, how these components change, conditions that affect whether a transformation occurs, and a rate law. The computational cost of the method, unlike conventional simulation approaches, is independent of the number of possible reactions, which need not be specified in advance or explicitly generated in a simulation. To demonstrate the method, we apply it to study the kinetics of multivalent ligand-receptor interactions. We expect the method will be useful for studying cellular signaling systems and other physical systems involving aggregation phenomena. PMID:18851068

The Prospective External Validation of International Ovarian Tumor Analysis (IOTA) Simple Rules in the Hands of Level I and II Examiners.

PubMed

Knafel, A; Banas, T; Nocun, A; Wiechec, M; Jach, R; Ludwin, A; Kabzinska-Turek, M; Pietrus, M; Pitynski, K

2016-10-01

Objective: To externally validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) by examiners with different levels of sonographic experience defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and to assess the morphological ultrasound features of the adnexal tumors classified as inconclusive based on IOTA SR. Materials and Methods: In the two-year prospective study adnexal tumors were assessed preoperatively with transvaginal ultrasound by examiners with different levels of experience (level 1- IOTA SR1, level 2-IOTA SR2). Additionally, an expert (level 3) evaluated all tumors by subjective assessment (SA). If the rules could not be applied, the tumors were considered inconclusive. The final diagnosis was based on the histopathological result of the removed mass. The diagnostic performance measures for the assessed model were sensitivity, specificity, negative (LR-) and positive(LR+) likelihood ratios, accuracy (ACC) and diagnostic odds ratio (DOR). Results: 226 women with adnexal tumors scheduled for surgery were included in the stutdy. The prevalence of malignancy was 36.3 % in the group of all studied tumors and was 52.5 % in the inconclusive group (n = 40) (p = 0.215). Fewer tumors were classified as inconclusive by level 2 examiners compared to level 1 examiners [20 (8.8 %) vs. 40 (17.7 %); p = 0.008], resulting from the discrepancy in the evaluation of acoustic shadows and the vascularization within the tumor. For level 1 examiners a diagnostic strategy using IOTA SR1 +MA (assuming malignancy when SR inconclusive) achieved a sensitivity, specificity and DOR of 96.3 %, 81.9 %, 13.624 respectively. For level 2 examiners the diagnostic strategy for IOTA SR2 +MA achieved a sensitivity, specificity and DOR of 95.1 %, 89.6 %, 137,143, respectively. Adding SA by an expert (or level 3 examiner) when IOTA SR were not applicable improved the specificity of the test and achieved a DOR of 505.137 (SR1 +SA) and 293.627 (SR2 +SA). The SA by an expert proved to have the best diagnostic performance with a DOR of 5768.857, and a sensitivity and specificity of 97.6 % and 99.3 % respectively. Within the inconclusive group the most common tumors were unilocular-solid (n-13), solid (n-8) and multilocular-solid (n-10) ones. All multilocular tumors were classified as inconclusive because of their size (≥ 100 mm) and were found to be benign by pathology. Most of the inconclusive tumors with cystic content presented low-level (43.75 %) echogenicity, followed by ground-glass (34.37 %), mixed (12.5 %) and anechoic (9.4 %). Conclusion: The study results show excellent diagnostic performance of IOTA Simple Rules followed by subjective expert assessment in inconclusive tumors irrespective of the level of experience, while subjective assessment by an expert still has the highest diagnostic odds ratio. The number of inconclusive cases seems to depend on the level of ultrasound expertise and less experienced examiners have a tendency to overestimate blood flow and a presence of acoustic shadows within the tumors. IOTA SR were not applicable either because no benign or malignant features were found or both were identified. Within inconclusive tumors the majority of cases comprise malignant masses that are either unilocular-solid, solid tumors or small multilocular-solid ones with a diameter of less than 100 mm. © Georg Thieme Verlag KG Stuttgart · New York.

47 CFR 95.401 - (CB Rule 1) What are the Citizens Band Radio Services?

Code of Federal Regulations, 2010 CFR

2010-10-01

... subpart B of this part. (c) The Low Power Radio Service (LPRS)—a private, short-distance communication... prohibited. (d) The Medical Device Radiocommunication Service (MedRadio)—an ultra-low power radio service, for the transmission of non-voice data for the purpose of facilitating diagnostic and/or therapeutic...

Recognition ROCS Are Curvilinear--Or Are They? On Premature Arguments against the Two-High-Threshold Model of Recognition

ERIC Educational Resources Information Center

Broder, Arndt; Schutz, Julia

2009-01-01

Recent reviews of recognition receiver operating characteristics (ROCs) claim that their curvilinear shape rules out threshold models of recognition. However, the shape of ROCs based on confidence ratings is not diagnostic to refute threshold models, whereas ROCs based on experimental bias manipulations are. Also, fitting predicted frequencies to…

A Model for Evidence Accumulation in the Lexical Decision Task

ERIC Educational Resources Information Center

Wagenmakers, Eric-Jan; Steyvers, Mark; Raaijmakers, Jeroen G. W.; Shiffrin, Richard M.; van Rijn, Hedderik; Zeelenberg, Rene

2004-01-01

We present a new model for lexical decision, REM-LD, that is based on REM theory (e.g., Shiffrin & Steyvers, 1997). REM-LD uses a principled (i.e., Bayes' rule) decision process that simultaneously considers the diagnosticity of the evidence for the 'WORD' response and the 'NONWORD' response. The model calculates the odds ratio that the presented…

A Comparison of Two Models for Cognitive Diagnosis. Research Report. ETS RR-04-02

ERIC Educational Resources Information Center

Yan, Duanli; Almond, Russell; Mislevy, Robert

2004-01-01

Diagnostic score reports linking assessment outcomes to instructional interventions are one of the most requested features of assessment products. There is a body of interesting work done in the last 20 years including Tatsuoka's rule space method (Tatsuoka, 1983), Haertal and Wiley's binary skills model (Haertal, 1984; Haertal & Wiley, 1993),…

42 CFR 478.15 - QIO review of changes resulting from DRG validation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false QIO review of changes resulting from DRG validation... review of changes resulting from DRG validation. (a) General rules. (1) A provider or practitioner dissatisfied with a change to the diagnostic or procedural coding information made by a QIO as a result of DRG...

Identifying Engineering Students' English Sentence Reading Comprehension Errors: Applying a Data Mining Technique

ERIC Educational Resources Information Center

Tsai, Yea-Ru; Ouyang, Chen-Sen; Chang, Yukon

2016-01-01

The purpose of this study is to propose a diagnostic approach to identify engineering students' English reading comprehension errors. Student data were collected during the process of reading texts of English for science and technology on a web-based cumulative sentence analysis system. For the analysis, the association-rule, data mining technique…

Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology.

PubMed Central

2000-01-01

The International Consortium in Psychiatric Epidemiology (ICPE) was established in 1998 by WHO to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of ICPE surveys in seven countries in North America (Canada and USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely--from > 40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorder were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early-onset cases, and only a minority of people with prevailing disorders received any treatment. Mental disorders are among the most burdensome of all classes of disease because of their high prevalence and chronicity, early age of onset, and resulting serious impairment. There is a need for demonstration projects of early outreach and intervention programmes for people with early-onset mental disorders, as well as quality assurance programmes to look into the widespread problem of inadequate treatment. PMID:10885160

Mathematical modelling of contact of ruled surfaces: theory and practical application

NASA Astrophysics Data System (ADS)

Panchuk, K. L.; Niteyskiy, A. S.

2016-04-01

In the theory of ruled surfaces there are well known researches of contact of ruled surfaces along their common generator line (Klein image is often used [1]). In this paper we propose a study of contact of non developable ruled surfaces via the dual vector calculus. The advantages of this method have been demonstrated by E. Study, W. Blaschke and D. N. Zeiliger in differential geometry studies of ruled surfaces in space R3 over the algebra of dual numbers. A practical use of contact is demonstrated by the example modeling of the working surface of the progressive tool for tillage.

Diagnostic Problem-Solving Process in Professional Contexts: Theory and Empirical Investigation in the Context of Car Mechatronics Using Computer-Generated Log-Files

ERIC Educational Resources Information Center

Abele, Stephan

2018-01-01

This article deals with a theory-based investigation of the diagnostic problem-solving process in professional contexts. To begin with, a theory of the diagnostic problem-solving process was developed drawing on findings from different professional contexts. The theory distinguishes between four sub-processes of the diagnostic problem-solving…

The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children

PubMed Central

Engel, Mark Emmanuel; Cohen, Karen; Gounden, Ronald; Kengne, Andre P.; Barth, Dylan Dominic; Whitelaw, Andrew C; Francis, Veronica; Badri, Motasim; Stewart, Annemie; Dale, James B.; Mayosi, Bongani M.; Maartens, Gary

2016-01-01

Background Existing clinical decision rules (CDR) to diagnose group A streptococcal (GAS) pharyngitis have not been validated in sub-Saharan Africa. We developed a locally applicable CDR while evaluating existing CDRs for diagnosing GAS pharyngitis in South African children. Methods We conducted a prospective cohort study and enrolled 997 children aged 3-15 years presenting to primary care clinics with a complaint of sore throat, and whose parents provided consent. Main outcome measures were signs and symptoms of pharyngitis, and a positive GAS culture from a throat swab. Bivariate and multivariate analyses were used to develop the clinical decision rule. In addition, the diagnostic effectiveness of six existing rules for predicting a positive culture in our cohort was assessed. Results 206 of 982 children (21%) had a positive GAS culture. Tonsillar swelling, tonsillar exudates, tender or enlarged anterior cervical lymph nodes, absence of cough and absence of rhinorrhea were associated with positive cultures in bivariate and multivariate analyses. Four variables (tonsillar swelling and one of tonsillar exudate, no rhinorrhea, no cough), when used in a cumulative score, showed 83.7% sensitivity and 32.2% specificity for GAS pharyngitis. Of existing rules tested, the McIsaac rule had the highest positive predictive value (28%), but missed 49% of the culture-positive children who should have been treated. Conclusion The new four-variable clinical decision rule for GAS pharyngitis (i.e., tonsillar swelling and one of tonsillar exudate, no rhinorrhea, no cough) outperformed existing rules for GAS pharyngitis diagnosis in children with symptomatic sore throat in Cape Town. PMID:27870815

Thoracic injury rule out criteria and NEXUS chest in predicting the risk of traumatic intra-thoracic injuries: A diagnostic accuracy study.

PubMed

Safari, Saeed; Radfar, Fatemeh; Baratloo, Alireza

2018-05-01

This study aimed to compare the diagnostic accuracy of NEXUS chest and Thoracic Injury Rule out criteria (TIRC) models in predicting the risk of intra-thoracic injuries following blunt multiple trauma. In this diagnostic accuracy study, using the 2 mentioned models, blunt multiple trauma patients over the age of 15 years presenting to emergency department were screened regarding the presence of intra-thoracic injuries that are detectable via chest x-ray and screening performance characteristics of the models were compared. In this study, 3118 patients with the mean (SD) age of 37.4 (16.9) years were studied (57.4% male). Based on TIRC and NEXUS chest, respectively, 1340 (43%) and 1417 (45.4%) patients were deemed in need of radiography performance. Sensitivity, specificity, and positive and negative predictive values of TIRC were 98.95%, 62.70%, 21.19% and 99.83%. These values were 98.61%, 59.94%, 19.97% and 99.76%, for NEXUS chest, respectively. Accuracy of TIRC and NEXUS chest models were 66.04 (95% CI: 64.34-67.70) and 63.50 (95% CI: 61.78-65.19), respectively. TIRC and NEXUS chest models have proper and similar sensitivity in prediction of blunt traumatic intra-thoracic injuries that are detectable via chest x-ray. However, TIRC had a significantly higher specificity in this regard. Copyright © 2018 Elsevier Ltd. All rights reserved.

