Problems of video-based pain detection in patients with dementia: a road map to an interdisciplinary solution.

BACKGROUND: Given the unreliable self-report in patients with dementia, pain assessment should also rely on the observation of pain behaviors, such as facial expressions. Ideal observers should be well trained and should observe the patient continuously in order to pick up any pain-indicative behavior; which are requisitions beyond realistic possibilities of pain care. Therefore, the need for video-based pain detection systems has been repeatedly voiced. Such systems would allow for constant monitoring of pain behaviors and thereby allow for a timely adjustment of pain management in these fragile patients, who are often undertreated for pain. METHODS: In this road map paper we describe an interdisciplinary approach to develop such a video-based pain detection system. The development starts with the selection of appropriate video material of people in pain as well as the development of technical methods to capture their faces. Furthermore, single facial motions are automatically extracted according to an international coding system. Computer algorithms are trained to detect the combination and timing of those motions, which are pain-indicative. RESULTS/CONCLUSION: We hope to encourage colleagues to join forces and to inform end-users about an imminent solution of a pressing pain-care problem. For the near future, implementation of such systems can be foreseen to monitor immobile patients in intensive and postoperative care situations.

Toward human-level concept learning: Pattern benchmarking for AI algorithms.

Artificial intelligence (AI) today is very successful at standard pattern-recognition tasks due to the availability of large amounts of data and advances in statistical data-driven machine learning. However, there is still a large gap between AI pattern recognition and human-level concept learning. Humans can learn amazingly well even under uncertainty from just a few examples and are capable of generalizing these concepts to solve new conceptual problems. The growing interest in explainable machine intelligence requires experimental environments and diagnostic/benchmark datasets to analyze existing approaches and drive progress in pattern analysis and machine intelligence. In this paper, we provide an overview of current AI solutions for benchmarking concept learning, reasoning, and generalization; discuss the state-of-the-art of existing diagnostic/benchmark datasets (such as CLEVR, CLEVRER, CLOSURE, CURI, Bongard-LOGO, V-PROM, RAVEN, Kandinsky Patterns, CLEVR-Humans, CLEVRER-Humans, and their extension containing human language); and provide an outlook of some future research directions in this exciting research domain.

ManuKnowVis: How to Support Different User Groups in Contextualizing and Leveraging Knowledge Repositories.

We present ManuKnowVis, the result of a design study, in which we contextualize data from multiple knowledge repositories of a manufacturing process for battery modules used in electric vehicles. In data-driven analyses of manufacturing data, we observed a discrepancy between two stakeholder groups involved in serial manufacturing processes: Knowledge providers (e.g., engineers) have domain knowledge about the manufacturing process but have difficulties in implementing data-driven analyses. Knowledge consumers (e.g., data scientists) have no first-hand domain knowledge but are highly skilled in performing data-driven analyses. ManuKnowVis bridges the gap between providers and consumers and enables the creation and completion of manufacturing knowledge. We contribute a multi-stakeholder design study, where we developed ManuKnowVis in three main iterations with consumers and providers from an automotive company. The iterative development led us to a multiple linked view tool, in which, on the one hand, providers can describe and connect individual entities (e.g., stations or produced parts) of the manufacturing process based on their domain knowledge. On the other hand, consumers can leverage this enhanced data to better understand complex domain problems, thus, performing data analyses more efficiently. As such, our approach directly impacts the success of data-driven analyses from manufacturing data. To demonstrate the usefulness of our approach, we carried out a case study with seven domain experts, which demonstrates how providers can externalize their knowledge and consumers can implement data-driven analyses more efficiently.

Explanatory machine learning for justified trust in human-AI collaboration: Experiments on file deletion recommendations.

In the digital age, saving and accumulating large amounts of digital data is a common phenomenon. However, saving does not only consume energy, but may also cause information overload and prevent people from staying focused and working effectively. We present and systematically examine an explanatory AI system (Dare2Del), which supports individuals to delete irrelevant digital objects. To give recommendations for the optimization of related human-computer interactions, we vary different design features (explanations, familiarity, verifiability) within and across three experiments (N 1 = 61, N 2 = 33, N 3= 73). Moreover, building on the concept of distributed cognition, we check possible cross-connections between external (digital) and internal (human) memory. Specifically, we examine whether deleting external files also contributes to human forgetting of the related mental representations. Multilevel modeling results show the importance of presenting explanations for the acceptance of deleting suggestions in all three experiments, but also point to the need of their verifiability to generate trust in the system. However, we did not find clear evidence that deleting computer files contributes to human forgetting of the related memories. Based on our findings, we provide basic recommendations for the design of AI systems that can help to reduce the burden on people and the digital environment, and suggest directions for future research.

IRVINE: A Design Study on Analyzing Correlation Patterns of Electrical Engines.

