ACCEPTANCE SPEECH.
ASSOCIATION FOR PATHOLOGY INFORMATICS.
HONORARY FELLOW, 2007.
LAST REVISED: 7/4/2009.
G. William Moore, MD, PhD: George.Moore4@va.gov
http://www.netautopsy.org/apihonfl.htm




Presented: 6:30 PM, September 11, 2007. Annual Awards Dinner, Advancing Practice, Instruction and Innovation through Informatics. Pittsburgh Marriott City Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219.

United States Government Work, uncopyrighted, public-domain. This document does not necessarily represent the views or policies of any United States Government agency. This document is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose and non-infringement. In no event shall the authors be liable for any claim, damages or other liability, whether in an action of contract, tort or otherwise, arising from, out of, or in connection with the document or the use or other dealings made with the document.
Thank you, Dr. Balis, for this great honor that the API has bestowed upon me. I hardly feel worthy to stand here in the company of its previous recipients.

I first became interested in human disease when I was a teenager, and one of my classmates, who might have been the next Joyce Carol Oates, came down with Hodgkin's disease. She died a year after my high school graduation. Two years earlier, I had participated in a mathematics enrichment program at Michigan State University, East Lansing, for Michigan high school students, funded by the United States Government, as part of a desperate effort to catch up in math and science education, after the recent launch of Sputnik by the Soviet Union in 1957. In my freshman year at the University of Michigan, Ann Arbor, I had the opportunity to write my own computer programs. At the time, I thought that computers and mathematics had a lot to contribute to our understanding of human biology and disease. I still do.

In my graduate school education at North Carolina State University at Raleigh, in medical school at Wayne State University, Detroit, and in my anatomic pathology residency, at Johns Hopkins Hospital, Baltimore, I was fortunate enough to study mathematics from the intellectual successors of Pál Erdös, Albert Einstein, Joseph H. Woodger, and Lotfi A. Zadeh; and pathology from the successors of Franklin P. Mall, William H. Welch, Ludwig Aschoff, and George L. Wied.

I owe an incalculable debt of gratitude to my family, my extended family, and most of all, to my wife of 36 years, Barbara.


One of the major strengths of pathology as a medical specialty is good record-keeping. We are the consultants who almost never see our patients, and who often don't even see the patient's primary care physician. However, our reports have a tremendous impact on these patients' lives. Thus, our reports must be clear, legible, and have accurate patient identification. Pathologists have always been pioneers in keeping good records. We were among the first medical specialties to use the typewriter in the late nineteenth century, and we have always been on the leading edge of new technology in computerized medical records. We as pathologists have a historical mandate to maintain our own records in the best possible order, and to encourage our clinical colleagues to do the same.

Terabytes of such records are collected each week in U. S. medical centers, almost entirely without standardization. My employer, the United States Department of Veterans Affairs, has collected comprehensive, computerized records on a population of over five million honorably discharged U. S. veterans over the past decade. These computerized records have all the deficiencies that we are used to in paper medical records: haphazard organization; incomprehensible abbreviations; misspellings; creative vocabulary and grammar, and so forth. With few exceptions, however, the records are all available, all legible, and the relevant clinicians' names are all present. The mandatory clinic note provides enough medical context to make sense out of sometimes otherwise puzzling morphologic findings. If the veteran was at the West Los Angeles Veterans Affairs hospital last month, I can immediately view those records from my computer workstation at the Baltimore Veterans Affairs hospital.

In all the fallout from Hurricane Katrina two years ago, and all of FEMA's mismanagement, it was little noticed in the popular media that any veteran who could find his/her way to any other Veterans Affairs hospital in the country two days later, could keep his/her clinic appointment, with the expectation that all the medical records from the New Orleans Veterans Affairs hospital were intact and available.

As with learning to type, which my father encouraged me to do at age 12, learning to write short computer programs to search records and perform small calculations has helped me immeasurably in my career. As a person with quality assurance responsibilities in our department, I write programs each month to search these records, looking for cases needing further attention. You just can't wait until somebody prepares a Request for Proposals and writes a program for you. You have to roll up your sleeves, and do it yourself.

Veterans Affairs has devoted relatively little attention toward epidemiologic applications of this incredible treasure-trove of patient data, and it's easy to see why. First, the primary perceived mission of Veterans Affairs is patient care, not academics or health policy. Second, the data are chaotic from a research standpoint. It is tough enough for Veterans Affairs to enforce record-entry in a timely fashion. It would be nearly impossible to get all providers to use standard vocabulary and syntax for all its records. Even the apparently simple process of providing metadata for procedure manuals and policy documents, such as creation-date, revision-date, primary-author, keywords, and audio captions for sight-impaired readers, is years behind schedule. If the metadata police did an inventory of our documents, most of us would be in metadata jail. I can only imagine that other medical institutions are similarly in arrears. So, it is far from a simple step to repackage Veterans Affairs text data into a giant Microsoft® Access® database, from which to answer epidemiologic questions on our veteran patients, as interesting as these questions might be.


Another major strong-point of pathology as a medical specialty is proof. Almost every new diagnosis of cancer requires pathology for proof of diagnosis, and most non-cancer diagnoses include a laboratory test or biopsy as part of the proof. A pathology proof is different from proofs in mathematics, such as we all learned in high school geometry, but less so that one might initially imagine. A Euclidean proof begins with a hypothesis, X, and ends with a conclusion, Y. Then one shows stepwise that X implies A, A implies B, ... implies Y.

The achievement of Euclid was not that he discovered anything new, but rather that he assembled one thousand years of Mediterranean mathematics under five general principles, or axioms.

A similar challenge lies before us as pathologists. We already have a surfeit of knowledge in pathology, that is somewhat organized in textbooks. It's difficult to purchase an illustrated specialty textbook in pathology these days for less than $300, that weighs less than ten pounds. Every one of these textbooks has a Table of Contents and a few organizing principles. Yet, there is no formal, stepwise method for deducing the entire book from these contents and principles.

What would these proofs look like? A good starting point might be Dr. Berman's tumor classification, based upon embryogenesis, which is comprehensive, strictly hierarchical, and satisfies the conditions of a class hierarchy proposed by the Semantic Worldwide Web initiative of the Worldwide Web Consortium. These classes are mathematically consistent, and have many desirable properties of elementary set theory. Every concept in a class has exactly one parent concept, which can be a significant straightjacket for an eclectic thinker such as myself. When a pathology concept seems to have more than one obvious parent, then a choice between two or more possible parents might have to be imposed by an overall doctrine or by executive fiat. We pathologists are a contentious group, and I can envision these sorts of arguments about selecting the appropriate unique parent spinning out over years.

In mathematics, each step in a proof must only be true. (Actually, being both true and intuitively appealing is a big help.) In medicine, each step in a proof must not only be true, but also be ethical and cost-effective. That is, each data collection step involving the patient must not unduly harm the patient, mustn't cost more, either in dollars or pain, than alternative data collection steps; must likely yield an answer commensurate with the cost, pain, or risk to the patient, and so forth.

In conclusion, a pathology proof is much like a mathematics proof, only with considerably more fundamental complexity and much more uncertainty at many steps along the way. Yet uncertainty is not unheardof in mathematics, either: probability theory; fuzzy set theory; incomputability theory; and ultimately, Gödel's undecidability proof. These are all areas of respectable mathematics, with their own styles of proof. Perhaps the Gödel of pathology informatics is sitting right here in the audience this evening, wishing that I would stop talking, so that he/she could finish dessert, and get out for an after dinner drink and a serious discussion about pathology informatics.

Thank you for your support and confidence in my work.


GLOSSARY, REFERENCES, AND NOTES:



1. Many of the ideas presented in these notes owe their beginnings to seventeen years of lunchroom conversations in the Baltimore Veterans Affairs Medical Center cafeteria, with my colleagues in pathology, radiology, surgery, and general medicine. We discuss exclusively medicine, science, religion, and politics; the more controversial, the better. The only constraint on these proceedings is: civility. Occasionally some of my colleagues become so upset that they must get up and leave the table.

2. Moore GW.
G. William Moore, MD, PhD. Curriculum Vitae.
http://www.gwmoore.org/gwmcv.htm
My six major areas of academic concentration are: (1) Bimodal distributions (2) Evolutionary/decision trees; (3) Ethical/modal logic; (4) Contingency tables; (5) Computer translation; and (6) Tissue geometry. Last tested: July 4, 2009.

3. Association for Pathology Informatics.
http://www.pathologyinformatics.org/
Last tested: July 4, 2009.

4. Association for Pathology Informatics. Honorary Fellow Award. Recipients.
Sidney A. Goldblatt, MD. 2002.
Donald P. Connelly, MD, PhD. 2003.
William R. Dito, MD. 2004.
Raymond D. Aller, MD. 2005.
Bruce A. Friedman, MD. 2006.
http://www.pathologyinformatics.org/FellowAward.htm
Last tested: July 4, 2009.

5. Pathology is the study of the etiology and pathogenesis of disease. Our modern understanding begins with the publication of Giovanni Battista Morgagni's De Sedibus et causis morborum per anatomem indagatis (1761) (On the seats and causes of diseases, demonstrated by anatomy). In the twentieth century, the work of George N. Papanicolaou, MD, PhD, saved more lives than any other single advance in pathology.

6. Joyce Carol Oates (1938-) "is an American author and the Roger S. Berlind '52 Professor in the Humanities, with the Program in Creative Writing at Princeton University, where she has taught since 1978. She serves as associate editor for the Ontario Review, a literary magazine, and the Ontario Review Press, a literary book publisher, both of which are edited by her husband, Raymond J. Smith. Oates has also written under the pseudonyms "Rosamond Smith" and "Lauren Kelly."
From Wikipedia: http://en.wikipedia.org/wiki/Joyce_Carol_Oates .
Last tested: July 4, 2009.

7. Hodgkin's disease "is a type of lymphoma first described in 1832 by Thomas Hodgkin (1798-1866). Hodgkin's lymphoma is characterized clinically by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. Pathologically, the disease is characterized by the presence of Reed-Sternberg cells. Hodgkin's lymphoma was one of the first cancers to be cured by radiation. Later it was one of the first to be cured by combination chemotherapy. The cure rate is about 93%, making it one of the most curable."
From Wikipedia: http://en.wikipedia.org/wiki/Hodgkin_disease .
Last tested: July 4, 2009.

8. Mathematics is the study of proof. Mathematical arguments may be motivated by real-world observations, but genuine mathematics stands on its own, as purely a study of reasoning processes. The five major branches of mathematics are: logic, arithmetic, geometry, algebra, and calculus.

9. Sputnik-1 (Ппутник-1). Man-made satellite launched by the now-defunct Union of Soviet Socialist Republics (USSR) on October 4, 1957, and a tremendous boost to the USSR in the ongoing propaganda battle with the USA and other western powers during the Cold War. "The surprise launch of Sputnik 1, coupled with the spectacular failure of the United States' first two Project Vanguard launch attempts, shocked the United States, which responded with a number of early satellite launches, including Explorer I, Project SCORE, Advanced Research Projects Agency and Courier 1B. The Sputnik crisis also led to the creation of NASA and major increases in U. S. government spending on scientific research and education...."
From Wikipedia: http://en.wikipedia.org/wiki/Sputnik_program .
Last tested: July 4, 2009.

10. Pál Erdös (1913-1996), peripatetic and prolific Hungarian mathematician. Pál Erdös (pronounced: Pahl Erdish) lived most of his life out of two suitcases, commuting among various university Departments of Mathematics, and wrote papers with many major mathematicians of the 20th century. If you have written a paper with Erdös, then your Erdös number is 1. If you have written a paper with someone who has written a paper with Erdös, then your Erdös number is 2; if you have written a paper with someone who has written a paper with someone who has written a paper with Erdös, then your Erdös number is 3, etc. Most significant mathematicians of the twentieth century have a single-digit Erdös number. I reckon that Isaac Newton's Erdös number must be about 20; and Archimedes' Erdös number must be about 100. Prof. Struble's Erdös number is 3.

11. Albert Einstein (1879-1955; Nobel Physics, 1921), Swiss-American physicist. Prof. Einstein corresponded with Prof. Raimond Struble, when he was a graduate student. Prof. Struble taught me mathematical analysis in graduate school, and has been my recent coauthor on three APIII abstracts on tissue geometry.