Diagnostic accuracy of history and physical examination in bacterial acute rhinosinusitis.

PubMed

Autio, Timo J; Koskenkorva, Timo; Närkiö, Mervi; Leino, Tuomo K; Koivunen, Petri; Alho, Olli-Pekka

2015-07-01

To evaluate the diagnostic accuracy of symptoms, the symptom progression pattern, and clinical signs in identifying bacterial acute rhinosinusitis (ARS). We conducted an inception cohort study among 50 military recruits with ARS. We collected symptoms daily from the onset of symptoms to approximately 10 days. At 9 to 10 days, standardized data on symptoms and physical findings were gathered. A positive culture of maxillary sinus aspirate was considered to be the reference standard for bacterial ARS. At 9 to 10 days, the presence or deterioration after 5 days of any of the symptoms could not be used to diagnose bacterial ARS. Toothache had an adequate positive likelihood ratio (positive likelihood ratio [LR+] 4.4) but was too rare to be used for screening. In contrast, several physical findings at 9 to 10 days were of more diagnostic use and frequent enough for screening. Moderate or profuse (vs. none/minimal) amount of secretion in nasal passage seen in anterior rhinoscopy satisfactorily either ruled in, if present (LR+ 3.2), or ruled out, if absent (negative likelihood ratio 0.2), bacterial ARS. If any secretion was seen in the posterior pharynx or middle meatus, the probability of bacterial ARS increased markedly (LR+ 5.3 and LR+ 11.0, respectively). We found symptoms or their change to be of little use in identifying bacterial ARS. In contrast, we observed several clinical findings after 9 to 10 days of symptoms to predict bacterial ARS quite accurately. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Polar bear encephalitis: establishment of a comprehensive next-generation pathogen analysis pipeline for captive and free-living wildlife.

PubMed

Szentiks, C A; Tsangaras, K; Abendroth, B; Scheuch, M; Stenglein, M D; Wohlsein, P; Heeger, F; Höveler, R; Chen, W; Sun, W; Damiani, A; Nikolin, V; Gruber, A D; Grobbel, M; Kalthoff, D; Höper, D; Czirják, G Á; Derisi, J; Mazzoni, C J; Schüle, A; Aue, A; East, M L; Hofer, H; Beer, M; Osterrieder, N; Greenwood, A D

2014-05-01

This report describes three possibly related incidences of encephalitis, two of them lethal, in captive polar bears (Ursus maritimus). Standard diagnostic methods failed to identify pathogens in any of these cases. A comprehensive, three-stage diagnostic 'pipeline' employing both standard serological methods and new DNA microarray and next generation sequencing-based diagnostics was developed, in part as a consequence of this initial failure. This pipeline approach illustrates the strengths, weaknesses and limitations of these tools in determining pathogen caused deaths in non-model organisms such as wildlife species and why the use of a limited number of diagnostic tools may fail to uncover important wildlife pathogens. Copyright © 2013 Elsevier Ltd. All rights reserved.

Application of decision rules for empowering of Indonesian telematics services SMEs

NASA Astrophysics Data System (ADS)

Tosida, E. T.; Hairlangga, O.; Amirudin, F.; Ridwanah, M.

2018-03-01

The independence of the field of telematics became one of Indonesia's vision in 2024. One effort to achieve it can be done by empowering SMEs in the field of telematics. Empowerment carried out need a practical mechanism by utilizing data centered, including through the National Economic Census database (Susenas). Based on the Susenas can be formulated the decision rules of determining the provision of assistance for SMEs in the field of telematics. The way it did by generating the rule base through the classification technique. The CART algorithm-based decision rule model performs better than C45 and ID3 models. The high level of performance model is also in line with the regulations applied by the government. This becomes one of the strengths of research, because the resulting model is consistent with the existing conditions in Indonesia. The rules base generated from the three classification techniques show different rules. The CART technique has pattern matching with the realization of activities in The Ministry of Cooperatives and SMEs. So far, the government has difficulty in referring data related to the empowerment of SMEs telematics services. Therefore, the findings resulting from this research can be used as an alternative decision support system related to the program of empowerment of SMEs in telematics.

77 FR 26474 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Approval of 2011 Consent...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

...EPA proposes to approve State Implementation Plan (SIP) revisions submitted by the Maryland Department of the Environment (MDE). These revisions approve specific provisions of a 2011 Consent Decree between MDE and GenOn to reduce particulate matter (PM), sulfur oxides (SOX), and nitrogen oxides (NOX) from the GenOn Chalk Point generating station (Chalk Point). These revisions also remove the 1978 and 1979 Consent Orders for the Chalk Point generating station from the Maryland SIP as those Consent Orders have been superseded by the 2011 Consent Decree. In the Final Rules section of this Federal Register, EPA is approving the State's SIP submittal as a direct final rule without prior proposal because the Agency views this as a noncontroversial submittal and anticipates no adverse comments. A detailed rationale for the approval is set forth in the direct final rule. If no adverse comments are received in response to this action, no further activity is contemplated. If EPA receives adverse comments, the direct final rule will be withdrawn and all public comments received will be addressed in a subsequent final rule based on this proposed rule. EPA will not institute a second comment period. Any parties interested in commenting on this action should do so at this time.

An extensible six-step methodology to automatically generate fuzzy DSSs for diagnostic applications.

PubMed

d'Acierno, Antonio; Esposito, Massimo; De Pietro, Giuseppe

2013-01-01

The diagnosis of many diseases can be often formulated as a decision problem; uncertainty affects these problems so that many computerized Diagnostic Decision Support Systems (in the following, DDSSs) have been developed to aid the physician in interpreting clinical data and thus to improve the quality of the whole process. Fuzzy logic, a well established attempt at the formalization and mechanization of human capabilities in reasoning and deciding with noisy information, can be profitably used. Recently, we informally proposed a general methodology to automatically build DDSSs on the top of fuzzy knowledge extracted from data. We carefully refine and formalize our methodology that includes six stages, where the first three stages work with crisp rules, whereas the last three ones are employed on fuzzy models. Its strength relies on its generality and modularity since it supports the integration of alternative techniques in each of its stages. The methodology is designed and implemented in the form of a modular and portable software architecture according to a component-based approach. The architecture is deeply described and a summary inspection of the main components in terms of UML diagrams is outlined as well. A first implementation of the architecture has been then realized in Java following the object-oriented paradigm and used to instantiate a DDSS example aimed at accurately diagnosing breast masses as a proof of concept. The results prove the feasibility of the whole methodology implemented in terms of the architecture proposed.

VUV absorption spectroscopy measurements of the role of fast neutral atoms in a high-power gap breakdown

NASA Astrophysics Data System (ADS)

Filuk, A. B.; Bailey, J. E.; Cuneo, M. E.; Lake, P. W.; Nash, T. J.; Noack, D. D.; Maron, Y.

2000-12-01

The maximum power achieved in a wide variety of high-power devices, including electron and ion diodes, z pinches, and microwave generators, is presently limited by anode-cathode gap breakdown. A frequently discussed hypothesis for this effect is ionization of fast neutral atoms injected throughout the anode-cathode gap during the power pulse. We describe a newly developed diagnostic tool that provides a direct test of this hypothesis. Time-resolved vacuum-ultraviolet absorption spectroscopy is used to directly probe fast neutral atoms with 1-mm spatial resolution in the 10-mm anode-cathode gap of the SABRE 5 MV, 1 TW applied-B ion diode. Absorption spectra collected during Ar RF glow discharges and with CO2 gas fills confirm the reliability of the diagnostic technique. Throughout the 50-100 ns ion diode pulses no measurable neutral absorption was seen, setting upper limits of (0.12-1.5)×1014 cm-3 for ground-state fast neutral atom densities of H, C, N, O, and F. The absence of molecular absorption bands also sets upper limits of (0.16-1.2)×1015 cm-3 for common simple molecules. These limits are low enough to rule out ionization of fast neutral atoms as a breakdown mechanism. Breakdown due to ionization of molecules is also found to be unlikely. This technique can now be applied to quantify the role of neutral atoms in other high-power devices.

VUV absorption spectroscopy measurements of the role of fast neutral atoms in high-power gap breakdown

DOE Office of Scientific and Technical Information (OSTI.GOV)

FILUK,A.B.; BAILEY,JAMES E.; CUNEO,MICHAEL E.

The maximum power achieved in a wide variety of high-power devices, including electron and ion diodes, z pinches, and microwave generators, is presently limited by anode-cathode gap breakdown. A frequently-discussed hypothesis for this effect is ionization of fast neutral atoms injected throughout the anode-cathode gap during the power pulse. The authors describe a newly-developed diagnostic tool that provides the first direct test of this hypothesis. Time-resolved vacuum-ultraviolet absorption spectroscopy is used to directly probe fast neutral atoms with 1 mm spatial resolution in the 10 mm anode-cathode gap of the SABRE 5 MV, 1 TW applied-B ion diode. Absorption spectramore » collected during Ar RF glow discharges and with CO{sub 2} gas fills confirm the reliability of the diagnostic technique. Throughout the 50--100 ns ion diode pulses no measurable neutral absorption is seen, setting upper limits of 0.12--1.5 x 10{sup 14} cm{sup {minus}3} for ground state fast neutral atom densities of H, C, N, O, F. The absence of molecular absorption bands also sets upper limits of 0.16--1.2 x 10{sup 15} cm{sup {minus}3} for common simple molecules. These limits are low enough to rule out ionization throughout the gap as a breakdown mechanism. This technique can now be applied to quantify the role of neutral atoms in other high-power devices.« less

An extensible six-step methodology to automatically generate fuzzy DSSs for diagnostic applications

PubMed Central

2013-01-01

Background The diagnosis of many diseases can be often formulated as a decision problem; uncertainty affects these problems so that many computerized Diagnostic Decision Support Systems (in the following, DDSSs) have been developed to aid the physician in interpreting clinical data and thus to improve the quality of the whole process. Fuzzy logic, a well established attempt at the formalization and mechanization of human capabilities in reasoning and deciding with noisy information, can be profitably used. Recently, we informally proposed a general methodology to automatically build DDSSs on the top of fuzzy knowledge extracted from data. Methods We carefully refine and formalize our methodology that includes six stages, where the first three stages work with crisp rules, whereas the last three ones are employed on fuzzy models. Its strength relies on its generality and modularity since it supports the integration of alternative techniques in each of its stages. Results The methodology is designed and implemented in the form of a modular and portable software architecture according to a component-based approach. The architecture is deeply described and a summary inspection of the main components in terms of UML diagrams is outlined as well. A first implementation of the architecture has been then realized in Java following the object-oriented paradigm and used to instantiate a DDSS example aimed at accurately diagnosing breast masses as a proof of concept. Conclusions The results prove the feasibility of the whole methodology implemented in terms of the architecture proposed. PMID:23368970

Search for Minimal and Semi-Minimal Rule Sets in Incremental Learning of Context-Free and Definite Clause Grammars

NASA Astrophysics Data System (ADS)

Imada, Keita; Nakamura, Katsuhiko

This paper describes recent improvements to Synapse system for incremental learning of general context-free grammars (CFGs) and definite clause grammars (DCGs) from positive and negative sample strings. An important feature of our approach is incremental learning, which is realized by a rule generation mechanism called “bridging” based on bottom-up parsing for positive samples and the search for rule sets. The sizes of rule sets and the computation time depend on the search strategies. In addition to the global search for synthesizing minimal rule sets and serial search, another method for synthesizing semi-optimum rule sets, we incorporate beam search to the system for synthesizing semi-minimal rule sets. The paper shows several experimental results on learning CFGs and DCGs, and we analyze the sizes of rule sets and the computation time.

