Using Machine Learning Classifiers to Assist Healthcare-Related Decisions: Classification of Electronic Patient Records

Surveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical and developmental history of patients. Each SL is associated with specific educational and clinical measures. The objective of the present paper was to verify computer-aided, automatic assignment of SLs. The present paper proposes a computer-aided approach for automatic recommendation of SLs. The approach is based on the classification of information from patient electronic records. For this purpose, a software architecture composed of three layers was developed. The architecture is formed by a classification layer that includes a linguistic module and machine learning classification modules. The classification layer allows for the use of different classification methods, including the use of preprocessed, normalized language data drawn from the linguistic module. We report the verification and validation of the software architecture in a Brazilian pediatric healthcare institution. The results indicate that selection of attributes can have a great effect on the performance of the system. Nonetheless, our automatic recommendation of surveillance level can still benefit from improvements in processing procedures when the linguistic module is applied prior to classification. Results from our efforts can be applied to different types of medical systems. The results of systems supported by the framework presented in this paper may be used by healthcare and governmental institutions to improve healthcare services in terms of establishing preventive measures and alerting authorities about the possibility of an epidemic.

Can neuroimaging be used as a support to diagnosis of borderline personality disorder? An approach based on computational neuroanatomy and machine learning

Several recent studies in literature have identified brain morphological alterations associated to Borderline Personality Disorder (BPD) patients. These findings are reported by studies based on voxel-based-morphometry analysis of structural MRI data, comparing mean gray-matter concentration between groups of BPD patients and healthy controls. On the other hand, mean differences between groups are not informative about the discriminative value of neuroimaging data to predict the group of individual subjects. In this paper, we go beyond mean differences analyses, and explore to what extent individual BPD patients can be differentiated from controls (25 subjects in each group), using a combination of automated-morphometric tools for regional cortical thickness/volumetric estimation and Support Vector Machine classifier. The approach included a feature selection step in order to identify the regions containing most discriminative information. The accuracy of this classifier was evaluated using the leave-one-subject-out procedure. The brain regions indicated as containing relevant information to discriminate groups were the orbitofrontal, rostral anterior cingulate, posterior cingulate, middle temporal cortices, among others. These areas, which are distinctively involved in emotional and affect regulation of BPD patients, were the most informative regions to achieve both sensitivity and specificity values of 80% in SVM classification. The findings suggest that this new methodology can add clinical and potential diagnostic value to neuroimaging of psychiatric disorders. (C) 2012 Elsevier Ltd. All rights reserved.

An ice machine adapted into an autonomous photovoltaic system without batteries using a variable-speed drive

The adaptation of a commercially available ice machine for autonomous photovoltaic operation without batteries is presented. In this adaptation a 1040 W(p) photovoltaic array directly feeds a variable-speed drive and a 24 V(dc) source. The drive runs an induction motor coupled by belt-and-pulley to an open reciprocating compressor, while the dc source supplies a solenoid valve and the control electronics. Motor speed and refrigerant evaporation pressure are set aiming at continuously matching system power demand to photovoltaic power availability. The resulting system is a simple integration of robust, standard, readily available parts. It produces 27 kg of ice in a clear-sky day and has ice production costs around US$0.30/kg. Although a few machine features might be specific to Brazil, its technical and economical guidelines are applicable elsewhere. Copyright (C); 2010 John Wiley & Sons, Ltd.

Heuristic methods for the single machine scheduling problem with different ready times and a common due date

The single machine scheduling problem with a common due date and non-identical ready times for the jobs is examined in this work. Performance is measured by the minimization of the weighted sum of earliness and tardiness penalties of the jobs. Since this problem is NP-hard, the application of constructive heuristics that exploit specific characteristics of the problem to improve their performance is investigated. The proposed approaches are examined through a computational comparative study on a set of 280 benchmark test problems with up to 1000 jobs.

Safety illusion and error trap in a collectively-operated machine accident

Workplace accidents involving machines are relevant for their magnitude and their impacts on worker health. Despite consolidated critical statements, explanation centered on errors of operators remains predominant with industry professionals, hampering preventive measures and the improvement of production-system reliability. Several initiatives were adopted by enforcement agencies in partnership with universities to stimulate production and diffusion of analysis methodologies with a systemic approach. Starting from one accident case that occurred with a worker who operated a brake-clutch type mechanical press, the article explores cognitive aspects and the existence of traps in the operation of this machine. It deals with a large-sized press that, despite being endowed with a light curtain in areas of access to the pressing zone, did not meet legal requirements. The safety devices gave rise to an illusion of safety, permitting activation of the machine when a worker was still found within the operational zone. Preventive interventions must stimulate the tailoring of systems to the characteristics of workers, minimizing the creation of traps and encouraging safety policies and practices that replace judgments of behaviors that participate in accidents by analyses of reasons that lead workers to act in that manner.

