bluuebunny/crossref_metadata_2025_split huggingface dataset:
Independence Estimating Equations for Controlled Clinical Trials with Small Sample Sizes
Authors: Dahmen G. , Ziegler A. 
Published: March 2018

Summary

Objectives:
The application of independence estimating equations (IEE) for controlled clinical trials (CCTs) has recently been discussed, and recommendations for its use have been derived for testing hypotheses. The robust estimator of variance has been shown to be liberal for small sample sizes. Therefore a series of modifications has been proposed. In this paper we systematically compare confidence intervals (CIs) proposed in the literature for situations that are common in CCTs.

Methods:
Using Monte-Carlo simulation studies, we compared the coverage probabilities of CIs and non-convergence probabilities for the parameters of the mean structure for small samples using modifications of the variance estimator proposed by Mancl and de Rouen [7], Morel et al. [8] and Pan [3].

Results:
None of the proposed modifications behave well in each investigated situation. For parallel group designs with repeated measurements and binary response the method proposed by Pan maintains the nominal level. We observed non-convergence of the IEE algorithm in up to 10% of the replicates depending on response probabilities in the treatment groups. For comparing slopes with continuous responses, the approach of Morel et al. can be recommended.

Conclusions:
Results of non-convergence probabilities show that IEE should not be used in parallel group designs with binary endpoints and response probabilities close to 0 or 1. Modifications of the robust variance estimator should be used for sample sizes up to 100 clusters for CI estimation.
Professional Ethics for System Developers in Health Care
Authors: Timpka T. 
Published: March 2018

AbstractMedical informaticians are multidisciplinary professionals responsible for developing complex technical systems. The aim of this study was to investigate how a code of ethics can help medical informaticians in avoiding design failures. An exploratory case study was performed to identify factors related to failure during system development. The literature on professional ethics was reviewed to derive a preliminary code of ethics. The case study showed that collaboration across individual and professional values is required to avoid failure during system development in health care. Having either the employer or the health care providers in focus for moral judgments may be misleading and cause confusion. The preliminary code emphasizes socialization, education and cooperation rather than enforced compliance. As a code is a distillation of experiences, its major benefit to medical informaticians should be its clarification of the profession’s position in society.
Analysis and Design of an Ontology for Intensive Care Diagnoses
Authors: Abu-Hanna A. , Cornet R. , Zwetsloot-Schonk J. H. M. , Stoutenbeek C. P. , de Keizer N. F. 
Published: March 2018

AbstractInformation about the patient‘s health status and about medical problems in general, play an important role in stratifying a patient population for quality assurance of intensive care. A terminological system which supports both the description of health problems for daily care practice and the aggregation of diagnostic information for evaluative research, is desirable for description of the patient population. This study describes the engineering of an ontology that facilitates a terminological system for intensive care diagnoses. We analyzed the criteria for such an ontology and evaluated existing terminological systems according to these criteria. The analysis shows that none of the existing terminological systems completely satisfies all our criteria. We describe choices regarding design, content and representation of a new ontology on which an adequate terminological system is based. The proposed ontology is characterized by the explicit and formal representation of the domain model, the metaspecification of its concepts, the vocabulary to define concepts and the nomenclature to support the composition of new concepts.
Factors Influencing Hospitalisation of Infants for Recurrent Gastroenteritis in Western Australia
Authors: Wang K. , Yau K. K. W. , Lee A. H. 
Published: March 2018

