(Ebook) Stochastic Medical Reasoning and Environmental

Health Exposure by George Christakos, Jin-Feng Wang,

Jiaping Wu ISBN 9781908977496, 1908977493 Pdf Download

https://ebooknice.com/product/stochastic-medical-reasoning-and-
environmental-health-exposure-5242442

★★★★★
4.7 out of 5.0 (61 reviews )

DOWNLOAD PDF

ebooknice.com
 (Ebook) Stochastic Medical Reasoning and Environmental
Health Exposure by George Christakos, Jin-Feng Wang, Jiaping
Wu ISBN 9781908977496, 1908977493 Pdf Download

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 EDUCATIONAL COLLECTION - LIMITED TIME

INSTANT DOWNLOAD VIEW LIBRARY

Here are some recommended products that we believe you will be
interested in. You can click the link to download.

(Ebook) Biota Grow 2C gather 2C cook by Loucas, Jason; Viles, James

ISBN 9781459699816, 9781743365571, 9781925268492, 1459699815,
1743365578, 1925268497

https://ebooknice.com/product/biota-grow-2c-gather-2c-cook-6661374

(Ebook) Quantitative Analysis and Modeling of Earth and Environmental

Data: Space-Time and Spacetime Data Considerations by Jiaping Wu,
Junyu He, George Christakos ISBN 9780128163412, 0128163410

https://ebooknice.com/product/quantitative-analysis-and-modeling-of-
earth-and-environmental-data-space-time-and-spacetime-data-
considerations-36654672

(Ebook) Matematik 5000+ Kurs 2c Lärobok by Lena Alfredsson, Hans

Heikne, Sanna Bodemyr ISBN 9789127456600, 9127456609

https://ebooknice.com/product/matematik-5000-kurs-2c-larobok-23848312

(Ebook) SAT II Success MATH 1C and 2C 2002 (Peterson's SAT II Success)

by Peterson's ISBN 9780768906677, 0768906679

https://ebooknice.com/product/sat-ii-success-
math-1c-and-2c-2002-peterson-s-sat-ii-success-1722018
(Ebook) Master SAT II Math 1c and 2c 4th ed (Arco Master the SAT
Subject Test: Math Levels 1 & 2) by Arco ISBN 9780768923049,
0768923042

https://ebooknice.com/product/master-sat-ii-math-1c-and-2c-4th-ed-
arco-master-the-sat-subject-test-math-levels-1-2-2326094

(Ebook) Cambridge IGCSE and O Level History Workbook 2C - Depth Study:

the United States, 1919-41 2nd Edition by Benjamin Harrison ISBN
9781398375147, 9781398375048, 1398375144, 1398375047

https://ebooknice.com/product/cambridge-igcse-and-o-level-history-
workbook-2c-depth-study-the-united-states-1919-41-2nd-edition-53538044

(Ebook) Large deviations for stochastic processes by Jin Feng, Thomas

G. Kurtz ISBN 9780821841457, 0821841459

https://ebooknice.com/product/large-deviations-for-stochastic-
processes-897380

(Ebook) Transition Metal Catalyzed Pyrimidine, Pyrazine, Pyridazine

and Triazine Synthesis by Xiao-Feng Wu, Zechao Wang ISBN
9780128093696, 9780128093788, 0128093692, 0128093781

https://ebooknice.com/product/transition-metal-catalyzed-pyrimidine-
pyrazine-pyridazine-and-triazine-synthesis-6614510

(Ebook) Principles and Methods for Assessing Autoimmunity Associated

with Exposure to Chemicals: Environmental Health Criteria Series No.
236 (Environmental Health Criteria) by ILO, UNEP ISBN 9789241572361,
9241572361
https://ebooknice.com/product/principles-and-methods-for-assessing-
autoimmunity-associated-with-exposure-to-chemicals-environmental-
health-criteria-series-no-236-environmental-health-criteria-1660004
 STOCHASTIC MEDICAL REASONING AND
ENVIRONMENTAL HEALTH EXPOSURE

