Strengthening argumentation in medical explanations by text planning revision

Explanations are an important by-product of medical decisionsupport activities, as they have proved to favour compliance and correct treatment performance. To achieve this purpose, these texts should have a strong argumentation content and should adapt to emotional, as well as to rational attitudes of the Addressee. This paper describes how Rhetorical Sentence Planning can contribute to this aim: the rulebased plan discourse revision is introduced between Text Planning and Linguistic Realization, and exploits knowledge about the user personality and emotions and about the potential impact of domain items on user compliance and memory recall. The proposed approach originates from analytical and empirical evaluation studies of computer generated explanation texts in the domain of drug prescription. This work was partially supported by a British-Italian Collaboration in Research and Higher Education Project, which involved the Universities of Reading and of Bari, in 1996.

Evaluating explanations about drug prescriptions: effects of varying the nature of information about side effects and its relative position in explanations

This study evaluates computer-generated written explanations about drug prescriptions that are based on an analysis of both patient and doctor informational needs. Three experiments examine the effects of varying the type of information given about the possible side effects of the medication, and the order of information within the explanation. Experiment 1 investigated the effects of these two factors on people's ratings of how good they consider the explanations to be and of their perceived likelihood of taking the medication, as well as on their memory for the information in the explanation. Experiment 2 further examined the effects of varying information about side effects by separating out the contribution of number and severity of side effects. It was found that participants in this study did not “like” explanations that described severe side effects, and also judged that they would be less likely to take the medication if given such explanations. Experiment 3 therefore investigated whether information about severe side effects could be presented in such a way as to increase judgements of how good explanations are thought to be, as well as the perceived likelihood of adherence. The results showed some benefits of providing additional explanatory information.

Generating recipient-centred explanations about drug prescription

In this paper we describe how we generated written explanations to ‘indirect users’ of a knowledge-based system in the domain of drug prescription. We call ‘indirect users’ the intended recipients of explanations, to distinguish them from the prescriber (the ‘direct’ user) who interacts with the system. The Explanation Generator was designed after several studies about indirect users' information needs and physicians' explanatory attitudes in this domain. It integrates text planning techniques with ATN-based surface generation. A double modeling component enables adapting the information content, order and style to the indirect user to whom explanation is addressed. Several examples of computer-generated texts are provided, and they are contrasted with the physicians' explanations to discuss advantages and limits of the approach adopted.

The effects of different forms of advice on the control of a simulated complex system

Three experiments examine the effect of different forms of computer-generated advice on concurrent and subsequent performance of individuals controlling a simulated intensive-care task. Experiment 1 investigates the effect of optional and compulsory advice and shows that both result in an improvement in subjects' performance while receiving the advice, and also in an improvement in subsequent unaided performance. However, although the advice compliance displayed by the optional advice group shows a strong correlation with subsequent unaided performance, compulsory advice has no extra benefit over the optional use of advice. Experiment 2 examines the effect of providing users with on-line explanations of the advice, as well as providing less specific advice. The results show that both groups perform at the same level on the task as the advice groups from Experiment 1, although subjects receiving explanations scored significantly higher on a written post-task questionnaire. Experiment 3 investigates in more detail the relationship between advice compliance and performance. The results reveal a complex relationship between natural ability on the task and the following of advice, in that people who use the advice more tend to perform either better or worse than the more moderate users. The theoretical and practical implications of these experiments are discussed.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

3D surface point and wireframe reconstruction from multiview photographic images

This paper describes a new method for reconstructing 3D surface points and a wireframe on the surface of a freeform object using a small number, e.g. 10, of 2D photographic images. The images are taken at different viewing directions by a perspective camera with full prior knowledge of the camera configurations. The reconstructed surface points are frontier points and the wireframe is a network of contour generators. Both of them are reconstructed by pairing apparent contours in the 2D images. Unlike previous works, we empirically demonstrate that if the viewing directions are uniformly distributed around the object's viewing sphere, then the reconstructed 3D points automatically cluster closely on a highly curved part of the surface and are widely spread on smooth or flat parts. The advantage of this property is that the reconstructed points along a surface or a contour generator are not under-sampled or under-represented because surfaces or contours should be sampled or represented with more densely points where their curvatures are high. The more complex the contour's shape, the greater is the number of points required, but the greater the number of points is automatically generated by the proposed method. Given that the viewing directions are uniformly distributed, the number and distribution of the reconstructed points depend on the shape or the curvature of the surface regardless of the size of the surface or the size of the object. The unique pattern of the reconstructed points and contours may be used in 31) object recognition and measurement without computationally intensive full surface reconstruction. The results are obtained from both computer-generated and real objects. (C) 2007 Elsevier B.V. All rights reserved.