Summary
Objective: To determine factors affecting length of hospitalisation of infants for recurrent gastroenteritis using linked data records from the Western Australia heath information system.
Methods: A seven-year retrospective cohort study was undertaken on all infants born in Western Australia in 1995 who were admitted for gastroenteritis during their first year of life (n = 519). Linked hospitalisation records were retrieved to derive the outcome measure and other demographic variables for the cohort. Unlike previous studies that focused mainly on a single episode of gastroenteritis, the durations of successive hospitalisations were analysed using a proportional hazards model with correlated frailty to determine the prognostic factors influencing recurrent gastroenteritis.
Results: Older children experienced a shorter stay with an increased discharge rate of 1.9% for each month increase in admission age. An additional comorbidity recorded in the hospital discharge summary slowed the adjusted discharge rate by 46.5%. Aboriginal infants were readmitted to hospital more frequently, and had an adjusted hazard ratio of 0.253, implying a much higher risk of prolonged hospitalisation compared to non-Aborigines.
Conclusions: The use of linked hospitalisation records has the advantage of providing access to hospital-based population information in the context of medical informatics. The analysis of linked data has enabled the assessment of prognostic factors influencing length of hospitalisations for recurrent gastroenteritis with high statistical power.
The Laryngectomee Substitute Voice: Image Processing of Endoscopic Recordings by Fusion with Acoustic Signals
Authors: Döllinger M. , Schuster M. , Eysholdt U. , Hoppe U. , Lohscheller J. 
Published: March 2018

Summary
Objectives: The most radical cancer therapy of the throat is the total excision of the larynx which postoperatively results in the loss of voice. A widely-used method of voice rehabilitation is the insertion of a silicone valve, which establishes an unidirectional connection between trachea and esophagus. Thus, during exhalation, air can be directed from the trachea into the esophagus. This air stream excites tissue vibrations of the esophagus and the hypo-pharynx which act as a substitute voice generator. Purpose of the current study is to present a technique for visualizing the dynamics of the substitute voice generating element.
Methods: Digital high speed videos of the vibrating tissue are simultaneously recorded with the emitted acoustic signal. The high speed sequences are directly evaluated by a three-step knowledge based algorithm. It considers correlation between image and acoustic data, information about the gray value of each pixel, and continuity of tissue vibration. The temporal properties of an image series are investigated by evaluating the time dependent gray value at each pixel position.
Results: The applicability of the algorithm is exemplar-ily demonstrated using the data of one male patient. It enables the identification of the regions within an image series which are mainly responsible for the acoustic signal. Additionally, the dynamics of tissue vibrations are visualized. The main propagation direction can be clearly identified.
Conclusions: The new methodology summarizes the information about endoscopic and acoustic recordings of substitute voice into a single image. The results allow a first estimation of tissue velocity and elastic properties of oscillating tissue.
Individual Prognosis of Diabetes Long-term Risks: A CBR Approach
Authors: Palaudàries A. , Plaza E. , Armengol E. 
Published: March 2018

AbstractWe present DIRAS, an application to support physicians in determining the risk of complications for individual diabetic patients. The risk pattern of each diabetic patient is obtained using a Case-based Reasoning method called LID. Case-based Reasoning is an Artificial Intelligence technique based on solving new situations according to past experiences. For each patient, the LID method determines the risk of each diabetic complication according to the risk of already diagnosed patients. In addition, LID builds a description that can be viewed as an explanation of the obtained risk.
Characteristics of Consumer Terminology for Health Information Retrieval
Authors: Kogan S. , Ash N. , Greenes R. A. , Boxwala A. A. , Zeng Q. 
Published: March 2018

Summary
Objectives: As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health information retrieval.
Methods: Our study focused on consumer queries that were used on a consumer health service Web site and a consumer health information Web site. We analyzed data from the site-usage logs and conducted interviews with patients.
Results: Our findings show that consumers’ information retrieval performance is very poor. There are significant mismatches at all levels (lexical, semantic and mental models) between the consumer terminology and both the information source terminology and standard medical vocabularies.
Conclusions: Comprehensive terminology support on all levels is needed for consumer health information retrieval.
Periodical Multiphasic Screening and Lung Cancer Prevention
Authors: Carel R. S. 
Published: March 2018