Optimization of OSEM parameters in myocardial perfusion imaging reconstruction as a function of body mass index: a clinical approach*

PubMed Central

de Barros, Pietro Paolo; Metello, Luis F.; Camozzato, Tatiane Sabriela Cagol; Vieira, Domingos Manuel da Silva

2015-01-01

Objective The present study is aimed at contributing to identify the most appropriate OSEM parameters to generate myocardial perfusion imaging reconstructions with the best diagnostic quality, correlating them with patients’ body mass index. Materials and Methods The present study included 28 adult patients submitted to myocardial perfusion imaging in a public hospital. The OSEM method was utilized in the images reconstruction with six different combinations of iterations and subsets numbers. The images were analyzed by nuclear cardiology specialists taking their diagnostic value into consideration and indicating the most appropriate images in terms of diagnostic quality. Results An overall scoring analysis demonstrated that the combination of four iterations and four subsets has generated the most appropriate images in terms of diagnostic quality for all the classes of body mass index; however, the role played by the combination of six iterations and four subsets is highlighted in relation to the higher body mass index classes. Conclusion The use of optimized parameters seems to play a relevant role in the generation of images with better diagnostic quality, ensuring the diagnosis and consequential appropriate and effective treatment for the patient. PMID:26543282

A novel prosodic-information synthesizer based on recurrent fuzzy neural network for the Chinese TTS system.

PubMed

Lin, Chin-Teng; Wu, Rui-Cheng; Chang, Jyh-Yeong; Liang, Sheng-Fu

2004-02-01

In this paper, a new technique for the Chinese text-to-speech (TTS) system is proposed. Our major effort focuses on the prosodic information generation. New methodologies for constructing fuzzy rules in a prosodic model simulating human's pronouncing rules are developed. The proposed Recurrent Fuzzy Neural Network (RFNN) is a multilayer recurrent neural network (RNN) which integrates a Self-cOnstructing Neural Fuzzy Inference Network (SONFIN) into a recurrent connectionist structure. The RFNN can be functionally divided into two parts. The first part adopts the SONFIN as a prosodic model to explore the relationship between high-level linguistic features and prosodic information based on fuzzy inference rules. As compared to conventional neural networks, the SONFIN can always construct itself with an economic network size in high learning speed. The second part employs a five-layer network to generate all prosodic parameters by directly using the prosodic fuzzy rules inferred from the first part as well as other important features of syllables. The TTS system combined with the proposed method can behave not only sandhi rules but also the other prosodic phenomena existing in the traditional TTS systems. Moreover, the proposed scheme can even find out some new rules about prosodic phrase structure. The performance of the proposed RFNN-based prosodic model is verified by imbedding it into a Chinese TTS system with a Chinese monosyllable database based on the time-domain pitch synchronous overlap add (TD-PSOLA) method. Our experimental results show that the proposed RFNN can generate proper prosodic parameters including pitch means, pitch shapes, maximum energy levels, syllable duration, and pause duration. Some synthetic sounds are online available for demonstration.

Selection rules for harmonic generation in solids

NASA Astrophysics Data System (ADS)

Moiseyev, Nimrod

2015-05-01

High-order harmonic generation (HHG) in a bulk crystal was first observed in 2011 [S. Ghimire, A. D. DiChiara, E. Sistrunk, P. Agostini, L. F. DiMauro, and D. A. Reis, Nat. Phys. 7, 138 (2011), 10.1038/nphys1847]. Only odd-order harmonics were observed as expected on the basis of the selection rules in solids, which were derived when only the interband currents were taken into consideration. Here we study HHG in solids when the intraband currents are taken into consideration as well. We show that the dynamical selection rules are broken in solids and the possibility of generation of even-order harmonics cannot be excluded on the basis of the dynamical symmetry analysis. However, a simple analysis of the expression we obtained for the amplitude of the emitted high-order harmonics shows, without the need to carry out numerical calculations, that the even-order harmonics are suppressed due to the localization of the field-free one-electron density probability on the atoms in the solids.

Rough Evaluation Structure: Application of Rough Set Theory to Generate Simple Rules for Inconsistent Preference Relation

NASA Astrophysics Data System (ADS)

Gehrmann, Andreas; Nagai, Yoshimitsu; Yoshida, Osamu; Ishizu, Syohei

Since management decision-making becomes complex and preferences of the decision-maker frequently becomes inconsistent, multi-attribute decision-making problems were studied. To represent inconsistent preference relation, the concept of evaluation structure was introduced. We can generate simple rules to represent inconsistent preference relation by the evaluation structures. Further rough set theory for the preference relation was studied and the concept of approximation was introduced. One of our main aims of this paper is to introduce a concept of rough evaluation structure for representing inconsistent preference relation. We apply rough set theory to the evaluation structure, and develop a method for generating simple rules for inconsistent preference relations. In this paper, we introduce concepts of totally ordered information system, similarity class of preference relation, upper and lower approximation of preference relations. We also show the properties of rough evaluation structure and provide a simple example. As an application of rough evaluation structure, we analyze questionnaire survey of customer preferences about audio players.

Evolving learning rules and emergence of cooperation in spatial prisoner's dilemma.

PubMed

Moyano, Luis G; Sánchez, Angel

2009-07-07

In the evolutionary Prisoner's dilemma (PD) game, agents play with each other and update their strategies in every generation according to some microscopic dynamical rule. In its spatial version, agents do not play with every other but, instead, interact only with their neighbours, thus mimicking the existing of a social or contact network that defines who interacts with whom. In this work, we explore evolutionary, spatial PD systems consisting of two types of agents, each with a certain update (reproduction, learning) rule. We investigate two different scenarios: in the first case, update rules remain fixed for the entire evolution of the system; in the second case, agents update both strategy and update rule in every generation. We show that in a well-mixed population the evolutionary outcome is always full defection. We subsequently focus on two-strategy competition with nearest-neighbour interactions on the contact network and synchronised update of strategies. Our results show that, for an important range of the parameters of the game, the final state of the system is largely different from that arising from the usual setup of a single, fixed dynamical rule. Furthermore, the results are also very different if update rules are fixed or evolve with the strategies. In these respect, we have studied representative update rules, finding that some of them may become extinct while others prevail. We describe the new and rich variety of final outcomes that arise from this co-evolutionary dynamics. We include examples of other neighbourhoods and asynchronous updating that confirm the robustness of our conclusions. Our results pave the way to an evolutionary rationale for modelling social interactions through game theory with a preferred set of update rules.

Defining Alcohol-Specific Rules Among Parents of Older Adolescents: Moving Beyond No Tolerance.

PubMed

Bourdeau, Beth; Miller, Brenda; Vanya, Magdalena; Duke, Michael; Ames, Genevieve

2012-01-01

Parental beliefs and rules regarding their teen's use of alcohol influence teen decisions regarding alcohol use. However, measurement of parental rules regarding adolescent alcohol use has not been thoroughly studied. This study used qualitative interviews with 174 parents of older teens from 100 families. From open-ended questions, themes emerged that describe explicit rules tied to circumscribed use, no tolerance, and "call me." There was some inconsistency in explicit rules with and between parents. Responses also generated themes relating to implicit rules such as expectations and preferences. Parents described their methods of communicating their position via conversational methods, role modeling their own behavior, teaching socially appropriate use of alcohol by offering their teen alcohol, and monitoring their teens' social activities. Findings indicate that alcohol rules are not adequately captured by current assessment measures.

Defining Alcohol-Specific Rules Among Parents of Older Adolescents: Moving Beyond No Tolerance

PubMed Central

Bourdeau, Beth; Miller, Brenda; Vanya, Magdalena; Duke, Michael; Ames, Genevieve

2012-01-01

Parental beliefs and rules regarding their teen’s use of alcohol influence teen decisions regarding alcohol use. However, measurement of parental rules regarding adolescent alcohol use has not been thoroughly studied. This study used qualitative interviews with 174 parents of older teens from 100 families. From open-ended questions, themes emerged that describe explicit rules tied to circumscribed use, no tolerance, and “call me.” There was some inconsistency in explicit rules with and between parents. Responses also generated themes relating to implicit rules such as expectations and preferences. Parents described their methods of communicating their position via conversational methods, role modeling their own behavior, teaching socially appropriate use of alcohol by offering their teen alcohol, and monitoring their teens’ social activities. Findings indicate that alcohol rules are not adequately captured by current assessment measures. PMID:23204931

Generating Concise Rules for Human Motion Retrieval

NASA Astrophysics Data System (ADS)

Mukai, Tomohiko; Wakisaka, Ken-Ichi; Kuriyama, Shigeru

This paper proposes a method for retrieving human motion data with concise retrieval rules based on the spatio-temporal features of motion appearance. Our method first converts motion clip into a form of clausal language that represents geometrical relations between body parts and their temporal relationship. A retrieval rule is then learned from the set of manually classified examples using inductive logic programming (ILP). ILP automatically discovers the essential rule in the same clausal form with a user-defined hypothesis-testing procedure. All motions are indexed using this clausal language, and the desired clips are retrieved by subsequence matching using the rule. Such rule-based retrieval offers reasonable performance and the rule can be intuitively edited in the same language form. Consequently, our method enables efficient and flexible search from a large dataset with simple query language.

History and physical examination plus laboratory testing for the diagnosis of adult female urinary tract infection.