12. Joseph H. Woodger (1894-1981), British biologist and author of The Axiomatic Method in Biology, which uses the mathematical methodology introduced in Whitehead and Russell's monumental work, Principia Mathematics. Lord Bertrand Russell once said that Prof. Woodger was one of the dozen or so persons who had actually read his book. Prof. Woodger translated works of the pre-World-War-II Warsaw-Lwow school of exact philosophy, headed by Jan Łukasiewicz, which fell victim to Hitler's destruction of the Polish intelligentsia after 1939.
Prof. Woodger was the PhD advisor of my PhD advisor, Prof. Mary B. Williams, an American biomathematician who received her PhD at the University of London. In those days, Prof. Williams was involved in some of the early discussions of the so-called French Flag problem, popularized by Lewis Wolpert, and contributed to my investigations with Prof. Struble on surface tissue geometry.

13. Lotfi A. Zadeh. The so-called Father of Fuzzy Logic, whose classic 1965 paper has been cited over 11,000 times in the peer-reviewed literature. The name, fuzzy logic, is an unfortunate misnomer, because (by Prof. Zadeh's own admission) there is nothing fuzzy about fuzzy logic. In fact, fuzzy logic is a generalization of classical (or crisp) logic, with the additional features that set-membership, and even truth itself, is formulated along a sliding scale from 0 to 1.

Prof. Zadeh's work has been applied to general medical problems by Prof. Kazem sadegh-zadeh, with whom I have had the pleasure of working and discussing ideas over the past thirty-five years.

14. Franklin P. Mall (1862-1917). Born "in Belle Plain, Iowa. He received his MD from the University of Michigan, in 1883 and for the next three years was involved in postgraduate study in embryology and physiology in Germany. He came to Baltimore in 1886, as one of William H. Welch's first fellows in pathology. Mall left Johns Hopkins in 1889 to become an adjunct professor of vertebrate anatomy at Clark University, Worcester, MA. From there he went to the University of Chicago, Chicago, IL, for a year as professor of anatomy, before returning to Johns Hopkins in 1893 as the first professor of anatomy at the school of medicine. His research included embryology and the relationship between structure and function in adult organs, particularly the spleen, liver, and heart. Mall, together with Welch, conceived the idea of a full-time faculty in medicine with salary support sufficient to allow time for research." From The Johns Hopkins archives.

15. Kazem Sadegh-zadeh is an analytic philosopher of medicine. He immigrated to Germany in March, 1960, and was naturalized in 1986. He studied medicine and philosophy at the German universities of Münster, Berlin, and Göttingen from 1960 through 1967; internship and residency, 1967-1971; MD, 1971; assistant professor and lecturer, 1972-1982; full professor of philosophy of medicine at the University of Münster, 1982-2004. Prof. Sadegh-Zadeh is founder of the analytic philosophy of medicine. His international recognition came especially through his work on clinical logic and methodology, including fuzzy logic and artificial intelligence in medicine. He is the founding editor of the international journals, Metamed, founded in 1977 (current title: Theoretical Medicine and Bioethics, published by Springer Verlag); and Artificial Intelligence in Medicine, founded in 1989 (published by Elsevier). His work includes: theory of medicine (in preparation), theory of fuzzy biopolymers, the prototype resemblance theory of disease, and theory of the Machina sapiens.
From Wikipedia: http://en.wikipedia.org/wiki/Kazem_Sadegh-Zadeh .
Last tested: July 4, 2009.

16. William H. Welch (1850-1934), American pathologist and microbiologist, for whom the bacterium Clostridium welchii is named. "He was first dean of the Johns Hopkins University School of Medicine. Born in Norfolk, Virginia, Welch was educated at Norfolk Academy and the Winchester Institute. He entered Yale College in 1866, where he studied Greek and classics. As an undergraduate, he joined the Skull and Bones honorary fraternity. In 1912, upon its creation, Welch was appointed to the Board of Scientific Directors of the preexisting Eugenic Records Office. This organization attempted to find the hereditary connection for "feebleminded" individuals between generations; with the understanding they could eradicate these and other undesirables through isolation, sterilization and euthanasia. The ERO had contributers such as the Rockefeller Foundation and the Harriman Family.

"From 1901 to 1933 he was founding president of the Board of Scientific Directors at the Rockefeller Institute for Medical Research. He was an instrumental reformer of medical education in the United States, as well as a president of the National Academy of Sciences from 1913-1917. He was also president of the American Medical Association in addition to other prestigious associations. He was a founding editor of the Journal of Experimental Medicine."
From Wikipedia: http://en.wikipedia.org/wiki/William_H._Welch .
Last tested: July 4, 2009.

Prof. Welch was a large pathologist with a messy desk, two features which endear him to me quite apart from his academic achievements.

17. Karl Albert Ludwig Aschoff (1866-1942), German pathologist, for whom Aschoff bodies in the heart (a morphologic finding in rheumatic heart disease) are named. Prof. Aschoff "... was one of the most productive of the group of German pathologists who flourished in the late nineteenth and early twentieth centuries. He is especially remembered for describing the reticuloendothelial system, and the bodies that bear his name. He studied in Bonn, Strassburg, and Göttingen, and graduated from the University of Bonn in 1889. He was conferred doctor of medicine in 1889; in 1894, he was habilitated [associate professorship] for pathological anatomy; and became first assistant at the Institute of pathology in Göttingen under Friedrich Daniel von Recklinghausen (1833-1910). He became professor of pathology at Marburg, in 1903; and from 1906 onward was professor in Freiburg im Breisgau, where he spent the rest of his career, retiring in 1936. At Freiburg, he established an institute of pathology that attracted students from all over the world.

"Aschoff made important studies on appendicitis, gallstones, jaundice, scurvy, and thrombosis, and wrote classical histological descriptions of rheumatic conditions. He is, however, particularly remembered for having recognized the phagocytic activity of certain cells found in diverse tissues, and named them the reticuloendothelial system.

"His outstanding textbook on pathological anatomy went through many editions, and was used as a standard text for many years.

"Aschoff was the publisher of Beiträge zur pathologischen Anatomie und zur allgemeinen Pathologie [Contributions to Pathologic Anatomy and General Pathology; now: Pathology, Research and Practice.] and Veröffentlichungen aus der (Kriegs-), Gewerbe und Konstitutionspathologie. [Publications from (Wartime-), Commercial, and Constitutional Pathology.]"
From: http://www.whonamedit.com/doctor.cfm/251.html
Last tested: July 4, 2009.

I worked in the Ludwig Aschoff Institute of Pathology, Freiburg i. Br., Germany, 1971-1972, as a technical assistant. There was a photograph of a stern-looking Prof. Aschoff in the library, with a single, handwritten word on the bottom of the photograph: "Arbeit!" ["Work!"].

At the time, the successor to Prof. Aschoff's chair, namely, Prof. Walter Sandritter, was working with Profs. George L. Wied, Peter H. Bartels, and Günter F. Bahr, who were, in turn, colleagues of the late Prof. George N. Papanicolaou.

18. Walter Sandritter (1920-1980) "... Director of the Institute of Pathology (Ludwig-Aschoff-Haus) of the University of Freiburg im Breisgau, died on November 12, 1980, at the age of 60. In Walter Sandritter, we have lost an enthusiastic researcher, a committed teacher, and a humane doctor. Milestones in his career were: training as a pathologist at the Senkenberg Institute of Pathology in Frankfurt am Main; the distinguished full professorships in the departments of pathology in Giessen and Freiburg im Breisgau; three textbooks of general, macroscopic, and microscopic pathology, which were recognized worldwide, and appeared in many additions; 462 original papers; the L. Schunk Prize in 1962 and the Goldblatt Award in 1980; membership in the Deutschen Akademie der Naturforscher Leopoldina [Emperor Leopold I (1687) German Academy of Natural Science Researchers]; editorship of the journal, Pathology, Research and Practice on which he left his impact; and lastingly, effective presidencies of the German Society of Pathology and the German Society of Cytology, of which he became an honorary member.

"...At the beginning of his career, Walter Sandritter preached quantitative methods as a new dimension of objective cell research, in an environment that was substantially influenced by subjectively descriptive anatomic anatomy. In 1980, Walter Sandritter advanced the opinion: "Quantitative methods, and with them, objectivity in scientific argumentation, are fashionable today. At the same time, one should not forget to think." A warning and a stimulus. In thinking, Walter Sandritter was always one step ahead."

Sprenger E.
Walter Sandritter, 1920-1980.
Cytometry. 1981:2(2):53.
http://www3.interscience.wiley.com/cgi-bin/abstract/110426493/ABSTRACT
Last tested: July 4, 2009.

I had the privilege of translating Prof. Sandritter's Maude Abbott Lecture, presented at the U. S. Canadian Academy of Pathology, in 1980 in New Orleans, into English.

19. George L. Wied (1921-2004) "... was no longer here, having passed away in Salzburg, Austria, on July 25th. But as the meeting unfolded, I realized that George's mark was deeply imprinted on the entire scientific program, and that his legacy was carried by most of the people in attendance.

"George Papanicolaou is attributed with the discovery of the cytologic method for detecting epithelial tumors. His laboratory at Cornell Medical Center in New York was the culture medium for the discipline, instructing such notable cytologists as Leopold Koss and George Wied. The medical specialty itself, however, owes its success to George Wied, for without him, it is doubtful whether it would have survived the skepticism of most other medical specialists.

"Dr. Wied had faith in the importance of cytology that was unwavering and his conviction was transmitted to all who followed him around the globe. A survivor of Nazi Germany, he was a fierce defender of individual freedoms, and he translated that zeal into inclusion of all peoples in his vision. He was an instinctual teacher and taught those around him to convey the criteria of those strange cellular samples via the Tutorials of Cytology. His attention to detail was impeccable, a trait that he insisted his faculty emulate.

"...But where Dr. Wied had the most fun was in the realm of cytology automation. As I listened Sunday to the presentations of experiences with the "new" imaging systems and their integration into the clinical cytology laboratory, I recalled the numerous conferences devoted to development of computerized scanners. As early as 1951, Dr. Wied recognized that computers would become an essential part of our daily lives, for data management and communication. He also realized that the task of screening slides was work intensive, subjective, and fraught with opportunities for error. If Dr. Wied didn't have the knowledge himself, he immediately reached out to others who did, and drafted them to the cause of automating his specialty. One of those recruits was Peter Bartels, a gifted optical scientist and incredibly creative problem solver. Together they built a team of researchers at the University of Chicago that attacked each obstacle to success like an army of dragon slayers...."

Rosenthal DL.
Remembering George L. Wied, MD, February 7, 1921-July 25, 2004.
CytoJournal. 2005;2:2.
From: http://www.cytojournal.com/content/2/1/2
Last tested: July 4, 2009.

20. Peter H. Bartels. Professor Emeritus of Optical Sciences. Director, Quantitative Diagnostic and Histopathologic Laboratory. Professor Emeritus of Pathology. Optical image analysis; quantitation in diagnostic cytology/pathology; very high-speed image scanning; multiprocessor computer design.
http://www.optics.arizona.edu/Faculty/Resumes/Bartels.htm
Last tested: July 4, 2009.

21. Günter F. Bahr, MD, FIAC (hon). Awarded the 1966 Maurice Goldblatt Cytology Award, inaugaurated in 1960 by the late Maurice Goldblatt, founder and honorary chairman of the Cancer Research Foundation, Chicago, IL. Selected from 143 Pubmed-listed articles:
21.1. Sperb RA, Arnold W, Bahr GF, Loning T, Gebbers JO. Comparative DNA image cytometry in imprint-, cytospin- and tissue section preparations of breast carcinoma. Anal Cell Pathol. 1993 Sep;5(5):265-275.

21.2. Mikel UV, Bahr GF.
A comparative study of DNA amount and nuclear dry weight in four different species (Rana catesbeiana, Salmo gairdneri, Gallus domesticus and Homo sapiens).
Comp Biochem Physiol B. 1993 Apr;104(4):743-746.

21.3. Arechaga J, Diaz J, Silio M, Bahr GF.
Mass and molecular weight of isolated nuclear rings.
Biol Cell. 1990;68(1):13-20.