AbstractThe purpose of this work is to evaluate the utilization of information gathered by multiphasic screening with respect to lung cancer detection and smoking cessation techniques. A cohort (follow-up) study is reported in which cancer incidence and factors affecting its occurrence are evaluated in a group of about 20,000 presumably healthy adults along a period of approximately 10 years following comprehensive multiphasic health examinations. Lung cancer occurrence is primarily related to smoking. The risk is higher in smokers and is dose-dependent; OR = 0.21, (CI = 0.08,.53) in never smokers, OR = 1.53 (CI = 0.8,3.2) in past and current moderate smokers, OR = 4.92 (CI = 2.18,11.11) in current heavy smokers. Moreover, smokers with compromised pulmonary function (FEVI/FVC < 75%) are at an even higher risk of developing lung cancer OR = 4.22 (CI = 2.2, 8.2) for past and current moderate smokers; and OR = 10.7 (CI-2.5, 38.6) in current heavy smokers. Information gathered in periodical multiphasic health examinations could be utilized by health professionals to encourage smoking cessation and smoking prevention in the appropriate screenees. Various elements of the multiphasic test results could contribute to such prevention efforts. While every smoker should receive appropriate evaluation and consultation regarding nicotine dependence, smokers with reduced pulmonary function represent an extra high risk group to which special attention should be given.
Building Clinical Classifiers Using Incomplete Observations – A Neural Network Ensemble for Hepatoma Detection in Patients with Cirrhosis
Authors: Parmanto B. , Munro P. W. , Marino I. R. , Aldrighetti K. , Doria C. , McMichael J. , Fung J. J. , Doyle H. R. 
Published: March 2018

Abstract:One objective of liver transplant evaluation is to identify patients that harbor a hepatoma, but standard screening techniques are not sensitive enough. We trained neural network ensembles to predict the presence of hepatoma in patients with cirrhosis, based on information collected at the time of transplant evaluation. Network architecture and training were modified to handle missing observations. Three ensembles were trained: ensemble A using the subset with no missing observations (528 patients); ensemble B using the complete set, which included missing observations (853 patients); and ensemble C using the smaller subset, originally with complete data, but after a fixed number of observations were deleted (i. e., made “missing”). Ensemble performance on testing sets was very good. The areas under the ROC curves were 0.91, 0.89, and 0.90, for ensembles A. B, and C, respectively. Neural networks can successfully perform this classification task, and strategies can be developed that allow use of incomplete observations.
Development of a Computerized Information System in the Harare City Health Department
Authors: Woelk G. B. , Moyo I. M. 
Published: March 2018

Abstract:The experience is reported with the health information system of the Health Department of Harare City, five years after its introduction. The system was evaluated in terms of the implementation procedure and improvements in the management process. It is concluded that careful management of the implementation process itself is a key to the successful realization of a health information system in developing countries. The statement that the quality of information produced during a computerization process is only as good as the original data fed into it, is emphasized.
A Graph-Grammar Approach to Represent Causal, Temporal and Other Contexts in an Oncological Patient Record
Authors: Thews O. , Rohrbach C. , Sergl M. , Pommerening K. , Müller R. 
Published: March 2018

AbstractThe data of a patient undergoing complex diagnostic and therapeutic procedures do not only form a simple chronology of events, but are closely related in many ways. Such data contexts include causal or temporal relationships, they express inconsistencies and revision processes, or describe patient-specific heuristics. The knowledge of data contexts supports the retrospective understanding of the medical decision-making process and is a valuable base for further treatment. Conventional data models usually neglect the problem of context knowledge, or simply use free text which is not processed by the program. In connection with the development of the knowledge-based system THEMPO (Therapy Management in Pediatric Oncology), which supports therapy and monitoring in pediatric oncology, a graph-grammar approach has been used to design and implement a graph-oriented patient model which allows the representation of non-trivial (causal, temporal, etc.) clinical contexts. For context acquisition a mouse-based tool has been developed allowing the physician to specify contexts in a comfortable graphical manner. Furthermore, the retrieval of contexts is realized with graphical tools as well.
Linking Patient Information Systems to Bibliographic Resources
Authors: Cimino J. J. 
Published: March 2018