In this design study, we present IRVINE, a Visual Analytics (VA) system, which facilitates the analysis of acoustic data to detect and understand previously unknown errors in the manufacturing of electrical engines. In serial manufacturing processes, signatures from acoustic data provide valuable information on how the relationship between multiple produced engines serves to detect and understand previously unknown errors. To analyze such signatures, IRVINE leverages interactive clustering and data labeling techniques, allowing users to analyze clusters of engines with similar signatures, drill down to groups of engines, and select an engine of interest. Furthermore, IRVINE allows to assign labels to engines and clusters and annotate the cause of an error in the acoustic raw measurement of an engine. Since labels and annotations represent valuable knowledge, they are conserved in a knowledge database to be available for other stakeholders. We contribute a design study, where we developed IRVINE in four main iterations with engineers from a company in the automotive sector. To validate IRVINE, we conducted a field study with six domain experts. Our results suggest a high usability and usefulness of IRVINE as part of the improvement of a real-world manufacturing process. Specifically, with IRVINE domain experts were able to label and annotate produced electrical engines more than 30% faster.

Automatic Coding of Facial Expressions of Pain: Are We There Yet?

INTRODUCTION: The experience of pain is regularly accompanied by facial expressions. The gold standard for analyzing these facial expressions is the Facial Action Coding System (FACS), which provides so-called action units (AUs) as parametrical indicators of facial muscular activity. Particular combinations of AUs have appeared to be pain-indicative. The manual coding of AUs is, however, too time- and labor-intensive in clinical practice. New developments in automatic facial expression analysis have promised to enable automatic detection of AUs, which might be used for pain detection. OBJECTIVE: Our aim is to compare manual with automatic AU coding of facial expressions of pain. METHODS: FaceReader7 was used for automatic AU detection. We compared the performance of FaceReader7 using videos of 40 participants (20 younger with a mean age of 25.7 years and 20 older with a mean age of 52.1 years) undergoing experimentally induced heat pain to manually coded AUs as gold standard labeling. Percentages of correctly and falsely classified AUs were calculated, and we computed as indicators of congruency, "sensitivity/recall," "precision," and "overall agreement (F1)." RESULTS: The automatic coding of AUs only showed poor to moderate outcomes regarding sensitivity/recall, precision, and F1. The congruency was better for younger compared to older faces and was better for pain-indicative AUs compared to other AUs. CONCLUSION: At the moment, automatic analyses of genuine facial expressions of pain may qualify at best as semiautomatic systems, which require further validation by human observers before they can be used to validly assess facial expressions of pain.

Automatic Detection of Pain from Facial Expressions: A Survey.

Pain sensation is essential for survival, since it draws attention to physical threat to the body. Pain assessment is usually done through self-reports. However, self-assessment of pain is not available in the case of noncommunicative patients, and therefore, observer reports should be relied upon. Observer reports of pain could be prone to errors due to subjective biases of observers. Moreover, continuous monitoring by humans is impractical. Therefore, automatic pain detection technology could be deployed to assist human caregivers and complement their service, thereby improving the quality of pain management, especially for noncommunicative patients. Facial expressions are a reliable indicator of pain, and are used in all observer-based pain assessment tools. Following the advancements in automatic facial expression analysis, computer vision researchers have tried to use this technology for developing approaches for automatically detecting pain from facial expressions. This paper surveys the literature published in this field over the past decade, categorizes it, and identifies future research directions. The survey covers the pain datasets used in the reviewed literature, the learning tasks targeted by the approaches, the features extracted from images and image sequences to represent pain-related information, and finally, the machine learning methods used.

The Next Generation of Medical Decision Support: A Roadmap Toward Transparent Expert Companions.

Increasing quality and performance of artificial intelligence (AI) in general and machine learning (ML) in particular is followed by a wider use of these approaches in everyday life. As part of this development, ML classifiers have also gained more importance for diagnosing diseases within biomedical engineering and medical sciences. However, many of those ubiquitous high-performing ML algorithms reveal a black-box-nature, leading to opaque and incomprehensible systems that complicate human interpretations of single predictions or the whole prediction process. This puts up a serious challenge on human decision makers to develop trust, which is much needed in life-changing decision tasks. This paper is designed to answer the question how expert companion systems for decision support can be designed to be interpretable and therefore transparent and comprehensible for humans. On the other hand, an approach for interactive ML as well as human-in-the-loop-learning is demonstrated in order to integrate human expert knowledge into ML models so that humans and machines act as companions within a critical decision task. We especially address the problem of Semantic Alignment between ML classifiers and its human users as a prerequisite for semantically relevant and useful explanations as well as interactions. Our roadmap paper presents and discusses an interdisciplinary yet integrated Comprehensible Artificial Intelligence (cAI)-transition-framework with regard to the task of medical diagnosis. We explain and integrate relevant concepts and research areas to provide the reader with a hands-on-cookbook for achieving the transition from opaque black-box models to interactive, transparent, comprehensible and trustworthy systems. To make our approach tangible, we present suitable state of the art methods with regard to the medical domain and include a realization concept of our framework. The emphasis is on the concept of Mutual Explanations (ME) that we introduce as a dialog-based, incremental process in order to provide human ML users with trust, but also with stronger participation within the learning process.

