Knowledge-based clinical pathway for medical quality improvement

Clinical pathways have been adopted for various diseases in clinical departments for quality improvement as a result of standardization of medical activities in treatment process. Using knowledge-based decision support on the basis of clinical pathways is a promising strategy to improve medical quality effectively. However, the clinical pathway knowledge has not been fully integrated into treatment process and thus cannot provide comprehensive support to the actual work practice. Therefore this paper proposes a knowledgebased clinical pathway management method which contributes to make use of clinical knowledge to support and optimize medical practice. We have developed a knowledgebased clinical pathway management system to demonstrate how the clinical pathway knowledge comprehensively supports the treatment process. The experiences from the use of this system show that the treatment quality can be effectively improved by the extracted and classified clinical pathway knowledge, seamless integration of patient-specific clinical pathway recommendations with medical tasks and the evaluating pathway deviations for optimization.

Incorporating semiotics into fuzzy logic to enhance Clinical Decision Support Systems

In order to enhance the quality of care, healthcare organisations are increasingly resorting to clinical decision support systems (CDSSs), which provide physicians with appropriate health care decisions or recommendations. However, how to explicitly represent the diverse vague medical knowledge and effectively reason in the decision-making process are still problems we are confronted. In this paper, we incorporate semiotics into fuzzy logic to enhance CDSSs with the aim of providing both the abilities of describing medical domain concepts contextually and reasoning with vague knowledge. A semiotically inspired fuzzy CDSSs framework is presented, based on which the vague knowledge representation and reasoning process are demonstrated.

An ontological approach to personalized medical knowledge recommendation

Knowledge recommendation has become a promising method in supporting the clinicians decisions and improving the quality of medical services in the constantly changing clinical environment. However, current medical knowledge management systems cannot understand users requirements accurately and realize personalized recommendation. Therefore this paper proposes an ontological approach based on semiotic principles to personalized medical knowledge recommendations. In particular, healthcare domain knowledge is conceptualized and an ontology-based user profile is built. Furthermore, the personalized recommendation mechanism is illustrated.

An ontological approach to personalized medical knowledge matching

Knowledge management has become a promising method in supporting the clinicians′ decisions and improving the quality of medical services in the constantly changing clinical environment. However, current medical knowledge management systems cannot understand users′ requirements accurately and realize personalized matching. Therefore this paper proposes an ontological approach based on semiotic principles to personalized medical knowledge matching. In particular, healthcare domain knowledge is conceptualized and an ontology-based user profile is built. Furthmore, the personalized matching mechanism and algorithm are illustrated.

Culture bag systems for clinical applications of adult human neural crest-derived stem cells

Introduction Facing the challenging treatment of neurodegenerative diseases as well as complex craniofacial injuries such as those common after cancer therapy, the field of regenerative medicine increasingly relies on stem cell transplantation strategies. Here, neural crest-derived stem cells (NCSCs) offer many promising applications, although scale up of clinical-grade processes prior to potential transplantations is currently limiting. In this study, we aimed to establish a clinical-grade, cost-reducing cultivation system for NCSCs isolated from the adult human nose using cGMP-grade Afc-FEP bags. Methods We cultivated human neural crest-derived stem cells from inferior turbinate (ITSCs) in a cell culture bag system using Afc-FEP bags in human blood plasma-supplemented medium. Investigations of viability, proliferation and expression profile of bag-cultured ITSCs were followed by DNA-content and telomerase activity determination. Cultivated ITSCs were introduced to directed in vitro differentiation assays to assess their potential for mesodermal and ectodermal differentiation. Mesodermal differentiation was determined using an enzyme activity assay (alkaline phosphatase, ALP), respective stainings (Alizarin Red S, Von Kossa and Oil Red O), and RT-PCR, while immunocytochemistry and synaptic vesicle recycling were applied to assay neuroectodermal differentiation of ITSCs. Results When cultivated within Afc-FEP bags, ITSCs grew three-dimensionally in a human blood plasma-derived matrix, thereby showing unchanged morphology, proliferation capability, viability and expression profile in comparison to three dimensionally-cultured ITSCs growing in standard cell culture plastics. Genetic stability of bag-cultured ITSCs was further accompanied by unchanged telomerase activity. Importantly, ITSCs retained their potential to differentiate into mesodermal cell types, particularly including ALP-active, Alizarin Red S-, and Von Kossa-positive osteogenic cell types, as well as adipocytes positive in Oil Red O assays. Bag culture further did not affect the potential of ITSCs to undergo differentiation into neuroectodermal cell types coexpressing β-III-tubulin and MAP2 and exhibiting the capability for synaptic vesicle recycling. Conclusions Here, we report for the first time the successful cultivation of human NCSCs within cGMP-grade Afc-FEP bags using a human blood plasma-supplemented medium. Our findings particularly demonstrate the unchanged differentiation capability and genetic stability of the cultivated NCSCs, suggesting the great potential of this culture system for future medical applications in the field of regenerative medicine.