AbstractMedical informatics researchers have explored a number of ways to integrate medical information resources into patient care systems. Particular attention has been given to the integration of on-line bibliographic resources. This paper presents an information model which breaks down the integration task into three components, each of which answers a question: what is the user’s question?, where can the answer be found?, and how is the retrieval strategy composed? Twelve experimental systems are reviewed and their methods for addressing one or more of these questions are described.
Medical Records and Other Stories: a Narratological Framework
Authors: Purves I. N. , Kay S. 
Published: March 2018

AbstractA new model of the medical record is introduced which can incorporate context, structure, process and use of the medical record within a single narratological framework. It is claimed that the analysis of narrative and, in particular, the study of the story metaphor can provide a theoretical model which provides coherence within the broad discipline of Medical Informatics. It is argued that this framework maintains different levels of abstraction, is useful for teaching and clinical practice, and that its concepts can be readily understood by those in both lay and technical healthcare professions.
Computer-Assisted Elaboration of Job Histories
Authors: Mouaddib A. , Robaux P. , Martin J.M. 
Published: March 2018

AbstractThree ways are proposed to help the occupational physician in constructing a worker’s job history or Curriculum Laboris (CL) with a PC. The quality and, therefore, the usefulness of any job history is greatly conditioned by the method and quality of data collection. The Curriculum Laboris method explained in a previous article has been briefly summarized as a basis of departure. Then, the workers who were submitted to special medical surveillance were considered. After this, the scrolling menu technique was applied in the elaboration of a job history. Finally, the authors show how the representation of company organization by means of a job exposure matrix (JEM) can help to efficiently elaborate job histories.
Development of a Computer-Aided Reference System for Differential Diagnostics Support
Authors: Wieding J. U. , Kretschmar T. , Schonle P. W. 
Published: March 2018

AbstractIn a situation of uncertain diagnosis, physicians may spend valuable time consulting relevant literature, often with unsatisfactory results. Therefore, our aim was to develop a computer system which supports differential diagnostics via rapid and comprehensive searches through information in literature. Based on entered signs and symptoms our prototype is able to offer probable diagnoses. Subsequently, further examinations and tests are suggested to confirm or exclude a certain disease. Thus, the final diagnosis is made gradually by differentiation of possible diseases.Our first attempt consisted in representing knowledge in a rule-based PROLOG system. However, because nearly all information for a sign-oriented differential diagnosis can be represented with very few relations only, we turned to a fact-oriented representation of signs and diseases. Access was possible via PROLOG or an imperative programming language. The index-sequential access on a fact-oriented representation of knowledge was suitable to manage a large knowledge base, which is necessary for a thorough differential diagnosis. A pointer structure was recently examined in order to handle different object-to-object relations. Efficient information processing is now possible which provides short response times using even broad knowledge bases.
Costs in Pituitary Surgery: Racial, Socioeconomic, and Hospital Factors
Authors: Workman Alan , Kidwai Sarah , Goljo Erden , Signore Anthony , Iloreta Alfred , Genden Eric , Shrivastava Raj , Navathe Amol , Govindaraj Satish , Parasher Arjun 
Published: March 2018