P892_9781908977496_tp.indd 1 10/2/14 3:11 pm

May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory PST˙ws

This page intentionally left blank

 STOCHASTIC MEDICAL REASONING AND
ENVIRONMENTAL HEALTH EXPOSURE

George Christakos
San Diego State University, USA

Jin-Feng Wang
Chinese Academy of Science, China

Jiaping Wu
Zhejiang University, China

Imperial College Press

ICP

P892_9781908977496_tp.indd 2 10/2/14 3:11 pm

 Published by
Imperial College Press
57 Shelton Street
Covent Garden
London WC2H 9HE

Distributed by
World Scientific Publishing Co. Pte. Ltd.
5 Toh Tuck Link, Singapore 596224
USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601
UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library.

STOCHASTIC â•›MEDICAL â•›REASONING â•›AND â•›ENVIRONMENTAL â•›HEALTH â•›EXPOSURE

Copyright © 2014 by Imperial College Press
All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means,
electronic or mechanical, including photocopying, recording or any information storage and retrieval
system now known or to be invented, without written permission from the Publisher.

For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance
Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy
is not required from the publisher.

ISBN 978-1-908977-49-6

Typeset by Stallion Press

Email: [email protected]

Printed in Singapore

Catherine - Stochastic Medical Reasoning.indd 1 4/2/2014 9:02:37 AM

February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

To friendship

v
May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory PST˙ws

This page intentionally left blank

February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

Contents

Preface xi

Chapter 1. Medical Sciences in the Age of Synthesis 1

1.1 Professional Practice and Stochastic Medical Reasoning . . . . 1
1.1.1 Synthesis in medical sciences . . . . . . . . . . . . . . . 1
1.1.2 Environmental health and geomedicine . . . . . . . . . 5
1.1.3 On ancient Greek and Chinese medicine . . . . . . . . 9
1.1.4 Decision-making in conditions of in situ
uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.1.5 A brief note on logical thinking in ancient
Greece and China . . . . . . . . . . . . . . . . . . . . . 14
1.1.6 Enter stochastic medical reasoning . . . . . . . . . . . 16
1.2 Health: The Fundamental Roles of Space–Time
and Uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.3 Abstract and Concrete Modes of Thinking . . . . . . . . . . . 23
1.4 Issues of Sound Medical Decision-Making . . . . . . . . . . . . 25
1.4.1 Key elements of a medical investigation . . . . . . . . . 26
1.4.2 Reflection, recognition primed decision and robust
decision methods . . . . . . . . . . . . . . . . . . . . . 30
1.4.3 Algorithmic medical decision-making methods . . . . . 33
1.4.4 Does expert knowledge translate into
expert judgment? . . . . . . . . . . . . . . . . . . . . . 34
1.5 Medical Dialectics and Knowledge Synthesis: An Outline . . . 36

Chapter 2. Reasoning Amidst Uncertainty 39

2.1 When “To Know” Means “To Be Uncertain Of” . . . . . . . . 39
2.1.1 Common medical reasoning errors . . . . . . . . . . . . 39
2.1.2 Physician’s language and metalanguage . . . . . . . . . 42
2.1.3 The notion of knowledge base . . . . . . . . . . . . . . 44