Effect of different restorative procedures on the fracture resistance of teeth submitted to internal bleaching

The aim of this study was to evaluate the influence of different restorative procedures on the fracture resistance of endodontically treated teeth submitted to intracoronal bleaching. Fifty upper central incisors were distributed into 5 groups: GI - healthy teeth; GII - endodontically treated teeth sealed with Coltosol; GIII - endodontically treated teeth bleached and sealed with Coltosol; GIV - endodontically treated teeth bleached and restored with composite resin; and GV - endodontically treated teeth bleached and restored with a fiberglass post and composite resin. In the bleached specimens, a cervical seal was made prior to bleaching with 38% hydrogen peroxide. The gel was applied on the buccal surface and in the pulp chamber, and was then light-activated for 45 s. This procedure was repeated three times per session for four sessions, and each group was submitted to the restorative procedures described above. The specimens were submitted to fracture resistance testing in a universal testing machine. There were statistically significant differences among the groups (p < 0.05). The mean value found for GIII was the lowest (0.32 kN) and was significantly different from the values found for GI (0.75 kN), GII (0.67 kN), GIV (0.70 kN), and GV (0.72 kN), which were not significantly different from each other (p > 0.05). The restorative procedures using composite resin were found to successfully restore the fracture resistance of endodontically treated and bleached teeth.

Effectiveness of immediate bonding of etch-and-rinse adhesives to simplified ethanol-saturated dentin

This study examined the immediate bond strength of etch-and-rinse adhesives to demineralized dentin saturated with either water or absolute ethanol. The research hypothesis was that there would be no difference in bond strength to dentin between water or ethanol wet-bonding techniques. The medium dentin of 20 third molars was exposed (n = 5). The dentin surface was then acid-etched, left moist and randomly assigned to be saturated via either water wet-bonding (WBT) or absolute ethanol wet-bonding (EBT). The specimens were then treated with one of the following etch-and-rinse adhesive systems: a 3-step, water-based system (Adper Scotchbond Multipurpose, or SBMP) or a 2-step, ethanol/water-based system (Adper Single Bond 2, or SB). Resin composite build-ups were then incrementally constructed. After water storage for 24 h at 37 degrees C, the tensile strength of the specimens was tested in a universal testing machine (0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey's test (alpha = 5%). The failure modes were verified using a stereomicroscope (40x). For both adhesives, no significant difference in bond strength was observed between WBT and EBT (p > 0.05). The highest bond strength was observed for SB, regardless of the bonding technique (p < 0.05). No significant interaction between adhesives and bonding techniques was noticed (p = 0.597). There was a predominance of adhesive failures for all tested groups. The EBT and WBT displayed similar immediate bond strength means for both adhesives. The SB adhesive exhibited higher means for all conditions tested. Further investigations are needed to evaluate long-term bonding to dentin mediated by commercial etch-and-rinse adhesives using the EBT approach.

Quality and quantity of milk produced by Saanen goats submitted to stress during three sequential days

The experiment aimed to study the effect of physiological stress on cortisol levels, quality and quantity of milk through punctual administration of ACTH. Twelve Saanen goats were divided in two experimental groups: ACTH group (0,5 mu g of ACTH/Kg.L.W); Placebo group (placebo solution). Milk production, and percentages of protein, fat, lactose and SCC (somatic cells counting) of the milk were analyzed before, during and after the administration of ACTH/placebo. Simultaneously to the ACTH/placebo administration and during three sequential days, blood was collected to evaluate cortisol concentrations. At times -30 and zero, both groups presented basal concentrations of cortisol. The increase of cortisol contents was significant at times 60 (group ACTH: 59.00 +/- 5.70 and groups placebo: 5.23 +/- 1.37ng/mL) and 120 (group ACTH: 47.96 +/- 9.72 and group placebo: 4.38 +/- 1,14ng/mL) since the cortisol content was higher on the ACTH group. The values returned to the basal level at 300 minutes. Concerning milk production, no differences were found between ACTH and placebo groups. Milk, protein, fat, lactose and SCC did not distinguish one group from another. The results indicated that the physiological stress induced during three days was not harmful to milk production and milk quality of Saanen goats.