Objective To investigate the influence of patient demographic factors and hospital factors on cost and length of stay in patients undergoing pituitary surgery.
Design/Setting A retrospective cross-sectional study of the 2008 to 2012 Nationwide/National Inpatient Sample.
Participants Patient demographics and hospital characteristics for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients.
Main Outcome Measures Variables associated with increased cost and increased length of hospital stay were ascertained and compared against each racial and ethnic group via multiple linear regression analysis.
Results Of 8,812 patients who underwent pituitary surgery, 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Patient variables found to be significantly different between racial groups via univariate analysis were age, chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Hospitalization cost was significantly lower for whites (−$3,082, 95% confidence interval [CI] −$3,961 to −$2,202) and significantly higher for both blacks ($1,889, 95% CI $842–$2,937) and Hispanics ($2,997, 95% CI $1,842–$4,152). Length of hospital stay was also significantly lower in whites (−1.01, 95% CI −1.31 to −0.72) and significantly higher for both blacks (0.65, 95% CI 0.30 to 1.00) and Hispanics (0.96, 95% CI 0.57–1.35).
Conclusions Racial and ethnic factors contribute to differences in hospital utilization and cost for patients undergoing pituitary surgery. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.
Auswirkungen von Missbrauch, Misshandlung und Vernachlässigung im Kindesalter auf die psychische und physische Gesundheit im Erwachsenenalter
Authors: Ignatius A. , Huber-Lang M. , Fegert J. M. , Plener P. L. 
Published: March 2018

ZusammenfassungIn der Gesamtbevölkerung stellen das Vorliegen einer Vorgeschichte von Vernachlässigung, Missbrauch oder Misshandlung im Kindes- und Jugendalter keineswegs seltene Phänomene dar. So werden schwere körperliche Misshandlungen von etwa 3%, sexueller Missbrauch von etwa 2%, schwere emotionale Vernachlässigung von knapp 7% und schwere körperliche Vernachlässigung von knapp 11% der Allgemeinbevölkerung in Deutschland berichtet. Wie die Forschungslage zeigt, werden durch das Erleben solcher Ereignisse in der Kindheit langdauernde Prozesse in Gang gesetzt, die im Erwachsenenalter zu psychischen oder physischen Folgeschäden führen können. Im Rahmen eines selektiven Reviews soll die aktuelle Literatur zu dieser Thematik aufgearbeitet werden. Studien, die vor allem innerhalb der letzten 10 Jahre publiziert wurden, zeigen sowohl funktionelle wie auch hirnmorphologische Veränderungen, die vor allem in Bereichen des emotionalen Erlebens und der emotionalen Regulation zu Veränderungen führen. Zusätzlich mehren sich die Hinweise für negative Konsequenzen auch auf somatischer Ebene. So konnten wiederholt Zusammenhänge mit chronischen Krankheiten gezeigt werden, wobei vor allem eine Einflussnahme über unser stressverarbeitendes System als mögliche Ursache diskutiert wurden. In Modellrechnungen wurde ein gesamtwirtschaftlicher Schaden von etwa 11 bis 30 Milliarden Euro pro Jahr als Folge von Vernachlässigung, Missbrauch und Misshandlung im Kindesalter errechnet. Der Prävention solcher Ereignisse sowie der frühzeitigen Erkennung und Behandlung kommt damit eine wesentliche gesellschaftliche Dimension zu.
Explanations of Statistical Concepts: Can they Penetrate the Haze of Bayes?
Authors: Politser P. E. 
Published: March 2018

SummaryThis experiment tested the ability of logical explanations to promote the use of statistical concepts. Sixty physicians in four experimental groups, matched for level of medical statistical training, were given a questionnaire that assessed their ability to rank the diagnosticity of various diagnostic test results. Each question was designed to test physician understanding of the impact of a particular statistical parameter, e.g., sensitivity and specificity, test-retest reliability. Logical explanations of the sources of test error increased the percentage of answers judged to be correct on the basis of published data. This was confirmed for a variety of questions. They tended to be less useful, however, when physicians expressed misinterpretations of statistical concepts or test patterns were not correctly perceived. The implications of these findings for medical education and for the design of computer-based explanation systems are clarified.
Morphologic Analysis of Compound Words
Authors: Wingert F. 
Published: March 2018

SummaryAlgorithms for morphologic analysis of compound words and related dictionary structures are described’ on the basis of different word models. The algorithms are formulated in Backus-Naur form as well as Augmented Transition Networks. The results of applying the algorithms to the 56,509 different words of the “Systematisierte Nomenklatur der Medizin” (SNOMED) are presented.