vii
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

viii Stochastic Medical Reasoning and Environmental Health Exposure

2.2 The Space–Time Domain of Stochastic Medical Reasoning . . 47

2.2.1 Location–time coordinates and metric . . . . . . . . . . 47
2.2.2 The spatiotemporal random field model . . . . . . . . . 51
2.3 In Situ Logic and Uncertain Mind States . . . . . . . . . . . . 53
2.3.1 How much a health care provider does not know:
Ontic and epistemic uncertainty . . . . . . . . . . . . . 54
2.3.2 Appreciating case individuality and legal disputes . . . 56
2.3.3 Case communication uncertainty: Entitled to their
own opinions but not to their own facts . . . . . . . . . 58
2.3.4 Formal vs. in situ logic . . . . . . . . . . . . . . . . . . 60
2.3.5 From state of nature to state of mind (assertion) . . . 63
2.3.6 Ranking of assertion forms . . . . . . . . . . . . . . . . 71
2.3.7 The Three Qs of the triadic case formula . . . . . . . . 74
2.3.8 Uncertainty factors: A review . . . . . . . . . . . . . . 76
2.4 SMR’s View of Medical Connectives: Beyond
Drug Digestion . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2.4.1 Conversational (dialogical) connective interpretation . 80
2.4.2 Content-dependent vs. content-independent
connectives . . . . . . . . . . . . . . . . . . . . . . . . . 83
2.5 Natural Laws and Scientific Models . . . . . . . . . . . . . . . 85
2.5.1 Infectious disease and human exposure modeling . . . . 86
2.5.2 Medical syllogism and the justification
of professional assertions . . . . . . . . . . . . . . . . . 89
2.5.3 Reconstructing Chinese arguments in terms
of Greek syllogisms . . . . . . . . . . . . . . . . . . . . 94
2.5.4 Revisiting content-dependent and
content-independent assertions . . . . . . . . . . . . . . 96
2.6 Substantive Conditionals in Medical Thinking . . . . . . . . . 99
2.6.1 The notion of content-dependent conditional . . . . . . 100
2.6.2 Paradoxes of mainstream logic . . . . . . . . . . . . . . 105
2.6.3 Conditionals and metalanguage . . . . . . . . . . . . . 114
2.6.4 Conditionals and natural laws . . . . . . . . . . . . . . 117
2.6.5 Over-extending and extrapolating . . . . . . . . . . . . 119
2.7 The Object Language–Metalanguage Connection . . . . . . . . 121
2.7.1 Relations between states . . . . . . . . . . . . . . . . . 122
2.7.2 Combinations of medical inferences
and derivative assertions . . . . . . . . . . . . . . . . . 131
2.7.3 Levels of justification and uncertainty . . . . . . . . . . 133
2.7.4 Does postmodern decision analysis make sense? . . . . 138
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

Contents ix

Chapter 3. The Role of Probability 141

3.1 How Much Understanding is Sufficient in Medical
Investigations? . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
3.1.1 Medical assertions and partial understanding . . . . . . 141
3.1.2 On rationality and belief . . . . . . . . . . . . . . . . . 144
3.1.3 Knowledge theory revisited: Platonism,
context and continuity in medical thinking . . . . . . . 145
3.1.4 Concerning medical expertise . . . . . . . . . . . . . . 147
3.2 Space–Time Probabilities of Medical Cases . . . . . . . . . . . 148
3.2.1 Common probability interpretations in health
care practice . . . . . . . . . . . . . . . . . . . . . . . . 148
3.2.2 Probability of a case assertion (mind state) . . . . . . . 152
3.2.3 Basic probability rules . . . . . . . . . . . . . . . . . . 155
3.2.4 Probability interpretations in object language
and metalanguage . . . . . . . . . . . . . . . . . . . . . 157
3.2.5 Body of evidence and medical interventions . . . . . . 161
3.3 Probabilities of Medical Conditionals . . . . . . . . . . . . . . 164
3.3.1 Standard logical relations and inference rules . . . . . . 164
3.3.2 Choosing a conditional probability form . . . . . . . . 166
3.3.3 Stochastic truth tables: A second look . . . . . . . . . 176
3.3.4 More on probability calculation: Is there
a probameter? . . . . . . . . . . . . . . . . . . . . . . . 181
3.4 Stochastic Medical Inferences . . . . . . . . . . . . . . . . . . 186
3.4.1 From standard to stochastic syllogisms . . . . . . . . . 187
3.4.2 Premise strengthening, internally consistent
and uninformative inferences . . . . . . . . . . . . . . . 199
3.5 Probability, Uncertainty and Information of Diagnoses
or Prognoses Sets . . . . . . . . . . . . . . . . . . . . . . . . . 205
3.6 Diagnosis Ranking and Symptom Confirmation Strength . . . 211
3.6.1 Quantitative case parameters . . . . . . . . . . . . . . 212
3.6.2 Principles of medical practice and their
quantitative expressions . . . . . . . . . . . . . . . . . 215
3.7 The Trouble with Medical Probability . . . . . . . . . . . . . . 217
3.8 Translating Medical Assertions into Probabilistic Terms . . . . 222
3.9 Space–Time Reasoning Dynamics . . . . . . . . . . . . . . . . 229
3.9.1 Changes in assertions and substantive conditionals . . 229
3.9.2 Probability dynamics and hypothesis confirmation . . . 235
3.9.3 The case of non-monotonic medical reasoning . . . . . 238
3.10 Medical Syllogisms Involving Likelihood Ratios . . . . . . . . 240
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