PubMed

Meister, Lisa; Morley, Eric J; Scheer, Diane; Sinert, Richard

2013-07-01

Emergency physicians often encounter females presenting with symptoms suggestive of urinary tract infections (UTIs). The diagnostic accuracy of history, physical examination, and bedside laboratory tests for female UTIs in emergency departments (EDs) have not been quantitatively described. This was a systematic review to determine the utility of history and physical examination (H&P) and urinalysis in diagnosing uncomplicated female UTI in the ED. The medical literature was searched from January 1965 through October 2012 in PUBMED and EMBASE using the following criteria: Patients were females greater than 18 years of age in the ED suspected of having UTIs. Interventions were H&P and urinalysis used to diagnose a UTI. The comparator was UTI confirmed by a positive urine culture. The outcome was operating characteristics of the interventions in diagnosing a UTI. Study quality was assessed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Sensitivity, specificity, and likelihood ratios (LRs) were calculated using Meta-DiSc. Four studies (pooled n = 948) were included with UTI prevalence ranging from 40% to 60%. H&P variables all had positive LRs (+LR, range = 0.8 to 2.2) and negative LRs (-LR, range = 0.7 to 1.0) that are insufficient to significantly alter pretest probability of UTI. Only a positive nitrite reaction (+LR = 7.5 to 24.5) was useful to rule in a UTI. To rule out UTI, only a negative leukocyte esterase (LE; -LR = 0.2) or blood reaction on urine dipstick (-LR = 0.2) were significantly accurate. Increasing pyuria directly correlated with +LR, and moderate pyuria (urine white blood cells [uWBC] > 50 colony-forming units [CFUs]/ml) and moderate bacteruria were good predictors of UTI (+LR = 6.4 and 15.0, respectively). No single H&P finding can accurately rule in or rule out UTI in symptomatic women. Urinalysis with a positive nitrite or moderate pyuria and/or bacteruria are accurate predictors of a UTI. If the pretest probability of UTI is sufficiently low, a negative urinalysis can accurately rule out the diagnosis. © 2013 by the Society for Academic Emergency Medicine.

19 CFR 191.24 - Certificate of manufacture and delivery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 191.24 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... manufactured or produced under a general manufacturing drawback ruling, the unique computer-generated number... manufactured or produced under a specific manufacturing drawback ruling, either the unique computer number or...

19 CFR 191.24 - Certificate of manufacture and delivery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Section 191.24 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... manufactured or produced under a general manufacturing drawback ruling, the unique computer-generated number... manufactured or produced under a specific manufacturing drawback ruling, either the unique computer number or...

19 CFR 191.24 - Certificate of manufacture and delivery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Section 191.24 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... manufactured or produced under a general manufacturing drawback ruling, the unique computer-generated number... manufactured or produced under a specific manufacturing drawback ruling, either the unique computer number or...

19 CFR 191.24 - Certificate of manufacture and delivery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Section 191.24 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... manufactured or produced under a general manufacturing drawback ruling, the unique computer-generated number... manufactured or produced under a specific manufacturing drawback ruling, either the unique computer number or...

19 CFR 191.24 - Certificate of manufacture and delivery.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Section 191.24 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... manufactured or produced under a general manufacturing drawback ruling, the unique computer-generated number... manufactured or produced under a specific manufacturing drawback ruling, either the unique computer number or...

Strategies for diagnosing leg oedema in primary care: a qualitative study of GPs' approaches.

PubMed

Diederich, Judith; Hartel, Simone; Baum, Erika; Bösner, Stefan

2014-12-01

The symptom leg oedema represents a broad range of possible underlying aetiologies. The background of leg oedema is multifactorial and usually the GP is the first contact point for patients presenting with this symptom. GPs rely on patient history and physical examination as their main diagnostic tools. To identify GPs' diagnostic approaches and heuristics in patients presenting with leg oedema. Interviews with 15 GPs (20-30 min) using a semi-structured interview-guideline were conducted. GPs described their individual diagnostic strategies concerning all patients presenting with leg oedema they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters. GPs applied a variety of diagnostic approaches, which can be grouped in active and passive strategies. Active strategies comprised the use of decision rules and guidelines, Bayesian arguing, problem dichotomisation and discrepancy heuristics. Passive approaches included test of time, therapy as diagnosis, and taking patient assumptions into account. When dealing with leg oedema, GPs use prior information of individual patients in a specific way. There is a broad variety of diagnostic approaches that can be grouped in 'active' and 'passive' behaviour. Approaches mostly match with established diagnostic strategies in primary care.

Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

PubMed Central

Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire

2012-01-01

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023

An Algorithm of Association Rule Mining for Microbial Energy Prospection

PubMed Central

Shaheen, Muhammad; Shahbaz, Muhammad

2017-01-01

The presence of hydrocarbons beneath earth’s surface produces some microbiological anomalies in soils and sediments. The detection of such microbial populations involves pure bio chemical processes which are specialized, expensive and time consuming. This paper proposes a new algorithm of context based association rule mining on non spatial data. The algorithm is a modified form of already developed algorithm which was for spatial database only. The algorithm is applied to mine context based association rules on microbial database to extract interesting and useful associations of microbial attributes with existence of hydrocarbon reserve. The surface and soil manifestations caused by the presence of hydrocarbon oxidizing microbes are selected from existing literature and stored in a shared database. The algorithm is applied on the said database to generate direct and indirect associations among the stored microbial indicators. These associations are then correlated with the probability of hydrocarbon’s existence. The numerical evaluation shows better accuracy for non-spatial data as compared to conventional algorithms at generating reliable and robust rules. PMID:28393846

Rule Extraction Based on Extreme Learning Machine and an Improved Ant-Miner Algorithm for Transient Stability Assessment.

PubMed

Li, Yang; Li, Guoqing; Wang, Zhenhao

2015-01-01

In order to overcome the problems of poor understandability of the pattern recognition-based transient stability assessment (PRTSA) methods, a new rule extraction method based on extreme learning machine (ELM) and an improved Ant-miner (IAM) algorithm is presented in this paper. First, the basic principles of ELM and Ant-miner algorithm are respectively introduced. Then, based on the selected optimal feature subset, an example sample set is generated by the trained ELM-based PRTSA model. And finally, a set of classification rules are obtained by IAM algorithm to replace the original ELM network. The novelty of this proposal is that transient stability rules are extracted from an example sample set generated by the trained ELM-based transient stability assessment model by using IAM algorithm. The effectiveness of the proposed method is shown by the application results on the New England 39-bus power system and a practical power system--the southern power system of Hebei province.

The Manchester Acute Coronary Syndromes (MACS) decision rule: validation with a new automated assay for heart-type fatty acid binding protein.

PubMed

Body, Richard; Burrows, Gillian; Carley, Simon; Lewis, Philip S

2015-10-01

The Manchester Acute Coronary Syndromes (MACS) decision rule may enable acute coronary syndromes to be immediately 'ruled in' or 'ruled out' in the emergency department. The rule incorporates heart-type fatty acid binding protein (h-FABP) and high sensitivity troponin T levels. The rule was previously validated using a semiautomated h-FABP assay that was not practical for clinical implementation. We aimed to validate the rule with an automated h-FABP assay that could be used clinically. In this prospective diagnostic cohort study we included patients presenting to the emergency department with suspected cardiac chest pain. Serum drawn on arrival was tested for h-FABP using an automated immunoturbidimetric assay (Randox) and high sensitivity troponin T (Roche). The primary outcome, a diagnosis of acute myocardial infarction (AMI), was adjudicated based on 12 h troponin testing. A secondary outcome, major adverse cardiac events (MACE; death, AMI, revascularisation or new coronary stenosis), was determined at 30 days. Of the 456 patients included, 78 (17.1%) had AMI and 97 (21.3%) developed MACE. Using the automated h-FABP assay, the MACS rule had the same C-statistic for MACE as the original rule (0.91; 95% CI 0.88 to 0.92). 18.9% of patients were identified as 'very low risk' and thus eligible for immediate discharge with no missed AMIs and a 2.3% incidence of MACE (n=2, both coronary stenoses). 11.1% of patients were classed as 'high-risk' and had a 92.0% incidence of MACE. Our findings validate the performance of a refined MACS rule incorporating an automated h-FABP assay, facilitating use in clinical settings. The effectiveness of this refined rule should be verified in an interventional trial prior to implementation. UK CRN 8376. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT.

PubMed

Ochs, Marco M; Siepen, Fabian Aus dem; Fritz, Thomas; Andre, Florian; Gitsioudis, Gitsios; Korosoglou, Grigorios; Seitz, Sebastian; Bogomazov, Yuriy; Schlett, Christopher L; Sokiranski, Roman; Sommer, Andre; Gückel, Friedemann; Brado, Matthias; Kauczor, Hans-Ulrich; Görich, Johannes; Friedrich, Matthias G W; Katus, Hugo A; Buss, Sebastian J

2017-07-01

The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA. SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts. SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.

With a little help from a computer: discriminating between bacterial and viral meningitis based on dominance-based rough set approach analysis

PubMed Central

Gowin, Ewelina; Januszkiewicz-Lewandowska, Danuta; Słowiński, Roman; Błaszczyński, Jerzy; Michalak, Michał; Wysocki, Jacek

2017-01-01

Abstract Differential Diagnosis of bacterial and viral meningitis remains an important clinical problem. A number of methods to assist in the diagnoses of meningitis have been developed, but none of them have been found to have high specificity with 100% sensitivity. We conducted a retrospective analysis of the medical records of 148 children hospitalized in St. Joseph Children's Hospital in Poznań. In this study, we applied for the first time the original methodology of dominance-based rough set approach (DRSA) to diagnostic patterns of meningitis data and represented them by decision rules useful in discriminating between bacterial and viral meningitis. The induction algorithm is called VC-DomLEM; it has been implemented as software package called jMAF (http://www.cs.put.poznan.pl/jblaszczynski/Site/jRS.html), based on java Rough Set (jRS) library. In the studied group, there were 148 patients (78 boys and 70 girls), and the mean age was 85 months. We analyzed 14 attributes, of which only 4 were used to generate the 6 rules, with C-reactive protein (CRP) being the most valuable. Factors associated with bacterial meningitis were: CRP level ≥86 mg/L, number of leukocytes in cerebrospinal fluid (CSF) ≥4481 μL−1, symptoms duration no longer than 2 days, or age less than 1 month. Factors associated with viral meningitis were CRP level not higher than 19 mg/L, or CRP level not higher than 84 mg/L in a patient older than 11 months with no more than 1100 μL−1 leukocytes in CSF. We established the minimum set of attributes significant for classification of patients with meningitis. This is new set of rules, which, although intuitively anticipated by some clinicians, has not been formally demonstrated until now. PMID:28796045

With a little help from a computer: discriminating between bacterial and viral meningitis based on dominance-based rough set approach analysis.

PubMed

Gowin, Ewelina; Januszkiewicz-Lewandowska, Danuta; Słowiński, Roman; Błaszczyński, Jerzy; Michalak, Michał; Wysocki, Jacek

2017-08-01

Differential Diagnosis of bacterial and viral meningitis remains an important clinical problem. A number of methods to assist in the diagnoses of meningitis have been developed, but none of them have been found to have high specificity with 100% sensitivity.We conducted a retrospective analysis of the medical records of 148 children hospitalized in St. Joseph Children's Hospital in Poznań. In this study, we applied for the first time the original methodology of dominance-based rough set approach (DRSA) to diagnostic patterns of meningitis data and represented them by decision rules useful in discriminating between bacterial and viral meningitis. The induction algorithm is called VC-DomLEM; it has been implemented as software package called jMAF (http://www.cs.put.poznan.pl/jblaszczynski/Site/jRS.html), based on java Rough Set (jRS) library.In the studied group, there were 148 patients (78 boys and 70 girls), and the mean age was 85 months. We analyzed 14 attributes, of which only 4 were used to generate the 6 rules, with C-reactive protein (CRP) being the most valuable.Factors associated with bacterial meningitis were: CRP level ≥86 mg/L, number of leukocytes in cerebrospinal fluid (CSF) ≥4481 μL, symptoms duration no longer than 2 days, or age less than 1 month. Factors associated with viral meningitis were CRP level not higher than 19 mg/L, or CRP level not higher than 84 mg/L in a patient older than 11 months with no more than 1100 μL leukocytes in CSF.We established the minimum set of attributes significant for classification of patients with meningitis. This is new set of rules, which, although intuitively anticipated by some clinicians, has not been formally demonstrated until now.