Medical image retrieval based on complexity analysis

Texture is one of the most important visual attributes used in image analysis. It is used in many content-based image retrieval systems, where it allows the identification of a larger number of images from distinct origins. This paper presents a novel approach for image analysis and retrieval based on complexity analysis. The approach consists of a texture segmentation step, performed by complexity analysis through BoxCounting fractal dimension, followed by the estimation of complexity of each computed region by multiscale fractal dimension. Experiments have been performed with MRI database in both pattern recognition and image retrieval contexts. Results show the accuracy of the method and also indicate how the performance changes as the texture segmentation process is altered.

JML- Based formal development of a Java card application for managing medical appointments

Although formal methods can dramatically increase the quality of software systems, they have not widely been adopted in software industry. Many software companies have the perception that formal methods are not cost-effective cause they are plenty of mathematical symbols that are difficult for non-experts to assimilate. The Java Modelling Language (short for JML) Section 3.3 is an academic initiative towards the development of a common formal specification language for Java programs, and the implementation of tools to check program correctness. This master thesis work shows how JML based formal methods can be used to formally develop a privacy sensitive Java application. This is a smart card application for managing medical appointments. The application is named HealthCard. We follow the software development strategy introduced by João Pestana, presented in Section 3.4. Our work influenced the development of this strategy by providing hands-on insight on challenges related to development of a privacy sensitive application in Java. Pestana’s strategy is based on a three-step evolution strategy of software specifications, from informal ones, through semiformal ones, to JML formal specifications. We further prove that this strategy can be automated by implementing a tool that generates JML formal specifications from a welldefined subset of informal software specifications. Hence, our work proves that JML-based formal methods techniques are cost-effective, and that they can be made popular in software industry. Although formal methods are not popular in many software development companies, we endeavour to integrate formal methods to general software practices. We hope our work can contribute to a better acceptance of mathematical based formalisms and tools used by software engineers. The structure of this document is as follows. In Section 2, we describe the preliminaries of this thesis work. We make an introduction to the application for managing medical applications we have implemented. We also describe the technologies used in the development of the application. This section further illustrates the Java Card Remote Method Invocation communication model used in the medical application for the client and server applications. Section 3 introduces software correctness, including the design by contract and the concept of contract in JML. Section 4 presents the design structure of the application. Section 5 shows the implementation of the HealthCard. Section 6 describes how the HealthCard is verified and validated using JML formal methods tools. Section 7 includes some metrics of the HealthCard implementation and specification. Section 8 presents a short example of how a client-side of a smart card application can be implemented while respecting formal specifications. Section 9 describes a prototype tools to generate JML formal specifications from informal specifications automatically. Section 10 describes some challenges and main ideas came acrorss during the development of the HealthCard. The full formal specification and implementation of the HealthCard smart card application presented in this document can be reached at https://sourceforge.net/projects/healthcard/.

How can micelle systems be rebuilt by a heating process?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Physical research in dynamized systems

The concept of dynamized medicines is commonly used in homeopathy. As a medical practice, homeopathy is based on clinical observations and experimental assays. In spite of the lack of a credible scientific explanation for its action mechanisms, clinical evidence has been collected since 200 years ago. This paper discusses the most important physical models related to dynamized systems, as well as some perspectives and consequences in studying such systems. While early theories dealt with structural changes in single solvent molecules, modern theories consider collective effects and self-organizing properties. The concept of information was recently introduced to model the capability of a dynamized system to interact with a biological organism, without a molecular agent being needed. The features and limitations of theoretical approaches, as well as experimental results are discussed. (C) 2002 Published by Elsevier B.V. Ltd.

