Cleft lip defects are usually regarded as a single entity, with the assumption that an accompanying cleft palate represents the more severe form. The authors linked data from the Medical Birth Registry of Norway with medical records from two centralized centers to provide a population-based data set. They assessed the distribution of cleft lip only and cleft lip with cleft palate by covariate. Among 1.8 million Norwegian livebirths between 1967 and 1998, there were 1,572 cases of cleft lip with cleft palate and 1,122 cases with cleft lip only. Seventeen percent of those with cleft lip and palate had another defect compared with 9% of those with cleft lip only. For boys, the risk was greater for cleft lip and palate than for cleft lip only (odds ratio ¼ 2.4 vs. 1.8, p < 0.001 for difference). The risk of cleft lip only, but not of cleft lip and palate, was increased for twins (odds ratio ¼ 1.6 vs. 1.1, p ¼ 0.11) and infants whose parents were first cousins (odds ratio ¼ 2.7 vs. 0.7, p ¼ 0.07). Although cleft lip with cleft palate may simply represent a more severe form of the defect, epidemiologic assessments of cleft lip should, when possible, include separate analyses of these two groups. abnormalities; cleft lip; cleft palate; Norway

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Cleft Lip and Palate versus Cleft Lip Only: Are They Distinct Defects?

Use of computer based decision tools to aid clinical decision making, has been a primary goal of research in biomedical informatics. Research in the last five decades has led to the development of Medical Decision Support (MDS) applications using a variety of modeling techniques, for a diverse range of medical decision problems. This paper surveys literature on modeling techniques for diagnostic decision support, with a focus on decision accuracy. Trends and shortcomings of research in this area are discussed and future directions are provided. The authors suggest that--(i) Improvement in the accuracy of MDS application may be possible by modeling of vague and temporal data, research on inference algorithms, integration of patient information from diverse sources and improvement in gene profiling algorithms; (ii) MDS research would be facilitated by public release of de-identified medical datasets, and development of opensource data-mining tool kits; (iii) Comparative evaluations of different modeling techniques are required to understand characteristics of the techniques, which can guide developers in choice of technique for a particular medical decision problem; and (iv) Evaluations of MDS applications in clinical setting are necessary to foster physicians' utilization of these decision aids.

Modeling Paradigms for Medical Diagnostic Decision Support: A Survey and Future Directions

Purpose – The purpose of this paper is to adopt a multiple case-study approach, of three companies, in order to identify the factors affecting Lean Six Sigma (L6σ) implementation in service industry. Design/methodology/approach – Secondary data were collected through companies’ documents, written procedures and quality assurance policies. Primary data were collected through a number of in-depth interviews with managers and quality experts. Findings – The analysis of qualitative data gathered through in-depth interviews with managers in all three cases resulted in the emergence of variety of critical success factors (CSFs) regarding L6σ implementation in service industry. As it can be seen the great majority of the factors have been identified in all three cases. Moreover the analysis shows that there are two categories of factors emerged. Originality/value – This study has four major contributions. First, it provides an intergraded multi-factor framework regarding the implementation of L6σ in service indu...

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Road towards Lean Six Sigma in service industry: a multi-factor integrated framework

Heuristic and Optimization for Knowledge Discovery A Heuristic Algorithm for Feature Selection Based on Optimization Techniques Cost-Sensitive Classification using Decision Trees, Boosting and MetaCost Heuristic Search-Based Stacking of Classifiers Designing Component-Based Heuristic Search Engines for Knowledge Discovery Clustering Mixed Incomplete Data Bayesian Learning The Role of Sampling in Data Mining The Gamma Test Neural Networks How to Train Multilayer Perceptrons Efficiently with Large Data Cluster Analysis of Marketing Data Examining On-Line Shopping Heuristics in Medical Data Mining Understanding Credit Card Users Behaviour Heuristic Knowledge Discovery for Archaeological Data Using Cultural Algorithms and Rough Sets