Efficiency of reactant site sampling in network-free simulation of rule-based models for biochemical systems

PubMed Central

Yang, Jin; Hlavacek, William S.

2011-01-01

Rule-based models, which are typically formulated to represent cell signaling systems, can now be simulated via various network-free simulation methods. In a network-free method, reaction rates are calculated for rules that characterize molecular interactions, and these rule rates, which each correspond to the cumulative rate of all reactions implied by a rule, are used to perform a stochastic simulation of reaction kinetics. Network-free methods, which can be viewed as generalizations of Gillespie’s method, are so named because these methods do not require that a list of individual reactions implied by a set of rules be explicitly generated, which is a requirement of other methods for simulating rule-based models. This requirement is impractical for rule sets that imply large reaction networks (i.e., long lists of individual reactions), as reaction network generation is expensive. Here, we compare the network-free simulation methods implemented in RuleMonkey and NFsim, general-purpose software tools for simulating rule-based models encoded in the BioNetGen language. The method implemented in NFsim uses rejection sampling to correct overestimates of rule rates, which introduces null events (i.e., time steps that do not change the state of the system being simulated). The method implemented in RuleMonkey uses iterative updates to track rule rates exactly, which avoids null events. To ensure a fair comparison of the two methods, we developed implementations of the rejection and rejection-free methods specific to a particular class of kinetic models for multivalent ligand-receptor interactions. These implementations were written with the intention of making them as much alike as possible, minimizing the contribution of irrelevant coding differences to efficiency differences. Simulation results show that performance of the rejection method is equal to or better than that of the rejection-free method over wide parameter ranges. However, when parameter values are such that ligand-induced aggregation of receptors yields a large connected receptor cluster, the rejection-free method is more efficient. PMID:21832806

Cellular Automata for Spatiotemporal Pattern Formation from Reaction-Diffusion Partial Differential Equations

NASA Astrophysics Data System (ADS)

Ohmori, Shousuke; Yamazaki, Yoshihiro

2016-01-01

Ultradiscrete equations are derived from a set of reaction-diffusion partial differential equations, and cellular automaton rules are obtained on the basis of the ultradiscrete equations. Some rules reproduce the dynamical properties of the original reaction-diffusion equations, namely, bistability and pulse annihilation. Furthermore, other rules bring about soliton-like preservation and periodic pulse generation with a pacemaker, which are not obtained from the original reaction-diffusion equations.

Generative rules of Drosophila locomotor behavior as a candidate homology across phyla

PubMed Central

Gomez-Marin, Alex; Oron, Efrat; Gakamsky, Anna; Dan Valente; Benjamini, Yoav; Golani, Ilan

2016-01-01

The discovery of shared behavioral processes across phyla is a significant step in the establishment of a comparative study of behavior. We use immobility as an origin and reference for the measurement of fly locomotor behavior; speed, walking direction and trunk orientation as the degrees of freedom shaping this behavior; and cocaine as the parameter inducing progressive transitions in and out of immobility. We characterize and quantify the generative rules that shape Drosophila locomotor behavior, bringing about a gradual buildup of kinematic degrees of freedom during the transition from immobility to normal behavior, and the opposite narrowing down into immobility. Transitions into immobility unfold via sequential enhancement and then elimination of translation, curvature and finally rotation. Transitions out of immobility unfold by progressive addition of these degrees of freedom in the opposite order. The same generative rules have been found in vertebrate locomotor behavior in several contexts (pharmacological manipulations, ontogeny, social interactions) involving transitions in-and-out of immobility. Recent claims for deep homology between arthropod central complex and vertebrate basal ganglia provide an opportunity to examine whether the rules we report also share common descent. Our approach prompts the discovery of behavioral homologies, contributing to the elusive problem of behavioral evolution. PMID:27271799

Hybrid modeling of nitrate fate in large catchments using fuzzy-rules

NASA Astrophysics Data System (ADS)

van der Heijden, Sven; Haberlandt, Uwe

2010-05-01

Especially for nutrient balance simulations, physically based ecohydrological modeling needs an abundance of measured data and model parameters, which for large catchments all too often are not available in sufficient spatial or temporal resolution or are simply unknown. For efficient large-scale studies it is thus beneficial to have methods at one's disposal which are parsimonious concerning the number of model parameters and the necessary input data. One such method is fuzzy-rule based modeling, which compared to other machine-learning techniques has the advantages to produce models (the fuzzy-rules) which are physically interpretable to a certain extent, and to allow the explicit introduction of expert knowledge through pre-defined rules. The study focuses on the application of fuzzy-rule based modeling for nitrate simulation in large catchments, in particular concerning decision support. Fuzzy-rule based modeling enables the generation of simple, efficient, easily understandable models with nevertheless satisfactory accuracy for problems of decision support. The chosen approach encompasses a hybrid metamodeling, which includes the generation of fuzzy-rules with data originating from physically based models as well as a coupling with a physically based water balance model. For the generation of the needed training data and also as coupled water balance model the ecohydrological model SWAT is employed. The conceptual model divides the nitrate pathway into three parts. The first fuzzy-module calculates nitrate leaching with the percolating water from soil surface to groundwater, the second module simulates groundwater passage, and the final module replaces the in-stream processes. The aim of this modularization is to create flexibility for using each of the modules on its own, for changing or completely replacing it. For fuzzy-rule based modeling this can explicitly mean that the re-training of one of the modules with newly available data will be possible without problem, while the module assembly does not have to be modified. Apart from the concept of hybrid metamodeling first results are presented for the fuzzy-module for nitrate passage through the unsaturated zone.

Computer based interpretation of infrared spectra-structure of the knowledge-base, automatic rule generation and interpretation

NASA Astrophysics Data System (ADS)

Ehrentreich, F.; Dietze, U.; Meyer, U.; Abbas, S.; Schulz, H.

1995-04-01

It is a main task within the SpecInfo-Project to develop interpretation tools that can handle a great deal more of the complicated, more specific spectrum-structure-correlations. In the first step the empirical knowledge about the assignment of structural groups and their characteristic IR-bands has been collected from literature and represented in a computer readable well-structured form. Vague, verbal rules are managed by introduction of linguistic variables. The next step was the development of automatic rule generating procedures. We had combined and enlarged the IDIOTS algorithm with the algorithm by Blaffert relying on set theory. The procedures were successfully applied to the SpecInfo database. The realization of the preceding items is a prerequisite for the improvement of the computerized structure elucidation procedure.

Toward sensor-based context aware systems.

PubMed

Sakurai, Yoshitaka; Takada, Kouhei; Anisetti, Marco; Bellandi, Valerio; Ceravolo, Paolo; Damiani, Ernesto; Tsuruta, Setsuo

2012-01-01

This paper proposes a methodology for sensor data interpretation that can combine sensor outputs with contexts represented as sets of annotated business rules. Sensor readings are interpreted to generate events labeled with the appropriate type and level of uncertainty. Then, the appropriate context is selected. Reconciliation of different uncertainty types is achieved by a simple technique that moves uncertainty from events to business rules by generating combs of standard Boolean predicates. Finally, context rules are evaluated together with the events to take a decision. The feasibility of our idea is demonstrated via a case study where a context-reasoning engine has been connected to simulated heartbeat sensors using prerecorded experimental data. We use sensor outputs to identify the proper context of operation of a system and trigger decision-making based on context information.

Diagnostic examination of the child with urolithiasis or nephrocalcinosis.

PubMed

Hoppe, Bernd; Kemper, Markus J

2010-03-01

Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis.

TROUBLE 3: A fault diagnostic expert system for Space Station Freedom's power system

NASA Technical Reports Server (NTRS)

Manner, David B.

1990-01-01

Designing Space Station Freedom has given NASA many opportunities to develop expert systems that automate onboard operations of space based systems. One such development, TROUBLE 3, an expert system that was designed to automate the fault diagnostics of Space Station Freedom's electric power system is described. TROUBLE 3's design is complicated by the fact that Space Station Freedom's power system is evolving and changing. TROUBLE 3 has to be made flexible enough to handle changes with minimal changes to the program. Three types of expert systems were studied: rule-based, set-covering, and model-based. A set-covering approach was selected for TROUBLE 3 because if offered the needed flexibility that was missing from the other approaches. With this flexibility, TROUBLE 3 is not limited to Space Station Freedom applications, it can easily be adapted to handle any diagnostic system.

New laser sources for clinical treatment and diagnostics of neonatal jaundice

NASA Astrophysics Data System (ADS)

Hamza, Mostafa; El-Ahl, Mohammad H. S.; Hamza, Ahmad M.

2001-06-01

An elevated serum bilirubin concentration in the newborn infant presents a therapeutic as well as a diagnostic problem to the physician. It has long been recognized that high levels of bilirubin cause irreversible brain damage and even death. The authors introduce the use of semiconductor diode lasers and diode-pumped solid-state lasers that can be used for solving such diagnostic and therapeutic problems. These new laser sources can improve the ergonomics of using laser, enhance performance capabilities and reduce the cost of employing laser energy to pump bilirubin out of an infant's body. The choice of laser wavelengths follows the principles of bilirubinometry and phototherapy of neonatal jaundice. The wide spread use of these new laser sources for clinical monitoring and treatment of neonatal hyperbilirubinemia will be made possible as each incremental or quantum jump cost reduction is achieved. Our leading clinical experience as well as the selection rules of laser wavelengths will be presented.

[Primary malignant melanoma of the central nervous system: A diagnostic challenge].

PubMed

Quillo-Olvera, Javier; Uribe-Olalde, Juan Salvador; Alcántara-Gómez, Leopoldo Alberto; Rejón-Pérez, Jorge Dax; Palomera-Gómez, Héctor Guillermo

2015-01-01

The rare incidence of primary malignant melanoma of the central nervous system and its ability to mimic other melanocytic tumors on images makes it a diagnostic challenge for the neurosurgeon. A 51-year-old patient, with a tumor located in the right forniceal callosum area. Total surgical excision was performed. Histopathological result was consistent with the diagnosis of primary malignant melanoma of the central nervous system, after ruling out extra cranial and extra spinal melanocytic lesions. The primary malignant melanoma of the central nervous system is extremely rare. There are features in magnetic resonance imaging that increase the diagnostic suspicion; nevertheless there are other tumors with more prevalence that share some of these features through image. Since there is not an established therapeutic standard its prognosis is discouraging. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Utility of a point-of-care malaria rapid diagnostic test for excluding malaria as the cause of fever among HIV-positive adults in rural Rakai, Uganda.