Micro-mechanical bond strength tests for the assessment of the adhesion of GIC to dentine

Background. The aim of this study is to critically evaluate the bond strength (BS) of Glass-Ionomer Cements (GIC) to dentine with microtensile (mu TBS) and microshear (mu SBS) BS tests by assessing their rankings and failure patterns. Methods. Samples were made on flat dentine surfaces and submitted to mTBS and mSBS. The materials used were: high viscosity GIC (Ketac (TM) Molar Aplicap-KM), resin-modified GIC (Fuji II-FII), nano-filled resin-modified GIC (Ketac (TM) N100-N100) and an etch-and-rinse adhesive system with a composite resin (Adper (TM) Single Bond 2 and Z100 (TM)-Z100). All tests were performed with a Universal Testing Machine (24 h water storage, crosshead speed of 1 mm/min). Debonded surfaces were examined with a stereomicroscope (x40) to identify the failure mode. The data was analyzed with two-way ANOVA (p < 0.05) and LSD test. Results. Means were statistically different regarding the tests and materials, indicating that values for BS obtained for each material depend on the test performed. Failure analysis revealed that failures produced by mTBS were mainly cohesive for KM and FII. mu SBS failures were mainly adhesive or mixed for all materials. For the mTBS, the rank was Z100 > FII > KM = N100, whereas for the mSBS it was Z100 = FII = KM > N100. Conclusion: It may be concluded that distinct micro-mechanical tests present different failure patterns and rankings depending on the material to be considered.

Shear bond strength between Ni-Cr alloy bonded to a ceramic substrate

Shear bond strength between Ni-Cr alloy bonded to a ceramic substrate Introduction: The aim of this study was to evaluate the shear bond strength between a Ni-Cr alloy and a ceramic system submitted or not to thermocycling. Materials and methods: Forty-eight cylinder blocks of Ni-Cr with 3.0 mm diameter by 4.0 mm hight and 48 disc-shaped specimens (7.0 mm in diameter by 2.0 mm thick) composed of ceramic were prepared. The Ni-Cr cylinder blocks were randomised in two groups of 24 specimens each. One group was submitted to air-particle abrasion (sandblasting) with 50 mu m Al2O3 (0.4-0.7 MPa) during 20 s, and the other group was submitted to mechanical retentions with carbide burrs. Each group was subdivided into other two groups (n = 12), submitted or not to thermocycling (500 cycles, 5-55 degrees C). The cylinder blocks were bonded to the disc-shaped ceramic specimens under 10 N of load. The shear bond strengths (MPa) were measured using a universal testing machine at a cross head speed of 0.5 mm/min and 200 kgf of load. The data were submitted to statistical analysis (ANOVA and Tukey's test). Results: The air-particle abrasion group exhibited significantly higher shear bond strength when compared to drilled group (p < 0.05). Conclusions: Thermocycling decreased significantly the bond strengths for all groups tested.

WEAR OF MATRIX OVERDENTURE ATTACHMENTS AFTER ONE TO EIGHT YEARS OF CLINICAL USE

Statement of problem. Matrices of unsplinted attachment systems are generally reported to be the weak component of implant overdentures, often requiring frequent maintenance. Clinical wear results in reduced retention of the prosthesis, requiring activation or renewal of the matrix to restore the initial level of retention. Purpose. The purpose of this retrospective study was to measure the wear of the matrix of a ball attachment after various periods of clinical wear. Material and methods. Seventy specimens of 3 groups of matrices of ball attachments that had been in use for mean periods of 12.3 months (1Y group, n=26), 39.0 months (3Y group, n=28) and 95.6 months (8Y group, n=16) were retrieved from 35 patients (2 specimens per patient) and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused matrices were used as controls (CTRL group). The external and internal matrix diameters and deviations from circularity were measured. For the various time periods, the decreases in matrix thickness were calculated and compared with controls. Kruskal-Wallis 1-way ANOVA by ranks, followed by the Mann-Whitney post hoc tests, were conducted to test for differences in median values among groups (alpha=.05). Results. For the internal upper diameter of the matrices tested, the Kruskal-Wallis and Mann-Whitney tests revealed significant differences for the 3 groups compared to the controls. For group 1Y, a significant difference (P<.001) of the internal upper diameter was found compared to the CTRL group. Compared to the controls, the nonparametric analyses for groups 3Y and 8Y showed significant differences for the internal upper diameter (P<.001) and deviations from circularity (P<.001). For groups 1Y, 3Y and 8Y, matrix thickness losses were 07, 47 and 70 pm, respectively. Conclusions. Within the limitations of this study, it was observed that one year of clinical wear had limited effect on the ball attachment matrices. Three to 8 years of clinical use resulted in a significant decrease of matrix thickness, especially at the tip of the retentive lamellae. (J Prosthet Dent 2012;107:191-198)

