A case study in communication disorders

Often, children with language disorders exhibit other more subtle delays or deviance in social, communicative, and cognitive development. By focusing on these three areas, the clinician can understand the developmental context in which the language delay manifests. This approach includes the following: gathering information, psychological and communicative examinations, psychiatric examination, and medical evaluation.     

Conceptual graph grammar--a simple formalism for sublanguage

There are a wide variety of computer applications that deal with various aspects of medical language: concept representation, controlled vocabulary, natural language processing, and information retrieval. While technical and theoretical methods appear to differ, all approaches investigate different aspects of the same phenomenon: medical sublanguage. This paper surveys the properties of medical sublanguage from a formal perspective, based on detailed analyses cited in the literature. A review of several computer systems based on sublanguage approaches shows some of the difficulties in addressing the interaction between the syntactic and semantic aspects of sublanguage. A formalism called Conceptual Graph Grammar is presented that attempts to combine both syntax and semantics into a single notation by extending standard Conceptual Graph notation. Examples from the domain of pathology diagnoses are provided to illustrate the use of this formalism in medical language analysis. The strengths and weaknesses of the approach are then considered. Conceptual Graph Grammar is an attempt to synthesize the common properties of different approaches to sublanguage into a single formalism, and to begin to define a common foundation for language-related research in medical informatics.     

From conceptual roles to structural relations: Bridging the syntactic cleft.

The distinction between underlying and superficial linguistic structure is a staple of modern cognitive psychology. Despite increasingly diverse conceptions of syntactic relations in linguistic theory, the received view in psycholinguistics has remained one in which the entities assigned to underlying relations may assume different surface relations. This view is examined in the context of language production and evidence is reviewed that the disposition to bind animate entities to the surface subject relation is a basic feature of language use, suggesting that mappings from conceptual categories to syntactic relations form a main support of the bridge from conception to language. Proceeding on this assumption, an evaluation of competing accounts of the mapping process in production is given. Results argue against syntactic relation-changing operations, but favor a division between meaning- and form-related mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Family Context of Preadolescents' Orientations Toward Education: Effects of Maternal Orientations and Behavior.

This study examines different pathways of maternal influence on the value that preadolescents attribute to mathematics and German language as domains of education. On the basis of data from 355 students and their mothers, the author tested effects of mothers' education, general parenting practices, leisure pursuits, joint activities with their children, school involvement, and their own evaluation of mathematics and German language. Results of structural equation modeling point to students' perceptions of maternal values as a central factor affecting students' values. Perceived maternal values vary depending on mothers' behavior rather than on values actually reported by mothers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical dictionaries for patient encoding systems: a methodology

Medical language is highly compositional and makes extensive use of common roots, especially Latino-Greek roots. Besides words devoted to common sense, medical language presents some typical characteristics, especially on morphological and semantic aspects of word formation. Morphological decomposition and identification precedes semantic analysis. It is only when these two prerequisites are fulfilled that an attempt to grasp the meaning of a whole expression is made possible. The main aim of the proposed approach is that of coping with 'the lack of coverage of the medical lexical knowledge', in order to help physicians find the correct international classification for diseases (ICD) codes for a written diagnosis. The proposed methodology allows the development of a powerful dynamic dictionary dedicated to natural language processing in the field of diagnoses and narrative procedures. It describes the design of an analyser that can profit from a dictionary. The methods used have proved to be efficient for various classifications, s well as for multiple languages, as the system presently supports French, German, English and Dutch for ICD-9 and ICD-10 classifications.     

Medical model as metaphor: Old habits die hard.