Amphetamine Poisoning in a Dog: Case Report, Literature Review and Veterinary Medical Perspectives

Amphetamine abuse in human beings has increased, resulting in many reports of toxicity and death. In the US over 4 million people have abused amphetamines at least once, thus small animals are exposed to increased accidental poisoning risk. This report describes an acute amphetamine poisoning in a dog due to ingestion of 15 mg/kg fenproporex, leading to typical signs of catecholamines release and effects in different organ systems. Similar clinical and laboratory findings observed in human beings are reviewed and physiopathogenic mechanisms discussed, as well as the therapeutic approaches available in veterinary medicine.

Autonomous mobile robots designing for the medical trash collector task

This paper describes the UNESP robotic team in the medical trash collector task, proposed on the 5 rd IEEE Latin American Robots Competition in the LEGO category. We present our understanding of the task and discuss the proposed solution, focusing on the mechanical and computational issues of the robots. The mechanics is based on rigid body capability of transforming rotational into curvilinear movement. With respect to the computational control, the system is modeled as a reactive system with sequential transition of behaviors. A state-machine is proposed to allow this transition, and the synchronization of robotic states is guaranteed by the communication system. The proposed approach has shown itself capable of dealing with the high difficulty degree of this cooperative task. ©2006 IEEE.

Abductive reasoning, information, and mechanical systems

We investigate, from a philosophical perspective, the relation between abductive reasoning and information in the context of biological systems. Emphasis is given to the organizational role played by abductive reasoning in practical activities of embodied embedded agency that involve meaningful information. From this perspective, meaningful information is provisionally characterized as a selforganizing process of pattern generation that constrains coherent action. We argue that this process can be considered as a part of evolutionarily developed learning abilities of organisms in order to help with their survival. We investigate the case of inorganic mechanical systems (like robots), which deal only with stable forms of habits, rather than with evolving learning abilities. Some difficulties are considered concerning the hypothesis that mechanical systems may operate with meaningful information, present in abductive reasoning. Finally, an example of hypotheses creation in the domain of medical sciences is presented in order to illustrate the complexity of abduction in practical reasoning concerning human activities. © 2007 Springer-Verlag Berlin Heidelberg.

Protecting medical images with biometric information

Medical images are private to doctor and patient. Digital medical images should be protected against unauthorized viewers. One way to protect digital medical images is using cryptography to encrypt the images. This paper proposes a method for encrypting medical images with a traditional symmetric cryptosystem. We use biometrics to protect the cryptographic key. Both encrypted image and cryptographic key can be transmitted over public networks with security and only the person that owns the biometrics information used in key protection can decrypt the medical image. © Springer Science+Business Media B.V. 2008.

A medical information system to manage a cancer database

Cancer is the second main cause of death in Brazil, and according to statistics disclosed by INCA - National Cancer Institute 466,730 new cases of the disease are forecast for 2008. The storage and analysis of tumour tissues of various types and patients' clinical data, genetic profiles, characteristics of diseases and epidemiological data may provide more precise diagnoses, providing more effective treatments with higher chances for the cure of cancer. In this paper we present a Web system with a client-server architecture, which manages a relational database containing all information relating to the tumour tissue and their location in freezers, patients, medical forms, physicians, users, and others. Furthermore, it is also discussed the software engineering used to developing the system.

Geometric modeling from the medical images in the CAD system to support prosthesis design

This paper presents an individual designing prosthesis for surgical use and proposes a methodology for such design through mathematical extrapolation of data from digital images obtained via tomography of individual patient's bones. Individually tailored prosthesis designed to fit particular patient requirements as accurately as possible should result in more successful reconstruction, enable better planning before surgery and consequently fewer complications during surgery. Fast and accurate design and manufacture of personalized prosthesis for surgical use in bone replacement or reconstruction is potentially feasible through the application and integration of several different existing technologies, which are each at different stages of maturity. Initial case study experiments have been undertaken to validate the research concepts by making dimensional comparisons between a bone and a virtual model produced using the proposed methodology and a future research directions are discussed.