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

Integrating augmented reality with home systems

Augmented Reality systems overlay computer generated information onto a user's natural senses. Where this additional information is visual, the information is overlaid on the user's natural visual field of view through a head mounted (or “head-up”) display device. Integrated Home Systems provides a network that links every electrical device in the home which provides to a user both control and data transparency across the network.

Chess Endgame News

Three topics are discussed. First, an issue in the epistemology of computer simulation - that of the chess endgame 'becoming' what computer-generated data says it is. Secondly, the endgames of the longest known games are discussed, and the concept of a Bionic Game is defined. Lastly, the set of record-depth positions published by Bourzutschky and Konoval are evaluated by the new MVL tables in Moscow - alongside the deepest known mate of 549 moves.

The new Hollywood, 1981–1999: special/visual effects

The emergence and development of digital imaging technologies and their impact on mainstream filmmaking is perhaps the most familiar special effects narrative associated with the years 1981-1999. This is in part because some of the questions raised by the rise of the digital still concern us now, but also because key milestone films showcasing advancements in digital imaging technologies appear in this period, including Tron (1982) and its computer generated image elements, the digital morphing in The Abyss (1989) and Terminator 2: Judgment Day (1991), computer animation in Jurassic Park (1993) and Toy Story (1995), digital extras in Titanic (1997), and ‘bullet time’ in The Matrix (1999). As a result it is tempting to characterize 1981-1999 as a ‘transitional period’ in which digital imaging processes grow in prominence and technical sophistication, and what we might call ‘analogue’ special effects processes correspondingly become less common. But such a narrative risks eliding the other practices that also shape effects sequences in this period. Indeed, the 1980s and 1990s are striking for the diverse range of effects practices in evidence in both big budget films and lower budget productions, and for the extent to which analogue practices persist independently of or alongside digital effects work in a range of production and genre contexts. The chapter seeks to document and celebrate this diversity and plurality, this sustaining of earlier traditions of effects practice alongside newer processes, this experimentation with materials and technologies old and new in the service of aesthetic aspirations alongside budgetary and technical constraints. The common characterization of the period as a series of rapid transformations in production workflows, practices and technologies will be interrogated in relation to the persistence of certain key figures as Douglas Trumbull, John Dykstra, and James Cameron, but also through a consideration of the contexts for and influences on creative decision-making. Comparative analyses of the processes used to articulate bodies, space and scale in effects sequences drawn from different generic sites of special effects work, including science fiction, fantasy, and horror, will provide a further frame for the chapter’s mapping of the commonalities and specificities, continuities and variations in effects practices across the period. In the process, the chapter seeks to reclaim analogue processes’ contribution both to moments of explicit spectacle, and to diegetic verisimilitude, in the decades most often associated with the digital’s ‘arrival’.

Flexibility and inhibitor binding in Cdc25 phosphatases

Cdc25 phosphatases involved in cell cycle checkpoints are now active targets for the development of anti-cancer therapies. Rational drug design would certainly benefit from detailed structural information for Cdc25s. However, only apo- or sulfate-bound crystal structures of the Cdc25 catalytic domain have been described so far. Together with previously available crystalographic data, results from molecular dynamics simulations, bioinformatic analysis, and computer-generated conformational ensembles shown here indicate that the last 30-40 residues in the C-terminus of Cdc25B are partially unfolded or disordered in solution. The effect of C-terminal flexibility upon binding of two potent small molecule inhibitors to Cdc25B is then analyzed by using three structural models with variable levels of flexibility, including an equilibrium distributed ensemble of Cdc25B backbone conformations. The three Cdc25B structural models are used in combination with flexible docking, clustering, and calculation of binding free energies by the linear interaction energy approximation to construct and validate Cdc25B-inhibitor complexes. Two binding sites are identified on top and beside the Cdc25B active site. The diversity of interaction modes found increases with receptor flexibility. Backbone flexibility allows the formation of transient cavities or compact hydrophobic units on the surface of the stable, folded protein core that are unexposed or unavailable for ligand binding in rigid and densely packed crystal structures. The present results may help to speculate on the mechanisms of small molecule complexation to partially unfolded or locally disordered proteins.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Comparação de dois sistemas de imagem para avaliação do perfil de tecido mole em cirurgia ortognática