PubMed

Mills, Lisa A; Kagaayi, Joseph; Nakigozi, Gertrude; Galiwango, Ronald M; Ouma, Joseph; Shott, Joseph P; Ssempijja, Victor; Gray, Ronald H; Wawer, Maria J; Serwadda, David; Quinn, Thomas C; Reynolds, Steven J

2010-01-01

We compared results of a malaria rapid diagnostic test (Binax Now Malaria, Binax-M, Inverness Medical Innovations, Inc., Waltham, MA) performed at rural mobile clinics in Uganda by clinicians evaluating febrile adult HIV patients to thick smear evaluated at a central laboratory by trained microscopists. Two hundred forty-six samples were analyzed, including 14 (5.7%) which were thick-smear positive for falciparum malaria. Sensitivity of Binax-M compared with thick smear was 85.7% (95% CI: 57.2-98.2), specificity 97.8% (95% CI: 94.9-99.3), positive and negative predictive values were 70.6% (95% CI: 44.0-89.7) and 99.1% (95% CI: 96.8-99.9), respectively. The rapid diagnostic test accurately ruled malaria "in or out" at the point-of-care, facilitating appropriate clinical management and averting unnecessary anti-malarial therapy.

Molecular engineering of antibodies for therapeutic and diagnostic purposes

PubMed Central

Ducancel, Frédéric; Muller, Bruno H.

2012-01-01

During the past ten years, monoclonal antibodies (mAbs) have taken center stage in the field of targeted therapy and diagnosis. This increased interest in mAbs is due to their binding accuracy (affinity and specificity) together with the original molecular and structural rules that govern interactions with their cognate antigen. In addition, the effector properties of antibodies constitute a second major advantage associated with their clinical use. The development of molecular and structural engineering and more recently of in vitro evolution of antibodies has opened up new perspectives in the de novo design of antibodies more adapted to clinical and diagnostic use. Thus, efforts are regularly made by researchers to improve or modulate antibody recognition properties, to adapt their pharmacokinetics, engineer their stability, and control their immunogenicity. This review presents the latest molecular engineering results on mAbs with therapeutic and diagnostic applications. PMID:22684311

Cue-type manipulation dissociates two types of task set inhibition: backward inhibition and competitor rule suppression.

PubMed

Regev, Shirley; Meiran, Nachshon

2016-07-01

Backward inhibition (BI) reflects the suppression of a recently abandoned task set to allow for smooth transition to a new task even when the rules do not generate a response conflict. Competitor rule suppression (CRS) reflects the inhibition/suppression of irrelevant task rules when these rules generate a response conflict even if they have not recently been abandoned. We assessed whether BI and CRS are differentially affected by the difficulty in retrieving category-response mappings from memory. Retrieval demands were manipulated via the information provided by the task cues, which either indicated the relevant dimension (dimension cues; "color") or the relevant dimension with its category-to-key mapping (mapping cues; "red green", indicating that "red" and "green" go with the left/right responses, respectively). CRS was larger with dimension compared to mapping cues when cue-type varied between groups and was larger after trials involving dimension cues when cue-type varied on a trial-by-trial basis. In contrast, BI was not influenced by cue-type. These results suggest that task switching involve at least two distinct inhibitory processes, with CRS being related to the ease of retrieval of category-response mappings from memory.

Style-independent document labeling: design and performance evaluation

NASA Astrophysics Data System (ADS)

Mao, Song; Kim, Jong Woo; Thoma, George R.

2003-12-01

The Medical Article Records System or MARS has been developed at the U.S. National Library of Medicine (NLM) for automated data entry of bibliographical information from medical journals into MEDLINE, the premier bibliographic citation database at NLM. Currently, a rule-based algorithm (called ZoneCzar) is used for labeling important bibliographical fields (title, author, affiliation, and abstract) on medical journal article page images. While rules have been created for medical journals with regular layout types, new rules have to be manually created for any input journals with arbitrary or new layout types. Therefore, it is of interest to label any journal articles independent of their layout styles. In this paper, we first describe a system (called ZoneMatch) for automated generation of crucial geometric and non-geometric features of important bibliographical fields based on string-matching and clustering techniques. The rule based algorithm is then modified to use these features to perform style-independent labeling. We then describe a performance evaluation method for quantitatively evaluating our algorithm and characterizing its error distributions. Experimental results show that the labeling performance of the rule-based algorithm is significantly improved when the generated features are used.

Using pattern enumeration to accelerate process development and ramp yield

NASA Astrophysics Data System (ADS)

Zhuang, Linda; Pang, Jenny; Xu, Jessy; Tsai, Mengfeng; Wang, Amy; Zhang, Yifan; Sweis, Jason; Lai, Ya-Chieh; Ding, Hua

2016-03-01

During a new technology node process setup phase, foundries do not initially have enough product chip designs to conduct exhaustive process development. Different operational teams use manually designed simple test keys to set up their process flows and recipes. When the very first version of the design rule manual (DRM) is ready, foundries enter the process development phase where new experiment design data is manually created based on these design rules. However, these IP/test keys contain very uniform or simple design structures. This kind of design normally does not contain critical design structures or process unfriendly design patterns that pass design rule checks but are found to be less manufacturable. It is desired to have a method to generate exhaustive test patterns allowed by design rules at development stage to verify the gap of design rule and process. This paper presents a novel method of how to generate test key patterns which contain known problematic patterns as well as any constructs which designers could possibly draw based on current design rules. The enumerated test key patterns will contain the most critical design structures which are allowed by any particular design rule. A layout profiling method is used to do design chip analysis in order to find potential weak points on new incoming products so fab can take preemptive action to avoid yield loss. It can be achieved by comparing different products and leveraging the knowledge learned from previous manufactured chips to find possible yield detractors.

Is Bipolar Disorder the Most Common Diagnostic Entity in Hospitalized Adolescents and Children?

ERIC Educational Resources Information Center

Isaac, George

1995-01-01

An evaluation of all children and adolescents (n=57) admitted to an acute psychiatric unit over a 3-month period was undertaken to determine the presence of bipolar disorder. Findings indicated that bipolar disorder was the most common diagnosis; thus, this disorder has to be ruled out in all youth admitted to acute care psychiatric units. (JPS)

Neural net diagnostics for VLSI test

NASA Technical Reports Server (NTRS)

Lin, T.; Tseng, H.; Wu, A.; Dogan, N.; Meador, J.

1990-01-01

This paper discusses the application of neural network pattern analysis algorithms to the IC fault diagnosis problem. A fault diagnostic is a decision rule combining what is known about an ideal circuit test response with information about how it is distorted by fabrication variations and measurement noise. The rule is used to detect fault existence in fabricated circuits using real test equipment. Traditional statistical techniques may be used to achieve this goal, but they can employ unrealistic a priori assumptions about measurement data. Our approach to this problem employs an adaptive pattern analysis technique based on feedforward neural networks. During training, a feedforward network automatically captures unknown sample distributions. This is important because distributions arising from the nonlinear effects of process variation can be more complex than is typically assumed. A feedforward network is also able to extract measurement features which contribute significantly to making a correct decision. Traditional feature extraction techniques employ matrix manipulations which can be particularly costly for large measurement vectors. In this paper we discuss a software system which we are developing that uses this approach. We also provide a simple example illustrating the use of the technique for fault detection in an operational amplifier.

Evaluating the performance of a fault detection and diagnostic system for vapor compression equipment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Breuker, M.S.; Braun, J.E.

This paper presents a detailed evaluation of the performance of a statistical, rule-based fault detection and diagnostic (FDD) technique presented by Rossi and Braun (1997). Steady-state and transient tests were performed on a simple rooftop air conditioner over a range of conditions and fault levels. The steady-state data without faults were used to train models that predict outputs for normal operation. The transient data with faults were used to evaluate FDD performance. The effect of a number of design variables on FDD sensitivity for different faults was evaluated and two prototype systems were specified for more complete evaluation. Good performancemore » was achieved in detecting and diagnosing five faults using only six temperatures (2 input and 4 output) and linear models. The performance improved by about a factor of two when ten measurements (three input and seven output) and higher order models were used. This approach for evaluating and optimizing the performance of the statistical, rule-based FDD technique could be used as a design and evaluation tool when applying this FDD method to other packaged air-conditioning systems. Furthermore, the approach could also be modified to evaluate the performance of other FDD methods.« less

77 FR 77032 - Healthcare Trade Mission to Russia, June 3-7, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

... humans. The world market for biotechnology (used for molecular genetics diagnostic technologies) was $13... generation vaccines, antibiotics and bacteriophages) 2. Biomedicine (molecular diagnostics, personalized...

78 FR 32369 - Healthcare Trade Mission to Russia, October 21-25, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

... environment on humans. The world market of biotechnology (used for molecular genetics diagnostic technologies..., phytomedicines, new generation vaccines, antibiotics and bacteriophages). Biomedicine (molecular diagnostics...

CONSTRAINTS ON VARIABLES IN SYNTAX.

ERIC Educational Resources Information Center

ROSS, JOHN ROBERT

IN ATTEMPTING TO DEFINE "SYNTACTIC VARIABLE," THE AUTHOR BASES HIS DISCUSSION ON THE ASSUMPTION THAT SYNTACTIC FACTS ARE A COLLECTION OF TWO TYPES OF RULES--CONTEXT-FREE PHRASE STRUCTURE RULES (GENERATING UNDERLYING OR DEEP PHRASE MARKERS) AND GRAMMATICAL TRANSFORMATIONS, WHICH MAP UNDERLYING PHRASE MARKERS ONTO SUPERFICIAL (OR SURFACE) PHRASE…

Training Material on Notification Under the Hazardous Waste Generators Academic Laboratories Rule

EPA Pesticide Factsheets

Guidance for eligible academic laboratories trying to figure out what the notification requirements are under the Academic Labs Rule 40 CFR 262 subpart K and when filling out RCRA Subtitle C Site Identification Form (8700-12) to obtain an EPA ID number.

Plasma diagnostic development and UHV testing for the ALPHA collaboration at Marquette University

NASA Astrophysics Data System (ADS)

Tharp, T. D.; Alpha Collaboration

2017-10-01

At Marquette, we are developing the next generation of nonneutral plasma diagnostics for the ALPHA experiment at CERN. ALPHA is building a new vertical experiment to test the gravitational interaction of antihydrogen with Earth. This expansion requires significant changes to the design of our plasma diagnostic suites: the next generation of tools must be able to measure plasmas from two directions, and must be capable of operating in a horizontal position. The diagnostic suite includes measurements of plasma density, shape, and temperature. The hardware used includes a MicroChannel Plate (MCP), a Faraday Cup, and an electron gun. In addition, we are building a vacuum chamber to test the viability of 3-d printed components for UHV compatibility, with target pressures of 10-10 mbar.

Diagnostic Hysteroscopy - A Retrospective Study of 1545 Cases

PubMed Central

STEFANESCU, Andreea; MARINESCU, Bogdan

2012-01-01

ABSTRACT Introduction: The development of hysteroscopy has provided a minimally invasive approach to common gynecologic problems, such as abnormal uterine bleeding. Diagnostic hysteroscopy is considered now "the gold standard" by the Association of Professors of Gynecology and Obstetrics (2002) in investigation of abnormal uterine bleeding (AUB) in order to rule out organic endouterine causes of AUB. Although the World Health Organization (WHO) recommends hysterosapingography (HSG) alone for management of infertile women many specialists use hysteroscopy as a first-line routine exam for infertility patients regardless of guidelines. Material and method: This paper is a retrospective study of 1545 diagnostic hysteroscopies performed in the "Prof. Dr. Panait Sirbu" Obstetrics and Gynecology Hospital between January 1, 2008 and June 30, 2011. The following parameters were studied: diagnostic hysteroscopy indications, type of anesthesia used, correlation between pre-and postoperative diagnoses. Outcomes: Of 1545 diagnostic hysteroscopies, 78% of cases were performed without anesthesia; of the total of 299 cases of primary infertility diagnostic hysteroscopy showed in 34% of cases tubal obstruction and endouterine pathology; of the total 396 cases of secondary infertility under investigation, diagnostic hysteroscopy showed in 40% of cases tubal obstruction and endouterine pathology; the highest accuracy of HSG was noted for uterine malformation and minimal accuracy was observed for intrauterine adhesions. Conclusions: Our experience supports the opinion that diagnostic hysteroscopy should be a first-line routine exam in infertility. Because of the high rate of false positive results for HSG in our study and considering the other studies in specialty literature, we always perform a diagnostic hysteroscopy before Assisted Human Reproduction procedures regardless of the HSG aspect. PMID:23483793

How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews.