21.4. Hafiz MA, Becker RL Jr, Mikel UV, Bahr GF.
Cytophotometric determination of DNA in mesotheliomas and reactive mesothelial cells.
Anal Quant Cytol Histol. 1988 Apr;10(2):120-126.

21.5. Norris HJ, Bahr GF, Mikel UV.
A comparative morphometric and cytophotometric study of intraductal hyperplasia and intraductal carcinoma of the breast.
Anal Quant Cytol Histol. 1988 Feb;10(1):1-9....


22. George N. Papanicolaou (1883-1962) "was born at Kimi on the island of Evia, in Greece. He was a pioneer in cytology and early cancer detection. He studied at the University of Athens, where he received his medical degree in 1904. Six years later, he received his PhD from the University of Munich, Germany. In 1913, he emigrated to the USA, in order to work in the Department of Pathology at New York Hospital and the Department of Anatomy at the Weill Medical College of Cornell University.

"Papanicolaou first reported that uterine cancer could be diagnosed by means of a vaginal smear in 1928, but the importance of his work was not recognized until the publication, together with Herbert Traut, of Diagnosis of Uterine Cancer by the Vaginal Smear in 1943. The book discusses the preparation of the vaginal and cervical smear, physiologic cytologic changes during the menstrual cycle, effect of various pathological conditions, and the changes seen in the presence of cancer of the cervix and the endometrium of the uterus. He thus became known for his invention of Papanicolaou's test, now known as the Pap smear, which is used worldwide for the detection and prevention of cervical cancer and other cytologic diseases of the female reproductive system.

"In 1961, Papanicolaou moved to Miami to develop the Papanicolaou Cancer Research Institute at the University of Miami, but died in 1962 prior to its opening. Dr. Papanicolaou was a recipient of the Lasker Award."
From Wikipedia: http://en.wikipedia.org/wiki/George_Papanicolaou .
Last tested: July 4, 2009.

Papanicolaou's work saved more lives in the twentieth century than any other single advance in pathology.

23. Typewriter. "The first typewriter to be commercially successful was invented in 1867 by Christopher Sholes, Carlos Glidden, and Samuel W. Soule. The patent (US 79,265) was sold for $12,000 to Densmore and Yost, who made an agreement with E. Remington and Sons to commercialize what was known as the Sholes and Glidden Type-Writer. Remington started production of its first typewriter on March 1, 1873, in Ilion, NY. Another early typewriter manufacturer was Underwood."

Typewritten autopsy records at The Johns Hopkins Hospital began in 1905.

24.Standardization. The fact that there are many standards for anatomic pathology text-diagnoses in medical informatics means that there are none at all. So-called standards include: UMLS, SNOMED, HL-7, DICOM. Another major obstacle to genuine standardization is that many parts of major standards are proprietary. As long as standards are expensive, they will never be universal. Standards should satisfy Berman's minimal criteria for biomedical programming: Free. Fast. Easy to learn. Large user community. Easy environment for correcting errors. Large, available library of specialized modules... (Berman, 2007).

25. Department of Veterans Affairs "Our goal is to provide excellence in patient care, veterans' benefits and customer satisfaction. We have reformed our department internally, and are striving for high quality, prompt and seamless service to veterans. Our department's employees continue to offer their dedication and commitment to help veterans get the services they have earned. Our nation's veterans deserve no less.
From: http://www.va.gov/about_va
Last tested: July 4, 2009.

26. West Los Angeles Veterans Affairs Medical Center. "Welcome to the VA Affairs Greater Los Angeles Healthcare System. Our staff is dedicated to working toward one purpose, making your healthcare at this VA the best possible. We welcome the opportunity to serve you."
From: http://www.losangeles.va.gov/
Last tested: July 4, 2009.

27. Baltimore Veterans Affairs Medical Center. "As one of the most modern health care facilities in the country, the Baltimore VA Medical Center offers veterans state-of-the-art medical technology, clinical services, and research programs. The medical center is home to the world's first filmless radiology department, which allows health care providers to have nearly instant access to patient radiology images from anywhere in the facility and throughout the health care system. The medical center's "patient friendly" design features plant-filled atriums, natural light from overhead skylights, and comfortable patient rooms and waiting areas."
From: http://www.maryland.va.gov/
Last tested: July 4, 2009.

28. Hurricane Katrina was "the costliest and one of the deadliest hurricanes in the history of the United States. It was the sixth-strongest Atlantic hurricane ever recorded and the third-strongest hurricane on record that made landfall in the United States. Katrina formed on August 23, 2005, during the 2005 Atlantic hurricane season and caused devastation along much of the north-central Gulf Coast. The most severe loss of life and property damage occurred in New Orleans, Louisiana, which flooded as the levee system catastrophically failed, in many cases hours after the storm had moved inland. The hurricane caused severe destruction across the entire Mississippi coast and into Alabama, as far as 100 miles (160 km) from the storm's center. Katrina was the eleventh tropical storm, fifth hurricane, third major hurricane, and second Category 5 hurricane of the 2005 Atlantic season.

"...At least 1,836 people lost their lives in Hurricane Katrina and in the subsequent floods, making it the deadliest U.S. hurricane since the 1928 Okeechobee Hurricane. The storm is estimated to have been responsible for $81.2 billion (2005 U.S. dollars) in damage, making it the costliest natural disaster in U.S. history. Criticism of the federal, state and local governments' reaction to the storm was widespread and resulted in an investigation by the U.S. Congress and the resignation of Federal Emergency Management Agency director Michael D. Brown. The storm also prompted Congressional review of the Army Corps of Engineers and the failure of the levee protection system. Conversely, the National Hurricane Center and National Weather Service were widely commended for accurate forecasts and abundant lead time."
From Wikipedia: http://en.wikipedia.org/wiki/Hurricane_Katrina .
Last tested: July 4, 2009.

29. The Federal Emergency Management Agency, or FEMA "is an agency of the United States Department of Homeland Security (DHS). The purpose of FEMA (begun by Presidential order March 30, 1979) is to coordinate the response to a disaster which has occurred in the United States and which overwhelms the resources of local and state authorities. The governor of the state in which the disaster occurred must declare a state of emergency and formally request from the President of the United States that FEMA and the Federal Government respond to the disaster."
From Wikipedia: http://en.wikipedia.org/wiki/FEMA .
Last tested: July 4, 2009.

30. New Orleans Veterans Affairs Medical Center. "Originally located on the shores of Lake Pontchartrain, LA, the VA Medical Center, New Orleans, LA, is a thriving part of the fabric of today's Crescent City. From a small Army hospital in the suburbs, today's VA Medical Center has evolved into a renowned center for state-of-the-art outpatient and inpatient services for a diverse 25-parish region, delivering primary, secondary and tertiary care to over 222,000 veterans throughout Southeast Louisiana. Housed in the heart of the New Orleans Central Business District, the Medical Center is a 450 bed acute care facility, offering health care in medicine, surgery, psychiatry, and rehabilitative medicine and supports the 120-bed Boggs Transitional Care Unit which provides extensive inpatient rehabilitation therapy. An active ambulatory care program supports over 270,000 outpatient visits annually in various medical, surgical and psychiatric sub-specialties. It provides a number of innovative clinical services, such as cardiac surgery, geriatric, and extended care, women veteran services, hemodialysis, spinal cord injury, coronary intensive care and care for Post Traumatic Stress Disorder (PTSD). The facility also operates a satellite clinic in Baton Rouge, the state's capital, which is located some 80 miles from New Orleans."
From: http://www.vba.va.gov/ro/new-orleans/vamcnola.htm
Last tested: July 4, 2009.

31. Metadata. (Greek: μετα = meta = after, beyond. Latin: data = things given; metadata = "beyond data"). Metadata are data about data. One metadatum may describe an individual datum, or content item, or a collection of data, including multiple content items. Metadata are used to facilitate the understanding, use, and management of data. The metadata required for effective data management vary with the type of data, and context of use. In Veterans Affairs medical institutions, the following data are required:
Title
Subject
Author
Creator:"Department of Veterans Affairs, Veterans Health Administration, Deputy Under Secretary for Operations and Management....
DateCreated -- YYYYMMDD
DateReviewed -- YYYYMMDD
Language -- en
Type -- CHAPTER


32. Audio Captions.
32.1. Sec. §508, U. S. FEDERAL REHABILITATION ACT / AMERICANS WITH DISABILITIES ACT requires the presence of ALT tags for images in all United States Government manuals. These ALT tags are supposed to make the images accessible to visually-impaired users with screen readers. One should not necessarily assume that the only readers for United States Government manuals are sighted persons. The ALT tag (really an attribute) contains descriptive text for the image in question and is very easy to implement. It goes right in the IMG SCR tag; the following is from the VAMHCS logo on the intranet home page:
<img src="images/new_header.gif" width="525" height="65" ALT="Back to VAMHCS Intranet Home Page" border="0">
If you hold you mouse over the image the ALT text will pop up.


32.2. ALT tags are just the obvious accessibility functionality that you can add to a site. Section §508 is very extensive, and includes warnings concerning animations (could trigger seizures) and certain color combinations (for color blindness).

32.3. There are a number of sites on §508, this is one of my favorites: http://www.jimthatcher.com/webcourse1.htm
The official goverment site: http://www.section508.gov/
Last tested: July 4, 2009.

32.4. Keep in mind that Section §508 is huge. If you try to implement everything it requires you may never get around to posting your materials. Right now I would concentrate on ALT tags.

32.5. "In 1998, Congress amended the Rehabilitation Act to require Federal agencies to make their electronic and information technology accessible to people with disabilities. Inaccessible technology interferes with an individual's ability to obtain and use information quickly and easily. Section §508 was enacted to eliminate barriers in information technology, to make available new opportunities for people with disabilities, and to encourage development of technologies that will help achieve these goals. The law applies to all Federal agencies when they develop, procure, maintain, or use electronic and information technology. Under Section §508 (29 U.S.C. 794d), agencies must give disabled employees and members of the public access to information that is comparable to the access available to others. It is recommended that you review the laws and regulations listed below to further your understanding about Section §508, and how you can support implementation.....


33. Microsoft® Access® database is the most popular database system available worldwide, but in my opinion not the best. However, the near-monopoly power of Microsoft® has effectively squeezed all its competitors out of business. A database consists of one or more spreadsheets, or rectangles of rows and columns. (By contrast, Microsoft®'s spreadsheet product, namely, Excel®, is excellent).

34. Classical Euclidean geometry consists of an axiomatic system; deductive proof of theorems.

There are five axioms of Classical Euclidean geometry:
1. Any two points can be joined by a straight line.
2. Any straight line segment can be extended indefinitely.
3. Circle can be drawn around any straight line segment.
4. All right angles are congruent.
5. Parallel postulate.

The fifth axiom, or parallel postulate generated considerable excitement in the late nineteenth century when two mathematicians, Hungarian János Bolyai (1802-1860) and Russian Nikolai Ivanovich Lobachevsky (1792-1856) determined that there were consistent systems of geometry in which the parallel postulate was negated. This demonstration of the existence of a consistent non-Euclidean geometry formed the basis for Albert Einstein's subsequent work on General Relativity Theory. Attempts to disprove Bolyai and Lobachevsky's work continued into the 1930s, after which it has become widely accepted in mathematics and physics circles.
From Wikipedia: http://en.wikipedia.org/wiki/Albert_Einstein .
From Wikipedia: http://en.wikipedia.org/wiki/Nikolai_Lobachevsky .
From Wikipedia: http://en.wikipedia.org/wiki/Janos_Bolyai .
From Wikipedia: http://en.wikipedia.org/wiki/Euclidean_geometry .
From Wikipedia: http://en.wikipedia.org/wiki/Non-Euclidean_geometry .
Last tested: July 4, 2009.

35. Berman JJ.
Tumor classification: molecular analysis meets Aristotle.
BMC Cancer. 2004 Mar 17;4:10.
PMID: 15113444
PubMed Entry
Last tested: July 4, 2009.

36. Embryogenesis. See:
Willis RA.
The Borderland of Embyology and Pathology.
London: Butterworths. 1958;:.
ASIN: B0007IXPWK, 33 pages.