Stop Thinking: An Experience Sampling Study on Suppressing Distractive Thoughts at Work.

In modern work environments, it can be difficult for workers to avoid becoming distracted from their current task. This study investigates person-situation interactions to predict thought control activities (kind of self-control), which aim to stop distracting thoughts that enter the mind. Specifically, it was examined (1) how challenging work demands (time pressure, task complexity) activate workers' thought control to stop distractive thoughts (n level 2 = 143) and relate to the effort to do so (n level 2 = 91) in daily working life and (2) how these relationships differ according workers' general cognitive ability to suppress unwanted thoughts. To understand these person-situation interactions, an experience sampling study was combined with a laboratory task assessing the ability to suppress unwanted thoughts (think/no-think task). Multilevel modeling revealed that workers' engage more often and more intensively in thought control activities at a moderate level of time pressure but only when they had a higher general ability to suppress unwanted thoughts. For workers with a lower ability to suppress unwanted thoughts, increasing time pressure was negatively related to thought control activities, even at very low levels of time pressure. Thus, whether time pressure activates or hinders thought control depends on individuals' ability to suppress distractive thoughts.

Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: a double-blind, randomized, placebo-controlled study.

Vascular effects of local anesthetics are especially important in dermatological surgery. In particular, adequate perfusion must be ensured in order to offset surgical manipulations during surgical interventions at the acra. However, the use of adrenaline additives appears fraught with problems when anesthesia affects the terminal vascular system, particularly during interventions at the fingers, toes, penis, outer ears, and tip of the nose. We studied skin blood flux at the fingerpads via laser Doppler flowmetry over the course of 24 hours in a prospective, double-blind, randomized, placebo-controlled study with 20 vascularly healthy test persons following Oberst's-method anesthetic blocks. In each case, 6 ml ropivacaine (7.5 mg/ml) (A), lidocaine 1% without an additive (B), and lidocaine 1% with an adrenaline additive (1:200,000) (C) was used respectively as a verum. Isotonic saline solution was injected as a placebo (D). Measurements were carried out with the aid of a computer simultaneously at D II and D IV on both hands. Administration of (A) led to increased blood flux (+155.2%); of (B) initially to a decrease of 27%; of (C) to a reduction of 55% which was reversible after 40 minutes and of (D) to no change.(A) resulted in sustained vasodilatation which was still demonstrable after 24 h. (B) had notably less vasodilative effect, although comparison with (D) clearly showed that (B) is indeed vasodilative. (C) resulted in only a passing decrease in perfusion; this was no longer measurable when checked after 6 and 24 h. This transient inadequacy of blood flux also appeared after administration of (D). These tests show that adrenaline additive in local anesthesia does not decrease blood flow more than 55% for a period of 16 min. Following these results an adrenaline additive can be safely used for anesthetic blocks at the acra in healthy persons.

[The internet as an information source for family caregivers of dementia patients]. / Das Internet als Informationsquelle für pflegende Angehörige eines Demenzpatienten.

OBJECTIVE: What significance has the Internet as a source of information for family caregivers of dementia patients? METHODS: In Middle Franconia (Germany), 391 family caregivers were requested to participate in a questionnaire-based postal survey about the significance of the Internet and other sources of information on dementia. The family caregivers in question were the relatives of patients of the Memory Clinic at Erlangen University Psychiatric Hospital, members of the Alzheimer's Society of Middle Franconia or the Nuremberg Family Counselling Society. RESULTS: Younger and better-educated family caregivers more often own a computer with Internet access than older ones. The Internet is in 4th place on their list of sources of information. Although doctors are by far the most important source, counselling centres and literature are rated only just before the Internet. CONCLUSIONS: The Internet is particularly significant for the younger better-educated family caregivers, independent of gender, as a source of information on the diagnosis and treatment of dementia.

Transformational and derivational strategies in analogical problem solving.

Analogical problem solving is mostly described as transfer of a source solution to a target problem based on the structural correspondences (mapping) between source and target. Derivational analogy (Carbonell, Machine learning: an artificial intelligence approach Los Altos. Morgan Kaufmann, 1986) proposes an alternative view: a target problem is solved by replaying a remembered problem-solving episode. Thus, the experience with the source problem is used to guide the search for the target solution by applying the same solution technique rather than by transferring the complete solution. We report an empirical study using the path finding problems presented in Novick and Hmelo (J Exp Psychol Learn Mem Cogn 20:1296-1321, 1994) as material. We show that both transformational and derivational analogy are problem-solving strategies realized by human problem solvers. Which strategy is evoked in a given problem-solving context depends on the constraints guiding object-to-object mapping between source and target problem. Specifically, if constraints facilitating mapping are available, subjects are more likely to employ a transformational strategy, otherwise they are more likely to use a derivational strategy.