Analytical tools to assess the voltage stability of induction-based distributed generators

The installation of induction distributed generators should be preceded by a careful study in order to determine if the point of common coupling is suitable for transmission of the generated power, keeping acceptable power quality and system stability. In this sense, this paper presents a simple analytical formulation that allows a fast and comprehensive evaluation of the maximum power delivered by the induction generator, without losing voltage stability. Moreover, this formulation can be used to identify voltage stability issues that limit the generator output power. All the formulation is developed by using the equivalent circuit of squirrel-cage induction machine. Simulation results are used to validate the method, which enables the approach to be used as a guide to reduce the simulation efforts necessary to assess the maximum output power and voltage stability of induction generators. (C) 2011 Elsevier Ltd. All rights reserved.

Microtensile bond strength of resin composite to dentin treated with Er:YAG laser of bleached teeth

The objective of this study was to evaluate the influence of Er:YAG laser (lambda = 2.94 mu m) on microtensile bond strength (mu TBS) and superficial morphology of bovine dentin bleached with 16% carbamide peroxide. Forty bovine teeth blocks (7 x 3 x 3 mm(3)) were randomly assigned to four groups: G1- bleaching and Er:YAG irradiation with energy density of 25.56 J/cm(2) (focused mode); G2 - bleaching; G3 - no-bleaching and Er:YAG irradiation (25.56 J/cm(2)); G4 - control, non-treated. G1 and G2 were bleached with 16% carbamide peroxide for 6 h during 21 days. Afterwards, all blocks were abraded with 320 to 600-grit abrasive papers to obtain flat standardized dentin surfaces. G1 and G3 were Er:YAG irradiated. Blocks were immediately restored with 4-mm-high composite resin (Adper Single Bond 2, Z-250-3 M/ESPE). After 24 h, the restored blocks (n = 9) were serially sectioned and trimmed to an hour-glass shape of approximately 1 mm(2) at the bonded interface area, and tested in tension in a universal testing machine (1 mm/ min). Failure mode was determined at a magnification of 100x using a stereomicroscope. One block of each group was selected for scanning electron microscope (SEM) analysis. mu TBS data was analyzed by two-way ANOVA and Tukey test (alpha = 0.05). Mean bond strengths (SD) in MPa were: G1- 32.7 (5.9)(A); G2- 31.1 (6.3)(A); G3- 25.2 (8.3)(B); G4- 36.7 (9.9).(A) Groups with different uppercase letters were significantly different from each other (p < .05). Enamel bleaching procedure did not affect mu TBS values for dentin adhesion. Er:YAG laser irradiation with 25.56 J/cm(2) prior to adhesive procedure of bleached teeth did not affect mu TBS at dentin and promoted a dentin surface with no smear layer and opened dentin tubules observed under SEM. On the other hand, Er:YAG laser irradiation prior to adhesive procedure of non-bleached surface impaired mu TBS compared to the control group.

Influence of alloy microstructure on the microshear bond strength of basic alloys to a resin luting cement

The aim of this study was to evaluate the influence of microstructure and composition of basic alloys on their microshear bond strength (µSBS) to resin luting cement. The alloys used were: Supreme Cast-V (SC), Tilite Star (TS), Wiron 99 (W9), VeraBond II (VBII), VeraBond (VB), Remanium (RM) and IPS d.SIGN 30 (IPS). Five wax patterns (13mm in diameter and 4mm height) were invested, and cast in a centrifugal casting machine for each basic alloy. The specimens were embedded in resin, polished with a SiC paper and sandblasted. After cleaning the metal surfaces, six tygon tubes (0.5 mm height and 0.75 mm in diameter) were placed on each alloy surface, the resin cement (Panavia F) was inserted, and the excess was removed before light-curing. After storage (24 h/37°C), the specimens were subjected to µSBS testing (0.5 mm/min). The data were subjected to a one-way repeated measures analysis of variance and Turkey's test (α=0.05). After polishing, their microstructures were revealed with specific conditioners. The highest µSBS (mean/standard deviation in MPa) were observed in the alloys with dendritic structure, eutectic formation or precipitation: VB (30.6/1.7), TS (29.8/0.9), SC (30.6/1.7), with the exception of IPS (31.1/0.9) which showed high µSBS but no eutectic formation. The W9 (28.1/1.5), VBII (25.9/2.0) and RM (25.9/0.9) showed the lowest µSBS and no eutectic formation. It seems that alloys with eutectic formation provide the highest µSBS values when bonded to a light-cured resin luting cement.