PubMed

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Ammirati, Christine; Bertrand, Catherine; Dory, Valérie; Charlin, Bernard

2014-12-01

The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses. We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective. The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available. The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

21 CFR Appendix B to Subpart B of... - Scope of Product Coverage

Code of Federal Regulations, 2013 CFR

2013-04-01

... Portable air compressor 2 Cardiovascular Panel Cardiovascular Diagnostic 870.1425 Programmable diagnostic... Pacemaker & Accessories 870.1750 External programmable pacemaker pulse generator 2 870.3630 Pacemaker...

21 CFR Appendix B to Subpart B of... - Scope of Product Coverage

Code of Federal Regulations, 2014 CFR

2014-04-01

... Portable air compressor 2 Cardiovascular Panel Cardiovascular Diagnostic 870.1425 Programmable diagnostic... Pacemaker & Accessories 870.1750 External programmable pacemaker pulse generator 2 870.3630 Pacemaker...

21 CFR Appendix B to Subpart B of... - Scope of Product Coverage

Code of Federal Regulations, 2012 CFR

2012-04-01

... Portable air compressor 2 Cardiovascular Panel Cardiovascular Diagnostic 870.1425 Programmable diagnostic... Pacemaker & Accessories 870.1750 External programmable pacemaker pulse generator 2 870.3630 Pacemaker...

RANWAR: rank-based weighted association rule mining from gene expression and methylation data.

PubMed

Mallik, Saurav; Mukhopadhyay, Anirban; Maulik, Ujjwal

2015-01-01

Ranking of association rules is currently an interesting topic in data mining and bioinformatics. The huge number of evolved rules of items (or, genes) by association rule mining (ARM) algorithms makes confusion to the decision maker. In this article, we propose a weighted rule-mining technique (say, RANWAR or rank-based weighted association rule-mining) to rank the rules using two novel rule-interestingness measures, viz., rank-based weighted condensed support (wcs) and weighted condensed confidence (wcc) measures to bypass the problem. These measures are basically depended on the rank of items (genes). Using the rank, we assign weight to each item. RANWAR generates much less number of frequent itemsets than the state-of-the-art association rule mining algorithms. Thus, it saves time of execution of the algorithm. We run RANWAR on gene expression and methylation datasets. The genes of the top rules are biologically validated by Gene Ontologies (GOs) and KEGG pathway analyses. Many top ranked rules extracted from RANWAR that hold poor ranks in traditional Apriori, are highly biologically significant to the related diseases. Finally, the top rules evolved from RANWAR, that are not in Apriori, are reported.

26 CFR 26.2651-1 - Generation assignment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Generation assignment. 26.2651-1 Section 26.2651... TAXES GENERATION-SKIPPING TRANSFER TAX REGULATIONS UNDER THE TAX REFORM ACT OF 1986 § 26.2651-1 Generation assignment. (a) Special rule for persons with a deceased parent—(1) In general. This paragraph (a...

26 CFR 26.2651-1 - Generation assignment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Generation assignment. 26.2651-1 Section 26... GIFT TAXES GENERATION-SKIPPING TRANSFER TAX REGULATIONS UNDER THE TAX REFORM ACT OF 1986 § 26.2651-1 Generation assignment. (a) Special rule for persons with a deceased parent—(1) In general. This paragraph (a...

26 CFR 26.2651-1 - Generation assignment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Generation assignment. 26.2651-1 Section 26.2651... TAXES GENERATION-SKIPPING TRANSFER TAX REGULATIONS UNDER THE TAX REFORM ACT OF 1986 § 26.2651-1 Generation assignment. (a) Special rule for persons with a deceased parent—(1) In general. This paragraph (a...

26 CFR 26.2651-1 - Generation assignment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Generation assignment. 26.2651-1 Section 26... GIFT TAXES GENERATION-SKIPPING TRANSFER TAX REGULATIONS UNDER THE TAX REFORM ACT OF 1986 § 26.2651-1 Generation assignment. (a) Special rule for persons with a deceased parent—(1) In general. This paragraph (a...

Incremental cost effectiveness evaluation in clinical research.

PubMed

Krummenauer, Frank; Landwehr, I

2005-01-28

The health economic evaluation of therapeutic and diagnostic strategies is of increasing importance in clinical research. Therefore also clinical trialists have to involve health economic aspects more frequently. However, whereas they are quite familiar with classical effect measures in clinical trials, the corresponding parameters in health economic evaluation of therapeutic and diagnostic procedures are still not this common. The concepts of incremental cost effectiveness ratios (ICERs) and incremental net health benefit (INHB) will be illustrated and contrasted along the cost effectiveness evaluation of cataract surgery with monofocal and multifocal intraocular lenses. ICERs relate the costs of a treatment to its clinical benefit in terms of a ratio expression (indexed as Euro per clinical benefit unit). Therefore ICERs can be directly compared to a pre-specified willingness to pay (WTP) benchmark, which represents the maximum costs, health insurers would invest to achieve one clinical benefit unit. INHBs estimate a treatment's net clinical benefit after accounting for its cost increase versus an established therapeutic standard. Resource allocation rules can be formulated by means of both effect measures. Both the ICER and the INHB approach enable the definition of directional resource allocation rules. The allocation decisions arising from these rules are identical, as long as the willingness to pay benchmark is fixed in advance. Therefore both strategies crucially call for a priori determination of both the underlying clinical benefit endpoint (such as gain in vision lines after cataract surgery or gain in quality-adjusted life years) and the corresponding willingness to pay benchmark. The use of incremental cost effectiveness and net health benefit estimates provides a rationale for health economic allocation discussions and founding decisions. It implies the same requirements on trial protocols as yet established for clinical trials, that is the a priori definition of primary hypotheses (formulated as an allocation rule involving a pre-specified willingness to pay benchmark) and the primary clinical benefit endpoint (as a rationale for effectiveness evaluation).

Refining Linear Fuzzy Rules by Reinforcement Learning

NASA Technical Reports Server (NTRS)

Berenji, Hamid R.; Khedkar, Pratap S.; Malkani, Anil

1996-01-01

Linear fuzzy rules are increasingly being used in the development of fuzzy logic systems. Radial basis functions have also been used in the antecedents of the rules for clustering in product space which can automatically generate a set of linear fuzzy rules from an input/output data set. Manual methods are usually used in refining these rules. This paper presents a method for refining the parameters of these rules using reinforcement learning which can be applied in domains where supervised input-output data is not available and reinforcements are received only after a long sequence of actions. This is shown for a generalization of radial basis functions. The formation of fuzzy rules from data and their automatic refinement is an important step in closing the gap between the application of reinforcement learning methods in the domains where only some limited input-output data is available.

Market protocols in ERCOT and their effect on wind generation

DOE PAGES

Sioshansi, Ramteen; Hurlbut, David

2009-08-22

Integrating wind generation into power systems and wholesale electricity markets presents unique challenges due to the characteristics of wind power, including its limited dispatchability, variability in generation, difficulty in forecasting resource availability, and the geographic location of wind resources. Texas has had to deal with many of these issues beginning in 2002 when it restructured its electricity industry and introduced aggressive renewable portfolio standards that helped spur major investments in wind generation. In this paper we discuss the issues that have arisen in designing market protocols that take account of these special characteristics of wind generation and survey the regulatorymore » and market rules that have been developed in Texas. We discuss the perverse incentives some of the rules gave wind generators to overschedule generation in order to receive balancing energy payments, and steps that have been taken to mitigate those incentive effects. Lastly, we discuss more recent steps taken by the market operator and regulators to ensure transmission capacity is available for new wind generators that are expected to come online in the future.« less

[Drug-induced fever: a diagnosis to remember].

PubMed

Vodovar, D; Le Beller, C; Lillo-Le-Louet, A; Hanslik, T; Megarbane, B

2014-03-01

Drug fever (DF) is a febrile reaction induced by a drug without additional clinical features like skin eruption. This adverse drug reaction is probably common but under diagnosed. While its outcome is generally favourable, DF generates unnecessary diagnostic procedures as well as hospitalisations or hospitalisation prolongations. Clinical presentation and biological findings are not specific. Fever is generally well tolerated but may be accompanied by general symptoms mimicking sepsis. Moderate biological disorders could be expected, including elevation or decrease in white blood cell count, eosinophilia, liver cytolysis, and increased C-reactive protein. An infection should be systematically ruled out. Clinical or biological signs of severity should question DF diagnosis. When DF is suspected, the involved drug(s) should be stopped after a reliable assessment of imputability. Antibiotics represent the most often implicated drugs. Fever disappearance after discontinuing the suspected drug is the cornerstone of DF diagnosis. Before stopping the administration of the suspected drug(s), a risk/benefit ratio assessment is necessary. Consistently, it may be complicated to stop an antimicrobial drug when treating an infection or an immunosuppressive drug if required. Copyright © 2013. Published by Elsevier SAS.

PaPrBaG: A machine learning approach for the detection of novel pathogens from NGS data

NASA Astrophysics Data System (ADS)

Deneke, Carlus; Rentzsch, Robert; Renard, Bernhard Y.

2017-01-01

The reliable detection of novel bacterial pathogens from next-generation sequencing data is a key challenge for microbial diagnostics. Current computational tools usually rely on sequence similarity and often fail to detect novel species when closely related genomes are unavailable or missing from the reference database. Here we present the machine learning based approach PaPrBaG (Pathogenicity Prediction for Bacterial Genomes). PaPrBaG overcomes genetic divergence by training on a wide range of species with known pathogenicity phenotype. To that end we compiled a comprehensive list of pathogenic and non-pathogenic bacteria with human host, using various genome metadata in conjunction with a rule-based protocol. A detailed comparative study reveals that PaPrBaG has several advantages over sequence similarity approaches. Most importantly, it always provides a prediction whereas other approaches discard a large number of sequencing reads with low similarity to currently known reference genomes. Furthermore, PaPrBaG remains reliable even at very low genomic coverages. CombiningPaPrBaG with existing approaches further improves prediction results.