x Stochastic Medical Reasoning and Environmental Health Exposure

3.11 Summing Up: Checking the Validity of Medical Arguments . . 242

3.12 Self-Referential Medical Assertions and Cognitive Favorability 244
3.13 Not Just a Set of Guidelines . . . . . . . . . . . . . . . . . . . 247

Chapter 4. Space–Time Medical Mapping

and Causation Modeling 249
4.1 Techniques With a “Health Warning” . . . . . . . . . . . . . . 249
4.2 Space–Time Disease Mapping . . . . . . . . . . . . . . . . . . 250
4.2.1 Objectives of medical mapping . . . . . . . . . . . . . . 251
4.2.2 The fundamental mapping equations . . . . . . . . . . 253
4.2.3 The insight behind the BME–SIR equations . . . . . . 256
4.2.4 A study of French flu . . . . . . . . . . . . . . . . . . . 258
4.3 Modeling Space–Time Infectious Disease Spread . . . . . . . . 264
4.4 Space–Time Causation Revisited . . . . . . . . . . . . . . . . . 268
4.5 Medical Causation in the SMR Inference Setting . . . . . . . . 271
4.5.1 Defining the problem . . . . . . . . . . . . . . . . . . . 272
4.5.2 The role of KB and the interpretation of
probabilistic causation . . . . . . . . . . . . . . . . . . 277
4.5.3 Causation: Epistemic vs. non-epistemic . . . . . . . . . 280
4.5.4 Some remarks regarding the form of the
causation conditional . . . . . . . . . . . . . . . . . . . 283
4.5.5 Stochastic causal inferences . . . . . . . . . . . . . . . 285
4.5.6 The role of secondary case attributes . . . . . . . . . . 287
4.6 Causation in Terms of Integrative Space–Time Prediction . . . 289
4.7 Causation Justification and the Dualistic Opposition . . . . . 291

Chapter 5. Looking Ahead 293

5.1 An Ibsenian Transformation . . . . . . . . . . . . . . . . . . . 293
5.2 SMR and Divergence of Rationality in Medical Thinking . . . 296
5.3 Challenges Emerging from the Incompleteness Principle and
Unanticipated Knowledge . . . . . . . . . . . . . . . . . . . . . 298
5.4 Information Technology-Based Medical Reasoning . . . . . . . 302
5.5 Social and Cultural Dimensions of Medical Thinking . . . . . 304
5.6 Quod Iacet Ante? . . . . . . . . . . . . . . . . . . . . . . . . . 308