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aplicação de filtro harmônico em sistemas elétricos de baixa tensão utilizando Lógica Fuzzy

Em um sistema elétrico existem vários circuitos e equipamentos industriais que se comportam como dispositivos não-lineares. Esse comportamento geram sinais que causam distorções dentro desse sistema. Essas distorções são chamadas de Harmônicas, que calculada de forma ampla nos fornece o valor do THD (do inglês Total Harmonic Distortion ou Distorção Harmônica Total). Este trabalho apresenta uma das várias soluções para minimizar esse indicador através da detecção por um algoritmo computacional instalado no medidor de THD apropriado e pela utilização de filtros harmônicos passivos. Este algoritmo computacional detecta e calcula em quais frequências o valor do THD está elevado em comparação a um índice normativo definido utilizando para isso a Lógica Fuzzy. Uma vez definido a necessidade da aplicação do filtro harmônico esse será projetado pelo algoritmo computacional. O filtro harmônico entregado neste trabalho será o filtro passivo devido a sua fácil instalação e ao seu baixo custo. Dessa forma, o algoritmo computacional proposto funciona no início da medição do THD, no equipamento medidor, indicando uma faixa classificatória de THD medido, utilizando para isso a Lógica Fuzzy, identifica a necessidade ou não da instalação do filtro harmônico passivo e seu projeto, e finaliza efetuando um novo cálculo de THD.

Investigação do efeito terapêutico do Psyllium sobre a dislipidemia infanto-juvenil

Psyllium é uma fonte rica de fibra solúvel mucilaginosa e é considerado um suplemento dietético útil no tratamento de pacientes com hipercolesterolemia. O objetivo deste estudo foi avaliar a eficácia e a segurança da suplementação do psyllium na redução do perfil lipídico em crianças e adolescentes brasileiros dislipidêmicos. Cinqüenta e cinco sujeitos (6-19 anos) com hipercolesterolemia moderada foram avaliados em um estudo clínico, paralelo, duplo cego, controlado e randomizado, conduzido em 2 períodos. Inicialmente, todos participantes recrutados passaram por um estágio de adaptação à dieta restrita em gordura saturada (<7%) e colesterol (<200 mg/dia) que durou 6 semanas antes do tratamento. Após este período, os participantes elegíveis foram alocados aleatoriamente para 2 grupos (controle n=25 e psyllium n=30) usando uma seqüência numerada randomizada gerada por computador. Durante o período de 8 semanas do ensaio clínico, o grupo psyllium manteve a dieta restrita em gordura saturada e colesterol, suplementada diariamente com 7,0 g de psyllium , enquanto o grupo controle recebeu a mesma dieta adicionada com uma quantidade equivalente de celulose (placebo). No final do tratamento, quatro sujeitos foram excluídos após randomização (perdas no seguimento) totalizando 51 sujeitos (grupo controle=24; grupo psyllium n=27), que completaram o estudo. O grupo que recebeu psyllium apresentou um decréscimo significativo nas concentrações de colesterol total (CT) (4,1% [-0,20mmol/L]; p=0,01) e de LDL-colesterol (LDL-c) (7,2% [-0,24 mmol/L]; p<0,001) em comparação à linha de base. Reduções adicionais foram observadas quando comparadas com o grupo controle (CT:4,1% [0,20mmol/L]; p=0,002) e (LDL-c:7,8% [0,26mmol/L]; p=0,007). Nenhum dos participantes relatou aversão ao cheiro, sabor e textura do psyllium, nem a presença de efeitos adversos significativos. A terapia com psyllium se mostrou eficaz na redução das concentrações do LDL-c e demonstrou ser seguro e aceitável pela população do estudo.