Machine Learning is the study of methods for programming computers to learn. Computers are applied to a wide range of tasks, and for most of these it is relatively easy for programmers to design and implement the necessary software. However, there are many tasks for which this is difficult or impossible. These can be divided into four general categories. First, there are problems for which there exist no human experts. For example, in modern automated manufacturing facilities, there is a need to predict machine failures before they occur by analyzing sensor readings. Because the machines are new, there are no human experts who can be interviewed by a programmer to provide the knowledge necessary to build a computer system. A machine learning system can study recorded data and subsequent machine failures and learn prediction rules. Second, there are problems where human experts exist, but where they are unable to explain their expertise. This is the case in many perceptual tasks, such as speech recognition, hand-writing recognition, and natural language understanding. Virtually all humans exhibit expert-level abilities on these tasks, but none of them can describe the detailed steps that they follow as they perform them. Fortunately, humans can provide machines with examples of the inputs and correct outputs for these tasks, so machine learning algorithms can learn to map the inputs to the outputs. Third, there are problems where phenomena are changing rapidly. In finance, for example, people would like to predict the future behavior of the stock market, of consumer purchases, or of exchange rates. These behaviors change frequently, so that even if a programmer could construct a good predictive computer program, it would need to be rewritten frequently. A learning program can relieve the programmer of this burden by constantly modifying and tuning a set of learned prediction rules. Fourth, there are applications that need to be customized for each computer user separately. Consider, for example, a program to filter unwanted electronic mail messages. Different users will need different filters. It is unreasonable to expect each user to program his or her own rules, and it is infeasible to provide every user with a software engineer to keep the rules up-to-date. A machine learning system can learn which mail messages the user rejects and maintain the filtering rules automatically. Machine learning addresses many of the same research questions as the fields of statistics, data mining, and psychology, but with differences of emphasis. Statistics focuses on understanding the phenomena that have generated the data, often with the goal of testing different hypotheses about those phenomena. Data mining seeks to find patterns in the data that are understandable by people. Psychological studies of human learning aspire to understand the mechanisms underlying the various learning behaviors exhibited by people (concept learning, skill acquisition, strategy change, etc.).

Machine learning

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

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Modern Applied Statistics With S

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

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Tips on getting published

A case of an extrahepatic biliary tract fibro-adenoma in a 35-year-old woman

The definitive version is available at www.blackwell-synergy.com Article first published online: 29 SEP 2004

How many surgeons do we need

BACKGROUND To assess the adherence rate of surveillance colonoscopy booking intervals to recommended National Health and Medical Research Council guidelines at The Queen Elizabeth Hospital, Adelaide, Australia. METHODS Patients on The Queen Elizabeth Hospital colorectal unit surveillance colonoscopy waiting list were included in this audit. Patient demographics, colonoscopy findings, follow-up plans and pathology results were analysed. Patients were categorized as normal/non-neoplastic finding, low-risk adenomas, high-risk adenomas, personal history of colorectal cancer (CRC) and family history of CRC. Booked colonoscopy within 2 months of guideline recommended interval was considered correct. RESULTS A total of 467 patients were included (59.1% male; mean age 60 years). Two hundred and fifty-one (53.7%) patients had an incorrect surveillance colonoscopy booking. Twenty-seven patients with a normal/non-neoplastic previous colonoscopy not requiring surveillance colonoscopy were incorrectly booked for a colonoscopy. For the 222 patients booked incorrectly and requiring surveillance colonoscopy, 88.7% were early and 11.3% were late. The proportions of incorrect bookings were highest in the low-risk finding (66.1%) and history of CRC (67.6%) groups. For the 186 patients requiring a 3-year surveillance interval, 38.7% were booked incorrectly. For the 197 patients requiring a 5-year surveillance interval, 63.5% were booked incorrectly, of which 99.2% were early. More 5-year surveillance interval patients were booked at 3 years (n = 79), than at the correct interval of 5 years (n = 72). CONCLUSION Adherence to the National Health and Medical Research Council guidelines for surveillance colonoscopy is poor. The majority of deviations represent early follow-up, which is most common among patients with low-risk findings or history of CRC. There is a tendency towards 3-year surveillance among low-risk patients.

Surveillance colonoscopies frequently booked earlier than the National Health and Medical Research Council guidelines: findings of a single centre audit.