Space applications of artificial intelligence; Proceedings of the Annual Goddard Conference, Greenbelt, MD, May 16, 17, 1989

NASA Technical Reports Server (NTRS)

Rash, James L. (Editor); Dent, Carolyn P. (Editor)

1989-01-01

Theoretical and implementation aspects of AI systems for space applications are discussed in reviews and reports. Sections are devoted to planning and scheduling, fault isolation and diagnosis, data management, modeling and simulation, and development tools and methods. Particular attention is given to a situated reasoning architecture for space repair and replace tasks, parallel plan execution with self-processing networks, the electrical diagnostics expert system for Spacelab life-sciences experiments, diagnostic tolerance for missing sensor data, the integration of perception and reasoning in fast neural modules, a connectionist model for dynamic control, and applications of fuzzy sets to the development of rule-based expert systems.

Computer-Aided Diagnostic System For Mass Survey Chest Images

NASA Astrophysics Data System (ADS)

Yasuda, Yoshizumi; Kinoshita, Yasuhiro; Emori, Yasufumi; Yoshimura, Hitoshi

1988-06-01

In order to support screening of chest radiographs on mass survey, a computer-aided diagnostic system that automatically detects abnormality of candidate images using a digital image analysis technique has been developed. Extracting boundary lines of lung fields and examining their shapes allowed various kind of abnormalities to be detected. Correction and expansion were facilitated by describing the system control, image analysis control and judgement of abnormality in the rule type programing language. In the experiments using typical samples of student's radiograms, good results were obtained for the detection of abnormal shape of lung field, cardiac hypertrophy and scoliosis. As for the detection of diaphragmatic abnormality, relatively good results were obtained but further improvements will be necessary.

Triage tools for detecting cervical spine injury in pediatric trauma patients.

PubMed

Slaar, Annelie; Fockens, M M; Wang, Junfeng; Maas, Mario; Wilson, David J; Goslings, J Carel; Schep, Niels Wl; van Rijn, Rick R

2017-12-07

Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule (CCR). Both tools are proven to be accurate in deciding whether or not diagnostic imaging is needed in adults presenting for blunt trauma screening at the emergency department. However, little information is known about the accuracy of these triage tools in a pediatric population. To determine the diagnostic accuracy of the NEXUS criteria and the Canadian C-spine Rule in a pediatric population evaluated for CSI following blunt trauma. We searched the following databases to 24 February 2015: CENTRAL, MEDLINE, MEDLINE Non-Indexed and In-Process Citations, PubMed, Embase, Science Citation Index, ProQuest Dissertations & Theses Database, OpenGrey, ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment, and the Aggressive Research Intelligence Facility. We included all retrospective and prospective studies involving children following blunt trauma that evaluated the accuracy of the NEXUS criteria, the Canadian C-spine Rule, or both. Plain radiography, computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine, and follow-up were considered as adequate reference standards. Two review authors independently assessed the quality of included studies using the QUADAS-2 checklists. They extracted data on study design, patient characteristics, inclusion and exclusion criteria, clinical parameters, target condition, reference standard, and the diagnostic two-by-two table. We calculated and plotted sensitivity, specificity and negative predictive value in ROC space, and constructed forest plots for visual examination of variation in test accuracy. Three cohort studies were eligible for analysis, including 3380 patients ; 96 children were diagnosed with CSI. One study evaluated the accuracy of the Canadian C-spine Rule and the NEXUS criteria, and two studies evaluated the accuracy of the NEXUS criteria. The studies were of moderate quality. Due to the small number of included studies and the diverse outcomes of those studies, we could not describe a pooled estimate for the diagnostic test accuracy. The sensitivity of the NEXUS criteria of the individual studies was 0.57 (95% confidence interval (CI) 0.18 to 0.90), 0.98 (95% CI 0.91 to 1.00) and 1.00 (95% CI 0.88 to 1.00). The specificity of the NEXUS criteria was 0.35 (95% CI 0.25 to 0.45), 0.54 (95% CI 0.45 to 0.62) and 0.2 (95% CI 0.18 to 0.21). For the Canadian C-spine Rule the sensitivity was 0.86 (95% CI 0.42 to 1.00) and specificity was 0.15 (95% CI 0.08 to 0.23). Since the quantity of the data was small we were not able to investigate heterogeneity. There are currently few studies assessing the diagnostic test accuracy of the NEXUS criteria and CCR in children. At the moment, there is not enough evidence to determine the accuracy of the Canadian C-spine Rule to detect CSI in pediatric trauma patients following blunt trauma. The confidence interval of the sensitivity of the NEXUS criteria between the individual studies showed a wide range, with a lower limit varying from 0.18 to 0.91 with a total of four false negative test results, meaning that if physicians use the NEXUS criteria in children, there is a chance of missing CSI. Since missing CSI could have severe consequences with the risk of significant morbidity, we consider that the NEXUS criteria are at best a guide to clinical assessment, with current evidence not supporting strict or protocolized adoption of the tool into pediatric trauma care. Moreover, we have to keep in mind that the sensitivity differs among several studies, and individual confidence intervals of these studies show a wide range. Our main conclusion is therefore that additional well-designed studies with large sample sizes are required to better evaluate the accuracy of the NEXUS criteria or the Canadian C-spine Rule, or both, in order to determine whether they are appropriate triage tools for the clearance of the cervical spine in children following blunt trauma.

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring

PubMed Central

Syed, Shahbaz; Gatien, Mathieu; Perry, Jeffrey J.; Chaudry, Hina; Kim, Soo-Min; Kwong, Kenneth; Mukarram, Muhammad; Thiruganasambandamoorthy, Venkatesh

2017-01-01

BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring intervention in the emergency department or within 8 hours of presentation to the emergency department. We calculated diagnostic characteristics for the clinical prediction rule. RESULTS: We included 796 patients (mean age 63.8 yr, 55.8% male, 8.9% admitted to hospital). Fifteen patients (1.9%) had an arrhythmia, and the rule performed with the following characteristics: sensitivity 100% (95% confidence interval [CI] 78.2%–100%) and specificity 36.4% (95% CI 33.0%–39.6%). Application of the Ottawa Chest Pain Cardiac Monitoring Rule would have allowed 284 out of 796 patients (35.7%) to be safely removed from cardiac monitoring. INTERPRETATION: We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources. PMID:28246315

Design Characteristics Influence Performance of Clinical Prediction Rules in Validation: A Meta-Epidemiological Study.

PubMed

Ban, Jong-Wook; Emparanza, José Ignacio; Urreta, Iratxe; Burls, Amanda

2016-01-01

Many new clinical prediction rules are derived and validated. But the design and reporting quality of clinical prediction research has been less than optimal. We aimed to assess whether design characteristics of validation studies were associated with the overestimation of clinical prediction rules' performance. We also aimed to evaluate whether validation studies clearly reported important methodological characteristics. Electronic databases were searched for systematic reviews of clinical prediction rule studies published between 2006 and 2010. Data were extracted from the eligible validation studies included in the systematic reviews. A meta-analytic meta-epidemiological approach was used to assess the influence of design characteristics on predictive performance. From each validation study, it was assessed whether 7 design and 7 reporting characteristics were properly described. A total of 287 validation studies of clinical prediction rule were collected from 15 systematic reviews (31 meta-analyses). Validation studies using case-control design produced a summary diagnostic odds ratio (DOR) 2.2 times (95% CI: 1.2-4.3) larger than validation studies using cohort design and unclear design. When differential verification was used, the summary DOR was overestimated by twofold (95% CI: 1.2 -3.1) compared to complete, partial and unclear verification. The summary RDOR of validation studies with inadequate sample size was 1.9 (95% CI: 1.2 -3.1) compared to studies with adequate sample size. Study site, reliability, and clinical prediction rule was adequately described in 10.1%, 9.4%, and 7.0% of validation studies respectively. Validation studies with design shortcomings may overestimate the performance of clinical prediction rules. The quality of reporting among studies validating clinical prediction rules needs to be improved.

47 CFR 73.1660 - Acceptability of broadcast transmitters.

Code of Federal Regulations, 2010 CFR

2010-10-01

... station at which it is used. (d) AM stereophonic exciter-generators for interfacing with approved or... stereophonic exciter-generators in accordance with § 73.1690. (e) Additional rules covering certification and...

Concordance of DSM-5 and DSM-IV-TR classifications for autism spectrum disorder.

PubMed

Ohashi, Kei; Mizuno, Yoshifumi; Miyachi, Taishi; Asai, Tomoko; Imaeda, Masayuki; Saitoh, Shinji

2015-12-01

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013. Autism spectrum disorder (ASD) has been structured for the three subtypes of pervasive developmental disorder (PDD), but the number of impairment in social and communication dimension is not stated. The subjects were 68 children who visited the Department of Psychology and Development at Nagoya City University Hospital for the first time between the ages of 6 and 15 years old. We retrospectively re-examined the subjects using DSM-IV-TR criteria and DSM-5 criteria with two rules (two of three and one of three on the social and communication dimension) and examined the concordance rate. Forty subjects were diagnosed with PDD, and 28 were not. The mean PDD subject age was 9.4 years, and mean IQ was 84.0 on the Wechsler Intelligence Scale for Children III or 62.7 on the Tanaka-Binet test. Twenty-seven (68%) of the PDD subjects were classified with ASD using DSM-5 criteria when the two of three rule was applied, while 32 (80%) were classified with ASD when the one of three rule was applied. All subjects without PDD were not diagnosed with ASD on DSM-5 criteria. DSM-5 criteria may exclude high functioning and older subjects from ASD because they tend to be atypical. The diagnostic procedure for DSM-5 criteria is ambiguous, especially in high functioning subjects and those diagnosed at an older age. © 2015 Japan Pediatric Society.

The Effect of Draft DSM-5 Criteria on Posttraumatic Stress Disorder Prevalence

PubMed Central

Calhoun, Patrick S.; Hertzberg, Jeffrey S.; Kirby, Angela C.; Dennis, Michelle F.; Hair, Lauren P.; Dedert, Eric A.; Beckham, Jean C.

2012-01-01

Background This study was designed to examine the concordance of proposed DSM-5 posttraumatic stress disorder (PTSD) criteria with DSM-IV classification rules and examine the impact of the proposed DSM-5 PTSD criteria on prevalence. Method The sample (N=185) included participants who were recruited for studies focused on trauma and health conducted at an academic medical center and VA medical center in the southeastern United States. The prevalence and concordance between DSM-IV and the proposed DSM-5 classifications were calculated based on results from structured clinical interviews. Prevalence rates and diagnostic efficiency indices including sensitivity, specificity, area under the curve (AUC), and Kappa were calculated for each of the possible ways to define DSM-5 PTSD. Results Ninety-five percent of the sample reported an event that met both DSM-IV PTSD Criterion A1 and A2, but only 89% reported a trauma that met Criterion A on DSM-5. Results examining concordance between DSM-IV and DSM-5 algorithms indicated that several of the algorithms had AUCs above .90. The requirement of two symptoms from both Clusters D and E provided strong concordance to DSM-IV (AUC = .93; Kappa = .86) and a greater balance between sensitivity and specificity than requiring three symptoms in both Clusters D and E. Conclusions Despite several significant changes to the diagnostic criteria for PTSD for DSM-5, several possible classification rules provided good concordance with DSM-IV. The magnitude of the impact of DSM-5 decision rules on prevalence will be largely affected by the DSM-IV PTSD base rate in the population of interest. PMID:23109002

Side-locked headaches: an algorithm-based approach.

PubMed

Prakash, Sanjay; Rathore, Chaturbhuj

2016-12-01

The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice.Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.