"Rupert Allan Willis (1898-1980), pathologist, was born on 24 December 1898 at Yarram, Victoria, Australia. He was educated at Yarram State and Melbourne High schools, and the University of Melbourne (M.B., B.S., 1922; M.D., 1929; D.Sc., 1932). He spent two years as a resident medical officer at the Alfred Hospital, Melbourne, Australia. In 1924, he moved to Lilydale, Tasmania, where Prof. Willis entered general practice, and carried out histological research in a backyard laboratory, studying diseased tissue from animals.

"... Returning to Melbourne in 1927, Willis was appointed medical superintendent of the Austin Hospital for Incurable and Chronic Diseases, Heidelberg. One reform he instituted was to remove the word 'Incurable' from the institution's title. His studies resulting from the hundreds of post-mortem examinations he performed there, many on cancer victims, led to the award of his doctorates.

"... Granted a Rockefeller Foundation fellowship in 1933, he conducted research on the transplantation of embryonic tissues at the Buckston Browne Research Farm at Downe, Kent, England, under Sir Arthur Keith. He demonstrated post-mortem examinations for medical students, and lectured at the university. Under his guidance the hospital's output in pathological testing trebled by 1940.

"...In 1945 Willis was appointed Collins professor of human and comparative pathology at the Hunterian Museum of the Royal College of Surgeons, London. He published Pathology of Tumours in 1948. That year he transferred to the Royal Cancer Hospital, Fulham, as director of pathology, his work resulting in Principles of Pathology (1950). In 1950 he moved to the University of Leeds as professor of pathology. The duties included research, teaching, administration and consultation with regional medical practitioners. His personal research was to culminate in The Borderland of Embryology and Pathology (1958). Retiring and unassuming by nature, he found university politics and committee work a stressful distraction from scholarship."

http://www.adb.online.anu.edu.au/biogs/A160662b.htm
Last tested: July 4, 2009.

Willis RA.
The borderland of embryology and pathology.
Bull N Y Acad Med. 1950 Jul;26(7):440-460.
PMID: 15426876.
PubMed Entry
Last tested: July 4, 2009.

37. Aristotle (Aριστοτελης, 384-322 BCE), Greek philosopher, teacher of Alexander the Great. Aristotle gets a lot of disrespect from pro-Enlightenment bigots, but his work is really quite remarkable, considering thast it was written in fourth century BCE. Dr. Berman's (2004) monumental paper on tumor classification reminds us how relevant Aristotle's work is to modern thought about molecular diagnostics.
From Wikipedia: http://en.wikipedia.org/wiki/Aristotle .
Last tested: July 4, 2009.

Perhaps the greatest blind spot in Aristotle's world view was his abhorrence of zero (Seife, 2000), which eventually found its intellectual home in Babylon, Persia, and India (Brahmagupta, 628). Aristotle also would not have been comfortable with the idea of fuzzy set theory.

The biggest problem with Aristotle's work wasn't really his fault. Europe fell asleep culturally between the Fall of Rome (476) until the publication of Fibonacci's Book of the Abacus (1202). Instead of consigning Aristotle's obsolete ideas into a dignified retirement during these seven centuries of intellectual darkness, mediaeval European scholars rigidified these ideas into required doctrines, with compliance enforced by the Inquisition. As late as 1600, Giordano Bruno was burnt at the stake for his unconventional ideas. Only Sephardic-Jewish, Islamic, and Indian scholars nurtured and advanced Aristotle's ideas, until Europe was ready to listen to them again.

38. Brahmagupta (589-668). Indian mathematician and astrophysicist. "The Brahmasphutasiddhanta (628) is the earliest known text to treat zero as a number in its own right, rather than as simply a placeholder digit in representing another number. It goes well beyond that, however, stating rules for arithmetic on negative numbers and zero which are quite close to the modern understanding."
From Wikipedia: http://en.wikipedia.org/wiki/Brahmagupta .
Last tested: July 4, 2009.

Sections from Brahmagupta's book read like a modern introductory text on mathematical field theory.

39. Euclid (Eυκλιδης, 325-270 BCE). "Greek mathematician of the Hellenistic period, who flourished in Alexandria, Egypt, during the reign of Ptolemy I (323-283 BCE). Euclid was born in Greece. His Elements is the most successful textbook in the history of mathematics. In it, the principles of Euclidean geometry are deduced from a small set of axioms. Furthermore, Euclid's method of proving mathematical theorems by logical reasoning from accepted first principles remains the backbone of mathematics and is responsible for that field's characteristic rigor. Although best-known for its geometric results, the Elements also includes various results in number theory, such as the connection between perfect numbers and Mersenne primes, the proof of the infinitude of prime numbers, Euclid's lemma on factorization (which leads to the fundamental theorem of arithmetic on uniqueness of prime factorizations), and the Euclidean algorithm for finding the greatest common divisor of two numbers. Euclid also wrote works on perspective, conic sections, spherical geometry, and quadric surfaces."
From Wikipedia: http://en.wikipedia.org/wiki/Euclid .
Last tested: July 4, 2009.

Euclid's work on the infinity of prime numbers forms the basis for modern cryptography methodology (Schneier, 1996), particularly the public key encryption method.

40. Computer security is a communication process, involving three persons or person-groups: sender,receiver, and attacker. The sender initiates a message, which is encrypted in a manner that can later be decrypted and read by the receiver, without knowledge or interference by the attacker. At the Baltimore VA Maryland Health Care System, possible senders include all health-care providers who issue reports or treat patients. Intended receivers for a particular message are those persons authorized to read reports, including providers and designated administrators. Attackers are all other persons.

The mathematical theory of encryption is called cryptography. The mathematical theory of decryption, including methods used by an attacker to invade someone else's encrypted messages, is called cryptanalysis.

There are two general issues in secure message transmission: confidentiality and authenticity. Confidentiality is the question of whether the receiver receives the sender's message without knowledge by the adversary. Authenticity is the question of whether the receiver receives a faithful message actually sent by the sender.

There are three general methods of computer security: who you are (e.g., thumbprints or retinal vessel pattern); what you have (e.g., door-keys); or what you know (e.g., passwords).

In classical cryptography, the usual objective of cryptography is to encode the sender's message in such a way that the attacker cannot understand it. In more complex cryptographic models, methods are used to authenticate the identity of the sender, to prevent the attacker from altering the message unbeknownst to the receiver, and to prevent the sender from later denying that he/she sent a particular message on a particular date and time. Schneier's Applied Cryptography is an absolutely fabulous introduction to cryptography, which can profitably be read by amateurs and professionals alike.

The initial message prepared by the sender is written as plaintext, which the sender converts into ciphertext (Arabic: شـر = shifr = zero, because ciphertext is typically full of zeros), before the message is transmitted. The process of converting plaintext into ciphertext is called encryption. The encryption process requires an encryption algorithm (Greek: κρυπτος = kryptos = hidden; Arabic: الخوارزمي = Al-Khawárizmi = algorithm) and a key. The process of recovering plaintext from ciphertext is called decryption.

The key is exchanged secretly between sender and receiver over secured communication, or through a trusted intermediary. The accepted view among professional cryptographers it that the encryption algorithm should be published, whereas the key must be kept secret. The purpose of publishing the encryption algorithm is to place it before the academic cryptography community, which will discover its flaws. Better that the flaws in the encryption algorithm be first discovered in academia than when the message is secretly decoded by the attacker.
From Wikipedia: http://en.wikipedia.org/wiki/Cryptography .
Last tested: July 4, 2009.

41. Moore GW, Brown LA, Miller RE.
Set Theory Definition and Algorithm for Medical De-Identification. (Abstract).
Arch Pathol Lab Med. 2001 Jun;125:.
http://apiii.upmc.edu/abstracts/posterarchive/2000/moore_2.html
http://www.netautopsy.org/apep00st.htm
Comment: This Kosher Kitchen Principle (כשר) for Medical De-identification might be summarized as follows: The patient should not be able to recognize his/her own medical record on the internet, and thus be embarrassed or otherwise injured by this recognition. This is a very ancient sensibility, and should not be ignored. The prohibition in Jewish kosher laws against mixing meat and dairy is based upon the sensibility of a mother goat's milk comixing with the flesh of its offspring: "Thou shalt not seethe a kid in his mother's milk" (Exodus 23:19). Two mechanisms against violating this sensibility are either to obliterate any distinctive (i.e., unique, or involving only a few patients) part of a report; or to create model (fictitious) reports.

42. Abu Abdullah Muhammad bin Musa Al-Khawárizmi (أبو عبدالله محمد بن موسى الخوارزمي, 780-850). Uzbek-Persian mathematician. Inventor of algebra. The Latinized form of his surname is: algorithmus.
From Wikipedia: http://en.wikipedia.org/wiki/Al-Khawarizmi .
Last tested: July 4, 2009.

43. Class. Resource Description Framework (RDF). "The Resource Description Framework (RDF) integrates a variety of applications from library catalogs and world-wide directories to syndication and aggregation of news, software, and content to personal collections of music, photos, and events using XML as an interchange syntax. The RDF specifications provide a lightweight ontology system to support the exchange of knowledge on the Web.

"The W3C Semantic Web Activity Statement explains W3C's plans for RDF, including the RDF Core WG, Web Ontology and the RDF Interest Group."
From Wikipedia: http://en.wikipedia.org/wiki/Resource_Description_Framework .
Last tested: July 4, 2009.

44. Semantic Worldwide Web "provides a common framework that allows data to be shared and reused across application, enterprise, and community boundaries. It is a collaborative effort led by W3C with participation from a large number of researchers and industrial partners. It is based on the Resource Description Framework (RDF).

"The Semantic Web is a web of data. There is lots of data we all use every day, and its not part of the web. I can see my bank statements on the web, and my photographs, and I can see my appointments in a calendar. But can I see my photos in a calendar to see what I was doing when I took them? Can I see bank statement lines in a calendar?

"Why not? Because we don't have a web of data. Because data is controlled by applications, and each application keeps it to itself.

"The Semantic Web is about two things. It is about common formats for integration and combination of data drawn from diverse sources, where on the original Web mainly concentrated on the interchange of documents. It is also about language for recording how the data relates to real world objects. That allows a person, or a machine, to start off in one database, and then move through an unending set of databases which are connected not by wires but by being about the same thing.
From www.w3c.org and Wikipedia: http://en.wikipedia.org/wiki/Semantic_Web .
Last tested: July 4, 2009.

45. Worldwide Web Consortium "is the main international standards organization for the World Wide Web (W3). It is arranged as a consortium where member organizations maintain full-time staff for the purpose of working together in the development of standards for the W3. As of March 2007, the W3C had 441 members. It is always open for new organizations to join.

"W3C also engages in education and outreach, develops software and serves as an open forum for discussion about the Web.

"The Consortium is headed by Sir Tim Berners-Lee, the primary author of the original URL (Uniform Resource Locator), HTTP (HyperText Transfer Protocol) and HTML (HyperText Markup Language) specifications, the principal technologies that form the basis of the World Wide Web.

"The World Wide Web Consortium (W3C) develops interoperable technologies (specifications, guidelines, software, and tools) to lead the Web to its full potential. W3C is a forum for information, commerce, communication, and collective understanding."
From www.w3c.org and Wikipedia: http://en.wikipedia.org/wiki/World_Wide_Web_Consortium .
Last tested: July 4, 2009.

46. Mathematical Consistency is the property of a mathematical system that a well-formed statement cannot be both true and false. Amazingly, since the proof of Gödel's Theorem, it has been demonstrated that it is not possible to prove that any of the common mathematical systems (logic, arithmetic, geometry, calculus, algebra) are consistent. See:
Boolos G:
The Unprovability of Consistency. An Essay in Modal Logic.
Cambridge: Cambridge University Press. 1979;:.
ISBN 0-521-21879-9, 184 pages.
George Boolos (1940-1996), American philosopher and logician.
That is, while these mathematical systems may be consistent, we can't prove it, in principle. The demonstration of consistency rests solely upon the efforts of three thousand years of bright mathematicians trying to find inconsistencies. There is no guarantee that yet another such bright mathematician might come along tomorrow and cause the entire structure to collapse.
From Wikipedia: http://en.wikipedia.org/wiki/George_Boolos .
Last tested: July 4, 2009.
From Wikipedia: http://en.wikipedia.org/wiki/Consistency .
Last tested: July 4, 2009.