Heuristics and optimization for knowledge discovery

INTRODUCTION: diagnostic radiology is recognised as a key component of modern healthcare however there is marked inequality in global access to imaging. Rural populations of low- and middle-income countries (LMICs) have the greatest need. Carefully coordinated healthcare planning is required to meet the ever increasing global demand for imaging and to ensure equitable access to services. However, meaningful planning requires robust data. Currently, there is no comprehensive published data on radiological equipment resources in low-income countries. The aim of this study was to conduct the first detailed analysis of registered diagnostic radiology equipment resources in a low income African country and compare findings with recently published South African data. METHODS: the study was conducted in Tanzania in September 2014, in collaboration with the Tanzanian Atomic Energy Commission (TAEC) which maintains a comprehensive database of the country’s registered diagnostic imaging equipment. All TAEC equipment data were quantified as units per million population by imaging modality, geographical zone and healthcare sector. RESULTS: there are 5.7 general radiography units per million population in the public sector with a relatively homogeneous geographical distribution. When compared with the South African public-sector, Tanzanian resources are 3-, 21- and 6-times lower in general radiography, computed tomography and magnetic resonance imaging respectively. CONCLUSION: the homogeneous Tanzanian distribution of basic public-sector radiological services reflects central government’s commitment to equitable distribution of essential resources. However, the 5.7 general radiography units per million population is lower than the 20 units per million population recommended by the World Health Organization.

Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country.

Objective: To propose a new method, which allows for a complete description of primary and secondary cleft palates, incorporating elements that are related to the palate, lip, and nose that will also reflect the complexity of this problem. Method: To describe the type of cleft, two embryonic structures were considered: (1) the primary palate, formed by the prolabium, premaxilla, and columella and (2) the secondary palate, which begins at the incisive foramen and is formed by a horizontal portion of the maxilla, the horizontal portion of the palatine bones, and the soft palate. Anatomical characteristics to be considered were defined, and a new method is proposed to more fully describe any cleft. Results: A description of five cases was made using the method proposed in this work and compared with other published methods for the classification and description of clefts. Conclusions: A mathematical expression was developed to characterize clefts of the primary palate, including the magnitude of pal...

A new approach to classify cleft lip and palate.

The main goal of this paper is to show the usefulness of the logic-combinatory approach in pattern recognition theory for developing auxiliary criteria for differential medical diagnosis, based on the methodology presented by Heathfield et al. (J Biomed Eng 13 (1991) 51-57). Firstly, we propose a change in the characterization base, from disease characterization to patient characterization then, we suggest a k-valued treatment for variables which allows us to assign them values in a wider range in order to represent different degrees in symptom manifestations. Secondly, the methodology proposed is based on Testor Theory. This theory allows us to obtain the minimum combination of features (symptoms) and the set of features combination equally discriminant (typical testors) among the diseases considered. Then, applying some classification algorithm that uses typical testors, physicians will have more making differential flexibility diagnosis.

A new approach to differential diagnosis of diseases

Delivery of services to a patient has to be given with an acceptable measure of quality that can be monitored through the patient's satisfaction. The objective of this work was to innovate processes eliminating waste and non value-added work in processes done at the Imaging Department in the National Institute of Respiratory Diseases (INER for its Spanish acronym) in Mexico City, to decrease the time a patient spends in a study and increase satisfaction. This innovation will be done using Lean Six Sigma tools and applied in a pilot program.

Lean Six Sigma applied to a process innovation in a Mexican health institute's imaging department

We propose an index to prioritize preventive maintenance for medical equipment. Our index considers seven variables: type of equipment, equipment function, maintenance requirements, calibration, equipment age, equipment location, and equipment hazards. We developed a mathematical model using these variables, and its result is interpreted as an index of equipment maintenance priority. The numerical output of the index was classified into three categories: high, medium, and low priority. We proposed our index model to technical staff at the Department of Biomedical Engineering of the National Institute of Respiratory Diseases in Mexico as a protocol for scheduling appropriate preventive maintenance for medical equipment during the year. The index was tested in a sample of 16 different medical equipment. Our model provides a guide to define the priority and the number of preventive maintenance routines required for medical equipment per year.

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M. R. Ortiz-Posadas

Papers

A new approach to classify cleft lip and palate.

A new approach to differential diagnosis of diseases

Lean Six Sigma applied to a process innovation in a Mexican health institute's imaging department

An index to prioritize the preventive maintenance of medical equipment

A similarity function to evaluate the orthodontic condition in patients with cleft lip and palate.