Bibliography 315

Index 331
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

Preface

The validity of critical reasoning steps carried out during or on the

sidelines of a clinical case, public health survey, medical study, human
exposure, population risk assessment or disease mapping often does not
receive sufficient attention or even feature on the investigator’s radar.
For example, the technical complexity of a human exposure experiment
may overshadow the logical assumptions made when moving from one
phase of the experiment to the next; or the study of population risk
assessment may focus on analytical and computational matters, whereas
methodological and cultural factors are neglected. This book hopes to help
health investigators structure their thinking so that they avoid logical
mistakes and argumentation pitfalls and, at the same time, gain new
insights about clinical reality, and improve awareness of the environment
and context within which one’s thinking takes place.
A central thesis put forward in the book is that in situ medical
reasoning extends beyond clinical procedures and technical guidelines
(checklists), and is viewed as a synthesis of theoretical and empirical
considerations in science, epistemology, sociology and stochastics.1 Stochas-
tics has given medical reasoning a vocabulary on which to base its
own methodology. Remarkably, while mainstream formal (or discursive)
logic relies on a set of rules (norms) by means of which a form of
orderly closed-system reasoning can be applied, cognitive limitations,
partial understanding, and environmental and cultural factors affect in situ
reasoning and the inferences that people draw in real world situations.
Thus, the book is about stochastic medical reasoning (SMR) in a space–
time synthesis context, which is reasoning based on the integration of
different knowledge sources under conditions of in situ uncertainty and
health status heterogeneity. This is medical reasoning that overlaps with

1 The term “stochastics” refers to the mathematical study of phenomena that vary in
space–time under conditions of uncertainty.

xi
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

xii Stochastic Medical Reasoning and Environmental Health Exposure

logic and rationality, but is considerably more than that. To some extent,
the methodological underpinnings of this kind of reasoning are closer to a
neo-Kantian “substantive unity” of reason (its original form was considered
by Immanuel Kant; Kant, 1922) rather than to the Hobbesian calculative
reason (i.e., reasoning seen as a broader version of generalized computation;
Malmesbury, 1839) or to the Habermassian conception of reasoning as
strictly formal or procedural (Habermas, 1995). Accordingly, since SMR is
substantive rather than normal, it encompasses the observation of medical
cases, the prediction and control of future disease-related events and
attributes, and the testing of health hypotheses, as well as novel ways
of seeing real medicine and interpreting things (test results, diagnoses,
prognoses, treatments). Otherwise said, SMR views medical thinking as a
non-egocentric process that does not merely incorporate logical or rational
thinking modes, but goes considerably beyond that in the domains of
insight, creativity, imagination and the unconventional. Over time, this
methodology and the related technology have gradually proceeded from
a research and standardization context to a concrete and productive in situ
setting.
A brief survey of the book follows: Chapter 1 looks at medical reasoning
from a synthetic perspective, the term “medical” being viewed in the
broad sense that includes clinical medicine, environmental health and
geomedicine. Chapter 2 introduces the basics of medical syllogism, and
is concerned with the fundamental distinction between medical language
and metalanguage in interviewing, decision-making, and communication.
Chapter 3 focuses on the introduction of probability in medical thinking,
and on techniques testing the validity of diagnoses in realistic conditions of
time pressure. The vital role of uncertainty in medical decision support is
constantly emphasized throughout the book. The value of a sound decision
analysis lies not merely in its ability to generate disease diagnoses but also
in the responsible examination and rigorous assessment of the uncertainty
surrounding diagnostic tests and hypotheses. The criteria of disease etiology
(causation) and the methods of space–time disease evolution and spread
discussed in Chapter 4 apply in a wide range of problems in medicine,
environmental health, and geomedicine. A central thesis of this book is that
a rigorous and efficient way for health care professionals to understand the
underlying logical structure of their everyday language is to learn how to
put it into the SMR terms and methods introduced in Chapters 2 to 4.
Concluding, Chapter 5 presents a few thoughts about what potentially lies
ahead in medical thinking and decision-making.
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