47. Classical set theory, or crisp set theory, is the mathematical theory of collections of abstract objects, or sets. The theory was originally developed by mathematicians in the late nineteenth century, to formulate and settle certain questions about infinity, so-called Cantor sets. There are two primary objects of classical set theory, i.e., set-membership, denoted ∈; and the empty set or null set, denoted {} or Ø, the set that contains no members. A set is defined exactly by its members. That is, two sets are considered equal if and only if they contain the same members. In classical set theory, we say that a proposition, p, is either a member of set P, denoted p∈P; or else p is not a member of set P, denoted p~∈P.
From Wikipedia: http://en.wikipedia.org/wiki/Set_theory .
Last tested: July 4, 2009.

48. Fuzzy set theory is an extension of ordinary set theory, and a misnomer. There is nothing really fuzzy about fuzzy set theory. In fuzzy set theory, a proposition, p, can be a partial member of set P, on a sliding scale of fuzzy values, from v=0 to v=1, inclusive. For fuzzy value v, we write pμvP. For fuzzy value v=1, pμ1P corresponds to full membership in classical set theory, or p∈P; for v=0, pμ0P corresponds to full non-membership in classical set theory, or p~∈P; for v=½, pμ½P corresponds to half-membership, etc. Fuzzy set theory has an ordinal property, i.e., if pμvP and v>w, then pμwP.
From Wikipedia: http://en.wikipedia.org/wiki/Fuzzy_logic .
Last tested: July 4, 2009.

Certainty levels, numbered z=0, 1, 2,..., correspond to fuzzy values, v, by the formula v=(1-2-z). Certainty level z=∞ corresponds to v=1, or full membership in classical set theory, p∈P. Certainty level z=0 corresponds to v=0, or full non-membership in classical set theory, p~∈P. Certainty level z=1 corresponds to v=½; certainty level z=2 corresponds to v=¾; certainty level z=3 corresponds to v=⅞, etc. Many concepts in medicine are characterized by their relative certainty in a given clinical setting, as rare, common, very frequent, etc., without assigning exact numeric values, so-called computing with words (Zadeh, 2001, 2006).

49. Fiat. (Latin: fiat = "let it be that..." or "it should be that...").
Doctrine. (Latin: docere = "to teach").
Dr. Berman's book:

Neoplasms: Principles of Development and Diversity.
Boston, Toronto, London, Singapore: Jones & Bartlett Publishers. 2008 Oct 1.
ISBN: 9780763755706, 464 pages.
http://www.jbpub.com/catalog/9780763755706/
Last tested: July 4, 2009.
discusses a classification for all human cancers, that includes controversial placements of endodermally-derived tumors, ectodermally-derived tumors, and germ-cell-derived tumors. There is a highly reasoned discussion on these placements, but they are not strictly based upon embryonic development.

50. Medical Ethics. Early contributors were Hippocrates, Galen, Avicenna, and Maimonides. There is a modern ethics of medical informatics, largely centered around issues of confidentiality, privacy, and other security issues. Dr. Berman's monumental new book, Biomedical Informatics, has a chapter devoted to medical ethics, as applied to medical informatics.

Included in Dr. Berman's book are a discussion of two large-scale medical experiments conducted in the USA, in Tuskegee, AL, and at the Sloan-Kettering Memorial Cancer Center in New York, NY, in which there were gross violations of medical ethics occurred.

51. Galen Greco-Roman physician (129-200). (Latin: Claudius Galenus) "of Pergamum was a prominent ancient Greco-Roman physician, whose theories dominated Western medical science for over a millennium."

"...Galen's writings on anatomy were the mainstay of the medieval physician's university curriculum, but they had suffered greatly from stasis and intellectual stagnation. In the 1530s, however, Belgian anatomist and physician Andreas Vesalius took on a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work, De humani corporis fabrica, was greatly influenced by Galenic writing and form. Seeking to revive Galen's methods and outlook, Vesalius turned to human cadaver dissection as an evolution of Galen's natural philosophy. Galen's writings enjoyed a revival at the hands of Vesalius, who promoted Galen and expounded on him through books and hands-on demonstrations. Since most of Galen's writings were also translated into Arabic, the Middle East knows and reveres him."
From Wikipedia: http://en.wikipedia.org/wiki/Galen .
Last tested: July 4, 2009.

52. Moses Maimonides. (משה דן מימון, 1135-1204) "was a Jewish rabbi, physician, and philosopher in Andalusia, Morocco and Egypt during the Middle Ages. He was one of the various medieval Jewish philosophers who also influenced the non-Jewish world. Although his copious works on Jewish law and ethics were initially met with opposition during his lifetime, he was posthumously acknowledged to be one of the foremost rabbinical arbiters and philosophers in Jewish history. Today, his works and his views are considered a cornerstone of Jewish thought and study."
From Wikipedia: http://en.wikipedia.org/wiki/Maimonides .
Last tested: July 4, 2009.

53. Computability Theory is the theory of how much computation one requires to solve certain classes of problems. For example, in an unsorted list of n objects, in the worst case, it requires n steps to find the smallest object in the list (if, say, the smallest object is the last object on the list). If the list is presorted and a binary search is performed, then only log2n steps are required, where log22=1, log24=2, log28=3, log216=4, log232=5, etc. This may not seem like a big deal for short lists, but if you are sorting, say, 300,000,000 social security numbers, then we are talking about the difference between 300,000,000 and log2300,000,000=25 computing steps. Same goes for searching a hospital census in a large, tertiary-care medical center for a returning patient. Some early hospital information systems in large medical institutions failed for insufficient attention to this important principle of computer science.

Computing tasks may be classified as:
logarithmic: log2n steps.
linear: n steps.
log-linear: nlog2n steps.
quadratic: n2 steps.
polynomial: nk steps, for some integer k.
exponential: 2n steps.
supra-exponential: greater than 2n steps.
undecidable: insoluble after infinite steps.
A large class of interesting problems, including tree-search, packaging, scheduling, and routing problems, lie in the borderland between polynomial (which are soluble for practical values of n, say, n=300,000,000, as long as k isn't too large) and exponential (effectively insoluble for practical values of n). These problems are called non-polynomial-complete (NPC). For such problems, there is no mathematical proof that the problems are beyond-polynomial, but nobody has produced a less-than-exponential computer algorithm, either. Considering the economic value of these problems, and the great minds that have addressed them in the past century, my guess is that NPC problems, alas, are exponential. See: (Tarjan, 1983), (Davis, 1978), (Amos, 2008).
From Wikipedia: http://en.wikipedia.org/wiki/Computability_theory_(computer_science) .
Last tested: July 4, 2009.

54. Undecidability. (German: Unentscheidbarkeit). There is an important subset of computing problems that cannot be solved in principle, i.e., require an infinite number of computing steps. The existence of such problems was shown by:
From Wikipedia: http://en.wikipedia.org/wiki/Decision_problem .
Last tested: July 4, 2009.

55. Kurt Gödel (1906-1978). Czech-American mathematician and logician. Author of arguably the most important paper in philosophy and mathematics of the twentieth century: Über unentscheidbare Sätze der Principia mathematica und verwandte Systeme. I. ["Regarding undecidable propositions of the Principia mathematica and related systems. I."] Monatsh Math Phys. 1931;38:173-198.

When I first became aware of Gödel's theorem as an arrogant, twenty-something graduate student in biomathematics, I thought the guy was a party pooper, for demonstrating that some true statements, even well-formed mathematical statements, cannot be proved.

A few years ago, an article appeared in The New Yorker about Gödel and Einstein (they both spent their later years at the Princeton Institute for Advanced Studies, Princeton, NJ). In this article, Gödel is quoted as saying that he attempted his famous proof because he was annoyed by the smugness of Alfred North Whitehead, Lord Bertrand Russell, and the logical positivists, for their conviction that their work on mathematical foundations wrapped up all of mathematics, and that there was nothing new to be proved. Gödel believed, and then proved, that there was still room for creativity in mathematics.

I now regard Gödel as a great benefactor to science and mathematics. See: (Gödel, 1931), (Nagel and Newman, 1958), (Casti and DePauli, 2000).
From Wikipedia: http://en.wikipedia.org/wiki/Kurt_Godel .
Last tested: July 4, 2009.

56. Uncertainty goes by many names: in medical slang, Sutton's Law ("Go where the money is.") Recently, a nice book was published on the subject by Nicholas Nassim Taleb (2007), called The Black Swan. The black swan (i.e., an usual event) has three properties:
1. Extremely unusual.
2. Typically, extremely costly.
3. People make up unreasonable narrative rationalizations after the fact, to account for the black swan.
Features (1) and (2) are, unfortunately quite common in clinical medicine. In my experience, it IS often possible to reconstruct, in retrospect, to account for the black swan, and to prevent its recurrence.

57. Willie Sutton (1901-1980), American bank robber. Sutton's Law: "Go where the money is."
Reporter's question: "Willie, why do you always rob banks?" Willie Sutton's Answer: "Because that's where the money is."
From Wikipedia: http://en.wikipedia.org/wiki/Willie_Sutton .
Last tested: July 4, 2009.

58. Plato (Πλατον, 427-348 BCE), Greek philosopher, and "second of the great trio of ancient Greeks, succeeding Socrates and preceding Aristotle, who between them laid the philosophical foundations of Western culture. Plato was also a mathematician, writer of philosophical dialogues, and founder of the Academy in Athens, the first institution of higher learning in the western world. Plato is widely believed to have been a student of Socrates, and to have been deeply influenced by his teacher's unjust death."
From Wikipedia: http://en.wikipedia.org/wiki/Plato .
Last tested: July 4, 2009.

In his doctrine of shadows in the cave, Plato promoted the ideas of an underlying reality, or essences; and random occurrences of these essences, or accidents. Through the years, this philosophy has been used to rationalize elitist political philosophies (where the monarch is the divine essence, and the ordinary subjects are accidents). However, Plato's ideas are also deeply embedded in Western scientific thought:
Essenceaccident
Theoryobservation
Populationsample
Gold Standardnew lab test
RDF ClassRDF property
In the usual statistical methods that pathologists use to evaluate a new test in the clinical laboratory, we compare a patient's "actual" disease against the results of a new test, and we speak of Type I Error (false positives) Type II Error (false negatives). (Goldburgh, 2006). This world-view is Platonic to the core.

59. Giovanni Battista Morgagni (1682-1771). Italian anatomist, born in Forlì, Italy. Father of modern anatomic pathology. Morgagni published his "great work which, once for all, made pathological anatomy a science, and diverted the course of medicine into new channels of exactness or precision: De Sedibus et causis morborum per anatomem indagatis (1761) (On the seats and causes of diseases, demonstrated by anatomy) which during the succeeding ten years, notwithstanding its bulk, was reprinted several times in its original Latin, and was translated into French (1765), English (1769), and German (1771)."
From Wikipedia: http://en.wikipedia.org/wiki/Giovanni_Battista_Morgagni .
Last tested: July 4, 2009.

For the younger members of this audience, please note that this monumental work was the product of Morgagni's mature years.

60. Sushruta. Indian anatomist. Performed the first autopsy in 500 BCE.
From Wikipedia: http://en.wikipedia.org/wiki/Sushruta .
Last tested: July 4, 2009.

61. Avicenna (Ibn-Sina) (980-1037). (Abu `Ali al-Husayn ibn `Abd Allah ibn Sina al-Balkhi; Latinized as Avicenna). Persian Muslim physician, philosopher, and polymath: physician, astronomer, alchemist, chemist, logician, mathematician, metaphysician, philosopher, physicist, poet, scientist, theologian, statesman, and soldier. Avicenna was born in Afshana near Bukhara in Khorasan (now part of Uzbekistan), and died in Hamadan (now in Iran).

Avicenna authored some 450 books on a wide range of subjects, many of which concentrated on philosophy and medicine. His most famous works are: The Book of Healing and The Canon of Medicine, which was for almost five centuries a standard medical text at many Islamic and European universities. Avicenna's medical system was that of Islamic medicine, which was influenced by the medical system of Galen, Aristotelian metaphysics, and early Persian and Arabian medicine. Avicenna is regarded as the father of modern medicine, and the father of the fundamental concept of momentum in physics.
From Wikipedia: http://en.wikipedia.org/wiki/Avicenna .
Last tested: July 4, 2009.