K. Chwalisz (see record 2001-07409-003) and S. Maltzman (see record 2001-07409-002) recognized that H. Ahn and B. E. Wampold's (see record 2001-07409-001) study demonstrated that component studies failed to identify specific ingredients responsible for therapeutic benefits but cautioned against rejecting a medical model of psychotherapy. The authors respond to their comments by discussing 5 fallacies: (a) The alternative to the medical model is a collection of common factors; (b) medical model language is appropriate for describing psychological treatments; (c) the medical model is valid, but only time will reveal evidence to support it; (d) rejection of the medical model implies separation from the medical establishment; and (e) a medical model conceptualization will further the mental health needs of diverse communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concept-oriented standardization and statistics-oriented classification: continuing the classification versus nomenclature controversy

Nowadays, most activities on controlled medical vocabularies focus on the provision of a sufficient atomic-level granularity for representing clinical data. Amongst others, clinical vocabularies should be concept oriented, compositional and should also reject "Not Elsewhere Classified". We strongly share the opinion that there is a need to deal with serious deficits of existing manually created vocabularies and with new demands for computer-based advanced processing and exchange of medical language data. However, we do not share the opinion that methodological requirements like observational and structural comparability needed for sound statistics should not be included in desiderata of controlled medical vocabularies. Statistical-oriented classifications are not developed for representing detailed clinical data but for providing purpose-dependent classes where cases of interest are assigned uniquely. Either statistical classifications are not included into the set of controlled medical vocabularies in the sense of Cimino, or his desiderata are misleading. We argue that statistical classifications should be linked to (formal) concept systems, but again this linkage does not change their different natures. With this article we continue the "classification versus nomenclature" controversy referring to Coté.     

Children with down syndrome: Implications for assessment and intervention in the school.

Down syndrome is the most common genetic cause of mental retardation and one of the most frequently occurring neurodevelopmental genetic disorders in children. Children with Down syndrome typically experience a constellation of symptomology that includes developmental motor and language delay, specific deficits in verbal memory, and broad cognitive deficits. Children with Down syndrome are also at increased risk of medical problems, which can exacerbate their cognitive deficits. Although the diagnosis of Down syndrome is facilitated by cytogenetic testing and the unique physical phenotype, the development of proper interventions for this group of children is less obvious. Despite their functional deficits, children with Down syndrome possess relative strengths, which can be the focus of interventions. This article reviews the etiology and developmental course of Down syndrome, appraises examples of empirically validated interventions, and discusses neurocognitive processing issues that should be considered during a psychoeducational evaluation for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using standardized patients and standardized physicians to improve patient-care quality: results of a pilot study

BACKGROUND: We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills. METHOD: Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions. RESULTS: Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language. CONCLUSIONS: Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.     

Language of learning and language of computing: The perceptual-language model.

A process-diagnostic orientation for assessment of special needs and for evaluation of instructional outcomes was implemented with a sample of 120 language-impaired preschool children. In one study, children's language impairments were characterized with respect to language processes associated previously with successful classroom learning. These classroom language processes were assessed with the Preschool Language Assessment Instrument, which operationalizes a "perceptual-language" model of classroom communication and learning outcomes. As predicted by the perceptual-language model, individual responses were characterized by a simplex structure. In a second study, children who participated in an environment that included instruction in the LOGO programming language demonstrated higher levels of perceptual-language skills postinstruction when compared with counterparts who either participated in a second software environment or were in a control condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disability law: problems and proposals

BACKGROUND: Medically disabled persons have traditionally encountered obstacles when seeking and maintaining employment. Integration of the medically disabled worker is the goal of recent legislation that directs removal of physical barriers and protects disabled workers from discrimination. The major force driving this social policy is the Americans With Disabilities Act (ADA). METHODS: Current disability laws and related judicial opinions are reviewed. Primary attention is focused on the ADA. RESULTS: Legislation addressing employment discrimination has serious deficiencies. Medical support of this important social policy is hampered by vague statutory definitions and seemingly capricious judicial opinions. CONCLUSION: Disability laws require precise language identifying specific, qualifying medical conditions. The laws should require comprehensive medical assessment that objectively establishes a connection between a medical disorder and severe, sustained impairment. Some currently included conditions, such as personality disorders, should be considered for exclusion.     