Population studies from various countries have demonstrated that obstructive sleep apnoea (OSA) is becoming highly prevalent in adults; approximately one in five adults have at least mild OSA and one in 15 adults have moderate or severe OSA.1 A 1995 Australian survey of 2202 people aged 35–69 years estimated that the prevalence of OSA, based on an apnoea–hypopnoea index (AHI) of ‡15 (moderate–severe OSA), was at least 3.6% (5.7% for men, 1.2% for women).2 With the increase in obesity this estimate could now be higher. There has been recent controversy over the role of upper airway surgical procedures in the treatment of OSA. Upper airway surgery includes phase I procedures such as uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), temperaturecontrolled radiofrequency tissue ablation (TCRFTA), palatal implants, and inferior sagittal mandibular osteotomy and genioglossus advancement with or without hyoid myotomy and suspension (ISMO and GA with or without HM); and more invasive phase II procedures such as maxillomandibular osteotomy and advancement (MMO), and mucosal sacrificing glossectomy techniques (laser midline glossectomy and lingualplasty). In line with the American Sleep Disorders Association (ASDA) guidelines, the role of upper airway surgery in adult OSA is generally accepted as appropriate only when less invasive treatments are ineffective, rejected or inappropriate.3 The critical issue is whether upper airway surgery should be offered in this context, or whether the patient should be left untreated, because the safety and effectiveness of surgery remain controversial. A systematic search of the literature indicated that there is a paucity of high-level evidence on the safety and effectiveness of upper airway surgery for treating OSA in comparison with conservative behavioural therapy, treatment with devices (continuous positive airway pressure (CPAP) or oral appliances), or no treatment. Five systematic reviews (which included four relevant randomized controlled trials (RCT)) were identified on this topic,4–8 as well as one additional RCT that was published too recently to be included in the systematic reviews.9 All reviews were restricted by the lack of RCT evidence. The available RCT included specific patient groups selected according to OSA severity, anatomy, or body mass index (BMI), and used different surgical procedures and comparators, precluding direct comparisons between studies. Results were generally limited by small sample sizes, short follow-up periods, and the inability to generalize results. The success of OSA surgery is usually measured by the level of improvement in polysomnography outcomes, but the systematic reviews and additional RCT provide insufficient evidence to determine the effect of upper airway surgery on polysomnography results. From limited short-term RCT evidence (follow up £1 year), it appears that UPPP and TCRFTA do not present significant benefits in mean polysomnography outcomes compared with conservative management or placebo, although one UPPP study reported a higher success rate in UPPP compared with conservative management.5,6 One RCT in LAUP and one in palatal implants found some benefit in surgery compared to no treatment or placebo in the short term (3 month follow up).5,6,9 Use of oral appliance therapy and CPAP produced better polysomnographic outcomes than surgery (follow up of 4 years for oral appliances vs surgery and 8 weeks for CPAP vs surgery);5,6 but unlike surgery any device has the additional issue of compliance. Higher level evidence was not available for any other procedures. Surgical success rates varied depending on the procedure, the patient population, and the actual definition of success. If the traditional definition of success is used (a 50% reduction in AHI and/or AHI £20), for phase I procedures approximately half of patients will achieve this level of success.7 From lower level (non-RCT) evidence the success rate of phase II procedures was approximately 85%.7 According to a recent review, the success rate after multi-level surgery (surgery to at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx) was 66%.8 There has, however, been recent discussion on whether the traditional measure of surgical success (‡50% reduction in AHI, and a decrease in score to £20) represents clinically significant health outcomes.7 In addition, the long-term effectiveness of the various surgical techniques cannot be established from the available evidence. Polysomnography alone is not an ideal measure of treatment success because it is poorly correlated with health outcomes. There was also insufficient evidence from the systematic reviews and RCT, however, to determine the effect of upper airway surgery on the health outcomes of daytime sleepiness, snoring or quality of life. When compared with conservative management or no treatment/ placebo, two RCT showed benefit for UPPP and palatal implants for daytime sleepiness and snoring, while two other RCT found no benefit for LAUP and TCRFTA for daytime sleepiness.5,6,9 For quality of life measures, one RCT found no benefit for LAUP, while two others reported possible benefit after TCRFTA and palatal implant compared with no treatment/placebo.5,6,9 There was no difference between surgery and use of devices (such as the gold standard treatment of CPAP) for quality of life measures or sleepiness outcomes.5,6 There was also insufficient evidence to determine levels of patient satisfaction, or to make long-term survival comparisons between upper airway surgery and alternative treatments. It is also important to note that there are no long-term RCT studies on noninvasive measures such as CPAP and oral appliances that show efficacy in treating the morbidity or mortality associated with OSA. From limited safety evidence it would appear that UPPP had more adverse effects than the less invasive procedures of TCRFTA and palatal implants. LAUP had similar adverse effects to UPPP, at similar rates of occurrence. Long-term safety data were not available from the included studies.5,6,9 Perspectives 223

Guy J. Maddern

Papers

Tips on getting published

A case of an extrahepatic biliary tract fibro-adenoma in a 35-year-old woman

How many surgeons do we need

Surveillance colonoscopies frequently booked earlier than the National Health and Medical Research Council guidelines: findings of a single centre audit.

Upper airway surgery for adult obstructive sleep apnoea: what is the evidence?