62. St Thomas Aquinas (1225-1274), Roman Catholic priest, philosopher, and theologian "in the scholastic tradition, known as Doctor Angelicus, Doctor Universalis and Doctor Communis. He is the foremost classical proponent of natural theology, and the father of the Thomistic school of philosophy and theology. St. Thomas is held in the Roman Catholic Church to be the model teacher for those studying for the priesthood. The work for which he is best-known is the Summa Theologica. One of the 33 Doctors of the Church, he is considered by many Roman Catholics to be the Church's greatest theologian. Consequently, many institutions of learning have been named after him."

St Thomas Aquinas brilliantly incorporated many of the doctrines of Aristotle into Christian theology. However, he was succeeded by church fathers of much inferior intelligence and vision, who turned Aristotle into a minor god, and slavishly followed all of Aristotle's teachings, regardless of their merit, including Aristotle's abhorrence of zero. Christian Europe avoided using Arabic numerals, that arose out of Islamic and Hindu scholarship and included zero, despite their obvious superiority to Roman numerals, for one hundred years after their introduction into Europe by Fibonacci.
From Wikipedia: http://en.wikipedia.org/wiki/Thomas_Aquinas .
Last tested: July 4, 2009.

63. Fibonacci. Leonardo of Pisa (1170-1250), also known as Fibonacci, was "an Italian mathematician, considered by some as the most talented mathematician of the Middle Ages. Fibonacci is best known to the modern world for:
"The spreading of Hindu-Arabic numeral system in Europe, primarily through the publication in the early 13th century of his Book of Calculation, the Liber Abaci.

"The Liber Abaci continued the use of Egyptian fraction arithmetic, as copied from Arab sources, as noted by seven conversion methods. Five of the rational number conversion methods date to the Egyptian Middle Kingdom as used in the Egyptian Mathematical Leather Roll, and the Rhind Mathematical Papyrus 2/nth table, and its 84 problems.

"A modern number sequence named after him known as the Fibonacci numbers, which he did not discover, but used as an example in the Liber Abaci."
From Wikipedia: http://en.wikipedia.org/wiki/Fibonacci .
Last tested: July 4, 2009.

Note: The Fibonacci sequence is: 1, 1, 2, 3, 5, 8, 13, 21, 34, 55,..., i.e., each number is the sum of the previous two numbers. The limit of one Fibonacci number divided by the previous Fibonacci number, is the Golden Ratio (Livio, 2003), the basis for many properties in nature and aesthetics.

64. Karl Pearson (1857-1936), British statistician. "Pearson's work was all-embracing in the wide application and development of mathematical statistics, and encompassed the fields of biology, epidemiology, anthropometry, medicine and social history. In 1901, with Weldon and Galton, he founded the journal Biometrika, whose object was the development of statistical theory. He edited this journal until his death. He also founded the journal, Annals of Eugenics (now Annals of Human Genetics) in 1925. He published the Drapers' Company Research Memoirs, largely to provide a record of the output of the Department of Applied Statistics not published elsewhere. Pearson's thinking underpins many of the 'classical' statistical methods which are in common use today. Some of his main contributions are:
Linear regression and correlation (Pearson's r).
Classification of distributions.
Pearson's chi-square test."
From Wikipedia: http://en.wikipedia.org/wiki/Karl_Pearson .
Last tested: July 4, 2009.

Pearson also introduced the idea of population and sample, which form the bedrock of our modern understanding of statistics, and which have their origins in Plato.

65. Jan Łukasiewicz (1878-1956), Polish logician. So-called "Polish logic" and multi-valued logic. Prof. Woodger translated many of Łukasiewicz's original papers from Polish, and made them more available to the English-speaking world.
From Wikipedia: http://en.wikipedia.org/wiki/Jan_Lukasiewicz .
Last tested: July 4, 2009.

66. Probability is the long-term frequency of an uncertain event, after an indefinite number of trials, such as the frequency of obtaining a full house or better after an indefinite number of poker hands. Each system of probability includes an event space of possible events and a probability function, that tells whether an event belongs, or does not belong, to a desired outcome, such as the full house. A common misuse of probability is to cite a probability value for an event, without citing (or perhaps even understanding) the event-space context for that event.

Probability theory was known to the ancients, but much developed by mathematicians in 18th century Europe, in the employment of noblemen wishing to improve their performance at the gaming tables. From these unseemly beginnings, probability theory is used to predict the behaviors of weather, national economies, outcomes of chemotherapy, and critical masses of nuclear bombs. This almost naive dependence upon the abstraction of a fair coin or a fair deck of cards has been characterized as the Ludic Fallacy (Taleb, 2007).

67. Mikhail Gorbachev (Михаил Горбачёв, 1931-), General Secretary of the Communist Party, Union of Soviet Socialist Republics, 1985-1991.
From Wikipedia: http://en.wikipedia.org/wiki/Mikhail_Gorbachev .
Last tested: July 4, 2009.

68. Damon Runyon (1884-1947), American journalist and fiction writer.
From Wikipedia: http://en.wikipedia.org/wiki/Damon_Runyon .
Last tested: July 4, 2009.


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Aristotle (384-322 BCE), Greek philosopher.
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9. Berman JJ.
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10. Berman JJ.
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Last tested: July 4, 2009.

11. Berman JJ.
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Last tested: July 4, 2009.

12. Berman JJ.
Doublet method for very fast autocoding.
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13. Berman JJ, Moore GW.
Implementing an RDF schema for pathology images.
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Last tested: July 4, 2009.

14. Berman JJ.
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Last tested: July 4, 2009.

15. Berman JJ.
Perl Programming for Medicine and Biology.
Boston, Toronto, London, Singapore: Jones & Bartlett Publishers; 1 edition (April 6, 2007)
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Last tested: July 4, 2009.

16. Berman JJ.
Perl: The Programming Language.
Boston, Toronto, London, Singapore: Jones & Bartlett Publishers. 2009;:.
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Last tested: July 4, 2009.

17. Berman JJ.
Ruby Programming for Medicine and Biology.
Boston, Toronto, London, Singapore: Jones & Bartlett Pub; 1 edition (September 13, 2007)
ISBN-10: 0763750905, 378 pages.
ISBN-13: 978-0763750909, 378 pages.
http://www.jbpub.com/catalog/9780763750909/
http://www.julesberman.info/
Last tested: July 4, 2009.

18. Berman JJ.
Ruby: The Programming Language.
Boston, Toronto, London, Singapore: Jones & Bartlett Publishers. 2009;:.
ISBN: 9780763757571, 46 pages.
http://www.jbpub.com/catalog/9780763757571/
Last tested: July 4, 2009.

19. Berman JJ.
Neoplasms: Principles of Development and Diversity.
Boston, Toronto, London, Singapore: Jones & Bartlett Publishers. 2008 Oct 1.
ISBN: 9780763755706, 464 pages.
http://www.jbpub.com/catalog/9780763755706/
Last tested: July 4, 2009.

20. Berman JJ, with Moore GW.
Precancer: The Beginning and the End of Cancer.
Boston, Toronto, London, Singapore: Jones and Bartlett. 2009 Aug 11;:.
ISBN 9780763777845, 200 pages.
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Last tested: July 4, 2009.

21. Berman JJ.
Web site: http://www.julesberman.info/
Last tested: July 4, 2009.

22. Berman JJ.
Blog site: http://julesberman.blogspot.com/
Last tested: July 4, 2009.

23. Zeman J.
Modal Logic, The Lewis-Modal Systems.
Oxford: Oxford University Press. 1973;:.
ISBN not stated, 302 pages.

24. Łukasiewicz J.
Elementy Logiki Matematycznej.
Warsaw. 1929;:.
as cited in Zeman, 1973.
Jan Łukasiewicz (1878-1956) Polish logician.

25. Łukasiewicz J.
A system of Modal Logic.
The Journal of Computing Systems. 1953;1:111-149.
as cited in Zeman, 1973.

26. Łukasiewicz J.
Arithmetic and Modal Logic.
The Journal of Computing Systems. 1953;1:213-219.
as cited in Zeman, 1973.

27. Łukasiewicz J.
On a Controversial Problem of Aristotle's Modal Syllogistic.
Dominican Studies. 1954;7:114-123.
as cited in Zeman, 1973.
Aristotle (384-322 BCE), Greek philosopher.

28. Heckerling PS.
Token swap test revisited.
Comput Methods Programs Biomed. 2003 Mar;70(3):265-269.
PMID: 12581559.
PubMed Entry
Last tested: July 4, 2009.
http://www.netautopsy.org/tokncube.htm
Last tested: July 4, 2009.

29. Hippocrates. (`Iπποκρατης, 460-370 BCE)
Hippocrates. Volume I.
Jones WHS, transl. Loeb Classical Library. Cambridge, MA: Harvard University Press. 1923.
ISBN 0-674-99162-1, 361 pages.
Includes Hippocrates' Oath, with explanatory notes.
"First, Do No Harm" is not in the Hippocratic Oath, but rather in Epidemics, Bk. 1, Sect. 11. One translation reads: 'Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things: to help, or at least to do no harm.'

This note supplied by Harris G. Yfantis, MD.

Ancient Greek medicine was based upon the concept of four humors (blood, bile, phlegm, and urine), as well as the location of the patient, season of the year, and nearby epidemics. Many medical terms that we use today, such as bronchitis, nephritis, hepatitis, carcinoma, etc., have their origins in the writings of Hippocrates, although we have a much different view of pathogenesis that did these ancient physicians.

30. Sutton W, Linn E.
Where the Money Was. The Memoirs of the World's Greatest Bank Robber.
New York: Ballantine Books. 1976;:.
ISBN 0-345-25371-X-195, 422 pages.
Part Two: Breaking Out. Sutton's Law, pp. 148-150.
Sutton's Law (Willie Sutton, 1901-1980; American bank robber.)
Report's question: "Willie, why do you always rob banks?"
Willie's Answer: "Because that's where the money is."
Willie Sutton admits, and Groopman re-iterates, that he never really said "where the money is...," but that this memorable line was concocted by an enthusiastic reporter (Chapter 6, p. 138).

31. Petersdorf RG, Beeson PB.
Fever of Unexplained Origin.
Medicine. 1961;40:1-30.
PMID: 13734791.
Remark about Sutton's Law on p. 27.
PubMed Entry

32. Quine WV.
Theory of Deduction.
Cambridge, MA: Harvard Cooperative Society. 1948;:65-81.

33. Hutchins WJ.
Machine Translation : Past, Present, Future .
Ellis Horwood/Wiley, Chichester/New York. 1986;:. Ellis Horwood Series in Computers and Their Applications.
ASIN: 0135435218 .

34. Nagao M. Machine Translation.
In: Shapiro SC, ed. Encyclopedia of Artificial Intelligence. Volume 2. M-Z.
New York: Wiley-Interscience. 1992;:898-902.

35. Condon EU.
Statistics of vocabulary.
Science. 1928;67:300, 1928.

36. Zadeh LA.
Fuzzy sets.
Information and Control. 1965;8:338-353.

37. Zadeh LA.
Fuzzy sets and systems.
In: J. Fox, ed. System Theory. Brooklyn, New York: Polytechnic Press. 1965;:29-39.

38. Zadeh LA.
Fuzzy Algorithms.
Information and Control. 1968;12:94-102.

39. Zadeh LA.
Towards a theory of fuzzy systems.
In: Kalman RE, DeClaris RN, eds. Aspects of Networks and Systems Theory. New York: Holt, Reinhart & Winston, 1971;:469-490.

40. Zadeh LA.
From computing with numbers to computing with words - from manipulation of measurements to manipulation of perceptions.
IEEE Trans Circuits System I: Fundam Theory Appl 1999;45:105-119.

41. Sadegh-Zadeh K.
Basic problems in the theory of clinical practice. Part 1. Explication of the concept of medical diagnosis.
Metamed 1977;1:76-102. [in German].