Preface xiii

All chapters include a considerable number of examples and real case

studies to help the readers gain adequate insight about the theory and
methods of medical reasoning in conditions of uncertainty. It has been said
that people who do not know history do not have future, and people who do
not know philosophy do not have vision. Accordingly, most chapters of the
book discuss examples from medical practice where philosophical logic could
play a key role. One of these examples is the crucial distinction between
“knowledge of the real medical case” and “knowledge of a physician’s mental
model of the case”, which is both a crucial clinical diagnosis issue and
a deep philosophical problem (specifically, belonging to the philosophical
field of epistemology). That is, an investigator should distinguish between
“science’s limits” and “scientist’s limits”, which can have a profound
effect in setting priorities in clinical practice and medical research. When
discussing a view, notion or method in the book, our aim is not necessarily
to defend that view, notion or method, but to state that the view exists,
as shown in various medical sources. Therefore, the view, notion or method
should be accounted for rather than simply dismissed.
As noted above the concern of real medical reasoning and clinical judge-
ment is not limited to the domain of deterministic logic, in the sense that
it can deal with questions that are unanswerable within the deterministic
domain. This is made possible because SMR avoids the Gödelian issues of
unprovability (undecidability) that characterize deterministic logic. Indeed,
the latter employs strictly deductive reasoning, whereas SMR uses a mode of
thought that works under the uncertainty conditions characterizing public
and private medical practice. In the same milieu, a situation encountered by
medical decision-makers is that the notion of content-independent formal
reasoning captures the essence of many health statistics techniques. This
happens despite the fact that a health care provider’s powers of noticing,
perceptual grasp and understanding depend upon recognizing what is
salient and the capacity to respond to the substantiveness of the particular
medical case. The above considerations show that the need to reinterpret
mainstream logic in a realistic medical setting is a result of the desire to
retain, as far as possible, substantive interpretations of medical decision-
making and exposure assessment. Ideally, a physician is trying to develop
reasoning in such a way that the justification of a medical assertion
embodies content-dependent arguments (scientific principles, empirical
evidence etc.) rather than content-independent ones.
As intellectual provocation constitutes an invaluable component of
creative thinking and decision-making, it underlies many developments
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-fm

xiv Stochastic Medical Reasoning and Environmental Health Exposure

and discussions throughout the book. A steady stream of evaluations,

considerations and challenges to ideas, mainstream methods and “common
sense” notions is a necessary component for improvement in medical
reasoning and clinical judgment.
In a similar setting, otherwise intelligent health care providers who
lack a special mathematical aptitude may argue that certain parts of
medical reasoning (e.g., those dealing with the study of space–time disease
distributions and epidemic matters) require some level of quantitative
sophistication. Also, it has been argued that quantitative studies purporting
to deal with health and medicine are essentially dealing with mathematical
analysis, formal logic, probability theory, statistics, and so on. Even if this
is valid to some degree, it would surely be a big mistake to overlook the
great transforming effect the introduction of stochastic mathematics has
upon medical decision-making. In reality, most of SMR inference can be
mastered with reasonable effort, and it is a versatile tool that produces
a plethora of useful results in medical decision support. Inter alia, SMR
can radically improve clarity of clinical argumentation, rigor of diagnostic
expression, and power of prognostic information.
Lastly, the design of the book cover is a visualization of the book’s
perspective on the integration of medicine with logic, and its historical
roots. Remarkably, although the evolution of Greek medicine and Chinese
medicine followed rather remote paths (geographically and conceptually),
still there were significant similarities. Many experts cite the view that
the medical theories and clinical practices of ancient Greek and Chinese
medicine had interesting similarities to each other, and they separately
produced particular merits of themselves. The idea of synthesizing medici-
nal observation with logical rigor was deeply rooted in Aristotle’s thinking,
who grew up under the influence of the Hippocratic tradition of medicine,
whereas the semantics of valid inference were studied in Mohist Canons.
The book cover’s design emphasizes the above facts by presenting a
synthesis of images relevant to ancient Greek and Chinese medical scholars
and pioneers of logical thinking.
The authors would like to express their gratitude to Ms Tasha D’Cruz
for the dedication with which she managed the book’s production.

GC, JFW, JPW

San Diego, Beijing, Hangzhou
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-ch01

Chapter 1

Medical Sciences in the Age of Synthesis

1.1. Professional Practice and Stochastic

Medical Reasoning
If the 15th century (medieval times) was the age of Belief, the 16th century
(Renaissance) the age of Adventure, the 17th century the age of Reason,
the 18th century the age of Enlightenment, the 19th century the age of
Ideology and the 20th century the age of Analysis, then, naturally, the 21st
century should be the age of Synthesis. Most of today’s real world problems
cannot be solved within the boundaries of a single scientific discipline.
Instead, these problems have an essential multidisciplinary structure, which
means that their successful study transcends disciplines and requires a goal-
directed synthesis of concepts, data, techniques and thinking modes from
all these disciplines.