Representing clinical narratives using conceptual graphs

The analysis of medical narratives and the generation of natural language expressions are strongly dependent on the existence of an adequate representation language. Such a language has to be expressive enough in order to handle the complexity of human reasoning in the domain. Sowa's Conceptual Graphs (CG) are an answer, and this paper presents a multilingual implementation, using French, English and German. Current developments demonstrate the feasibility of an approach to natural Language Understanding where semantic aspects are dominant, in contrast to syntax driven methods. The basic idea is to aggregate blocks of words according to semantic compatibility rules, following a method called Proximity Processing. The CG representation is gradually built, starting from single words in a semantic lexicon, to finally give a complete representation of the sentence under the form of a single CG. The process is dependent on specific rules of the medical domain, and for this reason is largely controlled by the declarative knowledge of the medical Linguistic Knowledge Base.     

Medical technology assessment: economic evaluation of new technologies

Growing expenditures in health care made it necessary to find control mechanisms to evaluate expenditure. Medical technology assessment is becoming a valuable tool to assist policymakers in controlling new medical technologies. This review deals with the increasing importance of economic evaluation as part of medical technology assessment and describes various techniques by which an economic evaluation can be performed.     

Your research: how to get it on paper and in print

Much worthwhile medical research is never accepted for publication or is ignored when published, often because it is poorly presented. The purpose of this article is to express in simple language how research is best presented in writing. Few actual data are given, though much experience is summarized. The result desired is greater ease, clarity, and effectiveness in communicating medical research. The principles presented here are intended to make medical research writing easier and clearer and to give the research itself more impact.     

Modeling concepts in medicine for medical language understanding

Over the past two decades, the construction of models for medical concept representation and for understanding of the deep meaning of medical narrative texts have been challenging areas of medical informatics research. This review highlights how these two inter-related domains have evolved, emphasizing aspects of medical modeling as a tool for medical language understanding. A representation schema, which balances partially but accurately with complete but complex representations of domain-specific knowledge, must be developed to facilitate language understanding. Representative examples are drawn from two major independent efforts undertaken by the authors: the elaboration and the subsequent adjustment of the RECIT multilingual analyzer to include a robust medical concept model, and the recasting of a frame-based interlingua system, originally developed to map equivalent concepts between controlled clinical vocabularies, to invoke a similar concept model.     

The Internet & Healthcare Education: HELIX

With the advent of the World Wide Web (WWW), we are now on the cusp of a revolution in computer technology that will dramatically enhance medical education. An historical analogy might be Johann Gutenberg's invention of movable type in the 1400's-radically decreasing the cost, time, and expertise required to reproduce printed materials. Now, the WWW can decrease the cost of disseminating medical educational materials. When an educational module is authored for the Web, it can be placed on a computer "server" which in turn, distributes the program on the WWW to anyone with a computer and Internet access. Rapidly emerging standards are being developed to allow increasingly rich educational experiences on the Internet. With the introduction of HTML (hypertext markup language), a standardized method of placing text and graphics, as well as the connections between them, was created.     

基于领域词典与CRF双层标注的中文电子病历实体识别

医疗实体识别是电子病历文本信息抽取的基本任务。针对中文电子病历文本复合实体较多、实体长度较长、句子成分缺失严重、实体边界不清的语言特点以及标注语料难以获取的现状,提出了一种基于领域词典和条件随机场（CRF）的双层标注模型。该模型通过对外部资源的统计分析构建医疗领域词典,再结合条件随机场,进行了两次不同粒度的标注,将领域词典识别的准确性和机器学习的自动性融为一体,从中文电子病历文本中识别出疾病、症状、药品、操作四类医疗实体。该模型在测试数据中的宏精确率为96.7%、宏召回率为97.7%、宏F1值为97.2%。同时对比分析了采用注意力机制的深度神经网络的识别效果,因受到领域数据集大小的限制,在该测试数据集中后者表现不佳。实验结果表明了该双层标注模型对中文医疗实体识别的高效性。