42. Sadegh-Zadeh K.
Fundamentals of clinical methodology: 1. Differential indication.
Artif Intell Med 1994;6:83-102.

43. Sadegh-Zadeh K.
Fundamentals of clinical methodology. 2. Etiology.
Artif Intell Med 1998;12:227-70.

44. Sadegh-Zadeh K.
Fundamentals of clinical methodology. 3. Nosology.
Artif Intell Med. 1999;17:87-108.

45. Sadegh-Zadeh K.
Advances in fuzzy theory.
Artif Intell Med 1999;15:309-23.

46. Sadegh-zadeh K.
Als der Mensch das Denken verlernte. Die Entstehung der Machina sapiens. [When humanity forgot how to think. The emergence of Machina sapiens.]
49545 Tecklenburg, Germany: Burgverlag. 2000;:.
ISBN 3-922506-99-2, 164 pages.
Review: http://www.netautopsy.org/machinasapiens/
Last tested: July 4, 2009.
Unfortunately, not available in translation. Prof. Sadegh-zadeh, an Iranian-German analytic philosopher of medicine, constructs a horrifying negative utopia of computers and the internet living off human beings in the same manner that we support intestinal flora live in our gut.

47. Sadegh-zadeh K.
Fuzzy Health, Illness, and Disease.
J Med Phil 2000;25(5):605-638.

48. Sadegh-zadeh K.
Fuzzy Genomes.
Artif Intell Med. 2000;18:1-28.

49. Sadegh-Zadeh K.
Fundamentals of clinical methodology: 4. Diagnosis.
Artif Intell Med. 2000;20:.

50. Sadegh-zadeh K.
The Fuzzy Revolution: Goodbye to the Aristotelian Weltanschauung.
Artif Intell Med. 2001;21:1-25.
Aristotle (384-322 BCE), Greek philosopher.

51. Sadegh-Zadeh K.
Family resemblance concepts fuzzified.
Artif Intell Med. 2001;22:.

52. Aristotle (Aριστοτελης).
The Metaphysics. Books I-IX [Engl. Translation: Hugh Tredennick].
London: William Heinemann, 1961.
Aristotle (384-322 BCE), Greek philosopher.

53. Steimann F.
Fuzzy Set Theory in Medicine. Editorial
Artif Intell Med. 1997;11:1-7.

54. Kalmanson D, Stegall HF.
Cardiovascular investigations and fuzzy set theory.
Am J Cardiol 1975;35:80-84.

55. Haack S.
Do we need fuzzy logic?
Intl J Man-Mach Stud. 1979:11:437-445.
Objections to fuzzy set theory in linguistics:
(1) speech itself is not fuzzy;
(2) there are no applications [sic!].

56. Klir GJ, Yuan B.
Fuzzy Sets and Fuzzy Logic. Theory and Applications.
Upper Saddle River, NJ: Prentice Hall. 1995;:.

57. Feinstein AR.
Clinical Judgment.
Huntington, NY: Krieger Publishing Co, Inc. 1976;:.

58. Zipf GK.
Human Behavior and The Principle of Least Effort. An Introduction to Human Ecology.
Reading, MA: Addison-Wesley Press. 1949;:19-55.
George K. Zipf (1902-1950), American philologist, Harvard University.

59. da Costa NCA.
On the theory of inconsistent formal systems.
Notre Dame J Formal Logic 1974;15:497-510.

60. Struble RA.
Curriculum Vitae.
http://www.medparse.com/strublcv.htm
Last tested: July 4, 2009.

61. Struble RA.
Can one do serious mathematics with pictures and calculus?
Colloquium. Department of Mathematics. North Carolina State University, Raleigh, NC. Tuesday, April 17, 1984. 3:45 PM, Harrelson Room 307.
http://www.infiniteproduct.info/strupict.htm
Last tested: July 4, 2009.

62. Struble RA.
Infinite products and integration.
http://www.infiniteproduct.info/struitgr.htm
Last tested: July 4, 2009.

63. Struble RA.
Infinite products rescued.
http://www.infiniteproduct.info/struinfp.htm
Last tested: July 4, 2009.

64. Derbyshire J.
Prime Obsession: Bernhard Riemann and the Greatest Unsolved Problem in Mathematics.
New York: Plume Books. 2004 May 25;:.
ISBN: 0452285259, 448 pages.

65. Seife C.
Zero. The Biography of a Dangerous Idea.
London: Penguin Books. 2000.
ISBN: 0-670-88457-X, 248 pages.
This book includes an account of the execution of Hippasus of Metapontum, a member of the Pythagorean cult, who had dared to reveal the existence of irrational numbers to persons outside the cult.

66. Maor E.
e: The Story of a Number.
Princeton, NJ: Princeton University Press. 1998;:.
ISBN: 0691058547, 232 pages.
"Rarely in the history of science has an abstract mathematical idea been received more enthusiastically by the entire scientific community than the invention of logarithms..."

67. Fryxell PA, Koch SD.
Pavonia Ecostata (Malvaceae), a New Species from Jalisco, Mexico.
Brittonia. 1991 Jan-Mar;43(1):24-26.

68. Ruse ME.
Gregg's Paradox: A Proposed Revision to Buck and Hull's Solution.
Systematic Zoology. 1971 Jun;20(2):239-245.

69. MacKenna MC, Bell SK.
Classification of Mammals.
ISBN-10: 0231110138, 640 pages.
ISBN-13: 978-0231110136, 640 pages.
"Attempts to systematize organism come and go; none is permanent and there are many kinds (Huxley 1869:1;Gilmour 1940, 1951; Griffiths 1974; Bouquet 1996)...".
"Such redundant monotypy, often cited as exemplifying "Gregg's paradox," should not (but sometimes does) create confusion (Buck and Hull 1966; Farris 1967, 1968, 1976; Gregg 1967; Wiley 1979, 1980)."

70. Gregg JR.
Guestbook.
http://www.legacy.com/gb2/default.aspx?bookid=8066076420182&sign=1&cid=sugg
Last tested: July 4, 2009.

71. Hawking S.
Black Holes and Baby Universes and Other Essays.
New York: Bantam Books. 1993;:. Pages 44-45.
ISBN 0-553-37411-7, 182 pages.
Erwin Schrödinger (1887-1961; Nobel Physics, 1933).
Here is Hawking's description of Schrödinger's cat:
"In my opinion, the unspoken belief in a model independent reality is the underlying reason for the difficulties philosophers of science have with quantum mechanics and the uncertainty principle. There is a famous thought experiment called Schrödinger's cat. A cat is placed in a sealed box. There is a gun pointing at it, and it will go off if a radioactive nucleus decays. The probability of this happening is fifty percent. (Today no one would dare propose such a thing, even purely as a thought experiment, but in Schrödinger's time they had not heard of animal liberation.)

"If one opens the box, one will find the cat either dead or alive. But before the box is opened, the quantum state of the cat will be a mixture of the dead cat state with a state in which the cat is alive. This some philosophers of science find very hard to accept. The cat can't be half shot and half not-shot, they claim, any more than one can be half pregnant. Their difficulty arises because they are implicitly using a classical concept of reality. In this view, an object has not just a single history but all possible histories. In most cases, the probability of having a particular history will cancel out with the probability of having a very slightly different history; but in certain cases, the probabilities of neighboring histories reinforce each other. It is one of these reinforced histories that we observe as the history of the object.

"In the case of Schrödinger's cat, there are two histories that are reinforced. In one the cat is shot, while in the other it remains alive. In quantum theory both possibilities can exist together. But some philosophers get themselves tied in knots because they implicitly assume that the cat can only have one history."
72. Taleb NN.
The Black Swan. The Impact of the Highly Improbable.
New York: Random House. 2007 Apr 17;:.
ISBN-13: 978-1400063512, 400 pages.
http://www.netautopsy.org/blckswan.htm
Last tested: July 4, 2009.
There are many, many forms of Sutton's Law, dating back to the ancient Plato (427-348 BCE, Greek philosopher) and Aristotle (384-322 BCE, Greek philosopher): the unwise Greek (as in: "All Greeks are wise; Socrates (470-399 BCE, Greek philosopher) is a Greek..."); the white crow ("all crows are black..."); the white raven; the black swan; the bird that can't fly, etc. To name a few more:
72.1. Impecunious banks.
Sutton's Law (Willie Sutton, 1901-1980; American bank robber.)
Report's question: "Willie, why do you always rob banks?"
Willie's Answer: "Because that's where the money is." (Sutton, 1976).

72.2. Zebras in the street: "If you hear hoofbeats in the street, think of horses, not zebras." (Croskerry, 2002).

72.3. Plato: Essence vs accident.
Plato (427-348 BCE, Greek philosopher)

72.4. Aristotle: "Amicus Plato, sed magis amica veritas." "Plato is my friend, but Truth is more my friend."
Aristotle (384-322 BCE), Greek philosopher.

72.5. Avicenna (Ibn-Sina, 980-1037): Temporal logic.

72.6. St Thomas Aquinas: Jesus' blood (essence) vs sacramental wine (accident).
St Thomas Aquinas (1225-1274), Roman Catholic theologian.

72.7. Karl Pearson: Population vs sample.
Karl Pearson (1857-1936), British statistician.

72.8. Jan Łukasiewicz. Multi-valued logic.
Jan Łukasiewicz (1878-1956), Polish logician.

72.9. C. I. Lewis: Modal logic.

72.10. Lotfi A. Zadeh: Fuzzy logic.

72.11. Susan Haack: Deviant logic.

72.12. Gerhard Brewka: Non-monotonic logic. An Overview.

72.13. Austrian folk poem: "Alle Kunst / Ist umsunst / Wenn der Engel / Auf dem Zundloch brunst." [All technology is in vain, if the Angel urinates on your musket."]

72.14. Kurt Gödel. (1906-1978, Czech-American mathematician).
Über unentscheidbare Sätze der Principia mathematica und verwandte Systeme. I.
["Regarding undecidable propositions of the Principia mathematica and related systems. I."]
Monatsh Math Phys. 1931;38:173-198.

72.15. "God is dead" --Nietzsche; "Nietzsche is Dead" -- God.
Friedrich W. Nietzsche (1844-1900), German philosopher.

72.16. Isaac Asimov: "The Mule" in The Foundation Series:
Foundation. Gnome Press. 1951.
Foundation and Empire. Gnome Press. 1952.
Second Foundation. Gnome Press. 1953.
Isaac Asimov (1920-1992), American chemist and science fiction author.

72.17. DaCosta's Paraconsistency.

72.18. Boolos G: The Unprovability of Consistency. An Essay in Modal Logic.
Cambridge: Cambridge University Press. 1979;:.
ISBN 0-521-21879-9, 184 pages.
George Boolos (1940-1996), American philosopher and logician.

72.19. Ronald W. Reagan (1911-2004; 40th President of the United States, 1981-1989): "Trust, but Verify" was a signature phrase of Ronald Reagan. He used it in public, although he was not the first person known to use it. When Reagan used this phrase, he was usually discussing relations with the Soviet Union, and he almost always presented it as a translation of the Russian proverb "doveryai, no proveryai" (доверяй но проверяй). At the signing of the INF Treaty, Reagan used the phrase again, and his counterpart Mikhail Gorbachev responded: "You repeat this phrase every time we meet." The phrase has also been attributed to Damon Runyon.

72.20. Disinformation (дезинформацйя, a quintessentially Russian Cold-War concept), fib, lie, mendacity, prevarication, ....


73. Wolpert L.
Positional information and pattern formation.
Curr Top Dev Biol. 1971;6(6):183-224. Review.
PMID: 4950136.
PubMed Entry
Last tested: July 4, 2009.

74. Wolpert L.
Role of diffusible gradients in regeneration.
Dev Biol. 1973 Feb;30(2):concl4-5.
PMID: 4703683.
PubMed Entry
Last tested: July 4, 2009.

75. Wolpert L.
From engineering to positional information to public understanding. An interview with Lewis Wolpert. Interview by James C Smith.
Int J Dev Biol. 2000;44(1):85-91.
PMID: 10761852.
PubMed Entry
Last tested: July 4, 2009.
"Lewis Wolpert is one of the most influential developmental biologists in Britain and the world. His concept of positional information, developed 30 years ago, changed the way we think about pattern formation in the embryo and allowed new generations of molecular developmental biologists to frame their questions in a way that would give sensible answers...."
Wolpert's work involved an informal collaboration with Dr. Mary B. Williams, who was also the advisor for Dr. Moore's PhD Thesis.

76. Schneier B.
Applied Cryptography, Second Edition. Protocols, Algorithms, and Source Code in C.
New York: John Wiley & Sons, 1996.
ISBN: 0-471-11709-9, 758 pages.

77. Schneier B.
The Blowfish Encryption Algorithm.
Dr Dobbs Journal. 1994;19:38-40.

78. Claburn T.
Blowfish.
Wired. 1997;:7.

79. U. S. Code of Federal Regulations. 1995. 45 CFR Subtitle A (10-1-95 Edition), part 46.101 (b) (4).
U. S. Department of Health and Human Services. Office of the Secretary.

80. U. S. Code of Federal Regulations. 1999. 45 CFR Parts 160 - 164. Standards for Privacy of Individually Identifiable Health Information; Proposed Rule.
Department of Health and Human Services. Office of the Secretary.
Fed Regist. 1999 Nov 3;64(212):59917-59966.
http://aspe.hhs.gov/admnsimp/
Last tested: July 4, 2009.

82. Moore GW, Berman JJ.
Anatomic Pathology Data Mining.
In: Cios KJ, ed. Medical Data Mining and Knowledge Discovery.
2001. XVIII, 502 pp. 98 figs., 98 tabs. Hardcover.
ISBN: 3-7908-1340-0.
Copyright Springer-Verlag: Berlin/Heidelberg 1999.
http://www.netautopsy.org/apdmchap.htm
Last tested: July 4, 2009.

83. Sweeney L.
Computational Disclosure Control: A Primer on Data Privacy Protection.
PhD Thesis. Massachusetts Institute of Technology. Spring, 2001. Draft.

84. Sweeney L.
Privacy and medical-records research.
N Engl J Med. 1998 Apr 9;338(15):1077.
PMID: 9537887.
PubMed Entry
Last tested: July 4, 2009.

85. Sweeney L.
Guaranteeing anonymity when sharing medical data, the Datafly System.
Proc AMIA Annu Fall Symp. 1997;:51-55.
PMID: 9357587.
PubMed Entry
Last tested: July 4, 2009.

86. Prof. Ron Rivest's security and cryptography webpage:
http://theory.lcs.mit.edu/~rivest/crypto-security.html
Last tested: July 4, 2009.

87. Moore GW, Brown LA, Miller RE.
Goedelization of a Pathology Database: Re-identification by Inference. (Abstract).
Arch Pathol Lab Med. 2002 Jun;126:.
October, 2001, conference, Advancing Pathology Informatics, Imaging, and the Internet.
http://apiii.upmc.edu/abstracts/posterarchive/2001/moore.html
http://www.netautopsy.org/apep01go.htm
Last tested: July 4, 2009.

88. Livio M.
The Golden Ratio. The Story of Phi, the World's Most Astonishing Number.
New York: Broadway Books. 2003.
ISBN 0-7679-0816-3, 290 pages.

89. Bernstein PL.
Against the Gods. The Remarkable Story of Risk.
New York: John Wiley & Sons, Inc. 1996.
ISBN 0-471-29563-9, 383 pages.
A fantastic excursion through the history of probability and chance, starting with the ancient Egyptians and ending with modern worldwide business practices. Probability was originally studied in order to INCREASE BENEFITS, as in winning at gambling or staying alive longer. Now, probability has its most important applications for CONTAINING LOSSES.

90. DeCew JW.
In Pursuit of Privacy. Law, Ethics, and the Rise of Technology.
Ithaca, NY: Cornell University Press. 1997.
ISBN 0-8014-3380-0, 199 pages.

91. Sandritter W.
Histopathologie. Lehrbuch und Atlas für Studierende und Ärzte. Sechste, verbesserte Auflage. [Histopathology. Textbook and Atlas for Students and Physicians. Sixth, improved edition.]
Stuttgart: F. K. Schattauer Verlag. 1975;:.
ISBN 3-7945-0454-2, 309 pages.

92. Goldburgh M.
Image Compression. Chapter 15.
In: Siegel EL, Kolodner RM, eds.
Filmless Radiology.
New York: Springer. 2006;:295-310.
ISBN 0-387-95390-6, 434 pages.
Description of Receiver-operating-characteristic methodology.

93. Groopman J.
How Doctors Think.
Boston, New York: A Mariner Book. Houghton Mifflin Company. 2008.
ISBN-10: 0-618-61003-0, 319 pages.
ISBN-13: 978-0-618-61003-7, 319 pages.
Moore GW et al. Review.
http://www.netautopsy.org/groopman.htm
Last tested: July 4, 2009.
A description of Sutton's Law, Black Swan, etc., in action in clinical medicine.
Chapter 5. A New Mother's Challenge. pp. 101-131.
p. 126. "Common things are common."
p. 126. "When you hear hoofbeats in the street, think about horses, not zebras.
p. 127. "... the phrase `zebra retreat' ... describes a doctor's shying away from a rare diagnosis."
Chapter 6. The Uncertainty of the Expert. pp. 132-155.
p. 138. Sutton's Law. Quoted in context of congenital heart disease.

94. Moore GW, Hutchins GM, Bulkley BH.
Certainty levels in the nullity method of symbolic logic: application to the pathogenesis of congenital heart malformations.
J Theor Biol. 1979 Jan 7;76(1):53-81.
PMID: 431088.
PubMed Entry
Last tested: July 4, 2009.

95. Croskerry P.
The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775-780. Review.
PMID: 12915363.
PubMed Entry
Last tested: July 4, 2009.

96. Croskerry P.
Cognitive forcing strategies in clinical decisionmaking.
Ann Emerg Med. 2003 Jan;41(1):110-120.
PMID: 12514691.
PubMed Entry
Last tested: July 4, 2009.

97. Cosby KS, Croskerry P.
Patient safety: a curriculum for teaching patient safety in emergency medicine.
Acad Emerg Med. 2003 Jan;10(1):69-78. Review.
PMID: 12511320.
PubMed Entry
Last tested: July 4, 2009.

98. Croskerry P.
Achieving quality in clinical decision making: cognitive strategies and detection of bias.
Acad Emerg Med. 2002 Nov;9(11):1184-1204.
PMID: 12414468.
PubMed Entry
Description of "zebra retreat".
As cited in Groopman (2007).
Last tested: July 4, 2009.

99. Croskerry P, Chisholm C, Vinen J, Perina D.
Quality and education.
Acad Emerg Med. 2002 Nov;9(11):1108-1115.
PMID: 12414458.
PubMed Entry
Last tested: July 4, 2009.

100. Shapiro MJ, Croskerry P, Fisher S.
Profiles in patient safety: sidedness error.
Acad Emerg Med. 2002 Apr;9(4):326-329.
PMID: 11927462.
PubMed Entry
Last tested: July 4, 2009.

101. Croskerry P, Shapiro MJ.
"Profiles in patient safety": a new feature.
Acad Emerg Med. 2002 Apr;9(4):324.
PMID: 11927460.
PubMed Entry
Last tested: July 4, 2009.

102. Croskerry P.
The feedback sanction.
Acad Emerg Med. 2000 Nov;7(11):1232-1238. Review.
PMID: 11073471.
PubMed Entry
Last tested: July 4, 2009.

103. Croskerry P.
The cognitive imperative: thinking about how we think.
Acad Emerg Med. 2000 Nov;7(11):1223-31. Review.
PMID: 11073470.
PubMed Entry
Last tested: July 4, 2009.

104. Asimov I.
Foundation.
Publisher: Spectra; Revised edition (October 1, 1991)
ISBN-10: 0553293354, 320 pages.
ISBN-13: 978-0553293357, 320 pages.

105. Asimov I.
Foundation and Empire.
Publisher: Spectra (June 1, 2004)
ISBN-10: 0553803727, 256 pages.
ISBN-13: 978-0553803723, 256 pages.

106. Asimov I.
Second Foundation.
Publisher: Spectra (June 1, 2004)
ISBN-10: 0553803735, 256 pages.
ISBN-13: 978-0553803730, 256 pages.

107. Asimov I.
The Complete Stories. Volume 1.
Publisher: Spectra (June 1, 2004)
ISBN-10: 0553803735, 256 pages
ISBN-13: 978-0553803730, 256 pages
The first short story in this volume, "The Dead Past", is a paradigm for the installation of comprehensive new software in a medical institution. As soon as you copy in the records from the past (as you must; there is no tabula rasa [Latin: blank tablet] in medicine), you find old records that you wish you hadn't found.

The short story gives an account of a history professor (Asimov's dream job, according to his autobiography), delving into why an expensive, government-sponsored project, to develop a look-back technology for historical events, has been fruitless for over twenty years. According to government propaganda, the results of this project would be the opportunity to witness Julius Caesar's assassination, Suliemann's assault on Vienna, Napoleon's surrender at Waterloo, etc.

What the history professor discovers is that the technology only supports accurate, short-term lookbacks, such as the argument you had with your boss or your spouse a few weeks ago, in which all the principals have made up and moved onward. Horrors! We are now all living in a fishbowl; all privacy is gone, etc.

Comment: Internet and email have created some of this privacy vacuum that Asimov writes about.

108. Bismarck OELv (Otto Eduard Leopold von Bismarck-Schönhausen, 1815-1898).
"...der kleine Mann nicht weiss, wie die Wurst und die Gesetze gemacht würden, denn sonst würde dem Bürger der Appetit vergehen."
German, loosely translated: "The making of laws and sausages should not be witnessed by their consumers."
Another paradigm for medical informatics: The making of some medical ethics decisions should not be witnessed by their consumers.
Paraphrased another way, it is OK to lie to the patient sometimes (see: chapter on Ethics, in Dr. Berman's Biomedical Informatics).
http://www.initiative.cc/Artikel/2004_10_25%20Kurz%20notiert.htm
http://en.wikipedia.org/wiki/Otto_von_Bismarck
Last tested: July 4, 2009.

109. Tarjan RE.
Data Structures and Network Algorithms. CBMS-NSF Regional Conference Series in Applied Mathematics.
Paperback, December, 1983.
New York: Society for Industrial & Applied Mathematics.
ISBN: 0898711878.

110. Davis M.
What is a computation?.
In: Steen LA, Mathematics Today. Twelve Informal Essays.
New York: Springer-Verlag. 1978;:.
ISBN 0-387-90305-4, 367 pages.

111. Stewart I.
Concepts of Modern Mathematics.
New York: Dover Publications, Inc. 1975;:.
ISBN 0-486-28424-7, 339 pages.
Discusses the NP complete computability problem.

112. Amos M.
Genesis Machines. The New Science of Biocomputing.
London: Atlantic Books. 2006;:.
ISBN-10: 1-84354-224-2, 353 pages.
ISBN-13: 978-184354-224-7, 353 pages.
http://www.netautopsy.org/bcig/genemach.htm
Discusses the NP complete computability problem.

113. Gödel K.
Über formal unentscheidbare Sätze der Principia Mathematica und verwandter Systeme. I. ["Regarding undecidable propositions of the Principia mathematica and related systems. I."]
Monatsh. Math. Phys. 1931;38:173-198.

114. Nagel E, Newman JR.
Gödel's Proof.
New York: New York University Press. 1958;:.
ISBN 0-8147-0325-9, 118 pages.

115. Casti JL, DePauli W.
Gödel. A Life of Logic. Cambridge, MA: Perseus Publishing. 2000;:.
ISBN 0-7382-0274-6, 210 pages.
Reviewed in: Neurocomputing. 2001 Jan;42(1):331.
http://www.netautopsy.org/rvgodell.htm
Last tested: July 4, 2009.

116. Turing AM.
On Computable Numbers, with an Application to the Entscheidungsproblem.
Proc Lond Math Soc. 1936; 2 42: 230-265.

117. Turing AM.
On Computable Numbers, with an Application to the Entscheidungsproblem: A correction.
Proc Lond Math Soc. 1937; 2 43: 544-546, 1937.
http://en.wikipedia.org/wiki/Alan_Turing
http://en.wikipedia.org/wiki/Turing_machine
Alan M. Turing (1912-1954), British mathematician, computer scientist.

118. Hawking S, ed.
God Created the Integers: The Mathematical Breakthroughs that Changed History.
Philadelphia: Running Press. 2005;:.
ISBN-13: 978-0-7624-1922-7.
Includes Turing's 1936-1937 paper, with commentary and biography.
Stephen Hawking, British physicist.

Last Updated: 7/4/2009, by G. William Moore, MD, PhD: George.Moore4@va.gov.