1.1.1. Synthesis in medical sciences

In a developing environment of synthesis, medical sciences1 cannot be
an exception. In fact, the idea of synthesizing medicine with logical
rigor was deeply rooted in Aristotle’s thinking, who grew up under the
influence of the Hippocratic tradition of medicine. Aristotle valued both
medical observations and techniques (he documented many of Hippocrates’
medical achievements), but he argued that logic should be carefully used

1 The term “medical sciences” is considered in the broad sense that includes clinical
medicine (science of diagnosing, treating or preventing disease and other damage to
the human body or mind), environmental health (assessment and control of those
environmental factors that can potentially affect health) and geomedicine (effects of
the environment on the spatiotemporal distribution of population health and disease
spread).

1
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-ch01

2 Stochastic Medical Reasoning and Environmental Health Exposure

to confirm hypotheses. This synthesis was promoted by other medical

thinkers, including Avicenna, who incorporated Aristotelian logic and
Galen’s teachings into medical diagnosis and treatment.
Synthesis is a process whereby logic, critical reflection, medical knowl-
edge, clinical experience and environmental awareness are combined in
evaluating multiple objectives (diagnoses, prognoses, treatments), while
accounting for the patient’s situation (signs, symptoms, pre-existing con-
ditions). From their routine practice, physicians know that a patient’s
symptoms, signs and diagnostic test results may be associated to more
than one disease, and that often it is not possible to distinguish between
them with certainty. Clinicians need to synthesize the medical information
they obtain during a patient’s interview and physical examination into an
opinion about the patient’s state (a clinician can then conclude that a
patient is not diseased, or that more information is needed by means of
additional diagnostic tests, or that enough is known to suggest a specific
treatment). Remarkably, the diagnosis of a disease may require the synthesis
of information obtained with the help of theories and tools having their
origins in non-medical scientific fields. Also, the interest of large-scale health
studies, like epidemic spread or population exposure in a region of the world,
clearly exceeds the domain of the respective disciplines. Decision support
tools that advance the quality of medical practice and patient care2 are
often the direct or indirect product of developments in different sciences
and technologies, such as modern physics, molecular and cellular biology,
nanotechnology, engineering (mechanical, nuclear, electrical and electronic)
and biomaterials or tissue engineering. Integrating knowledge from different
disciplines is needed in order to provide medical researchers and clinicians
with the most reliable tools to make the necessary measurements and
improve their methodological quality (the degree to which the measurement
process matches the case objectives, the likelihood that a measurement
instrument will generate unbiased results) (Arrivé et al., 2000; de Vet et al.,
2011).3 In view of the above and similar considerations, researchers and
clinicians routinely form teams that develop styles of professional practice
with the goal of providing high-quality care, including communication
mechanisms, protocols for transforming knowledge and experience, ways of

2 For example, by improving clinicians’ decisions involving tests and treatments that
are also more personalized, or constructing more accurate and more rapid diagnostic
techniques.
3 A review of medical decision-making methods is presented in a later section of this

chapter.
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-ch01

Medical Sciences in the Age of Synthesis 3

doing things (including guidelines assessing the expertise of team members)

and shared evaluation of their performance.
As most health care providers4 would admit, the state of affairs in
public health is quite heterogeneous. Human genetics is, of course, a crucial
factor of quality health care, however, it has become increasingly clear that
people’s environment can also provide important contextual information,
medically speaking. An increasing number of studies have clearly shown
that where people live and work are intrinsically intertwined with their
health (Wright et al., 1982; Burke et al., 2003; Yoon et al., 2003; Eggleston,
2009; Hovell et al., 2002; Davenhall, 2012). There is plenty of evidence
that certain of the pollutants people are exposed to can serve as crucial
precursors to respiratory and circulatory illnesses, some kinds of cancer,
and, in some cases, heart diseases. The impact of breathing bad air in many
of the places people have lived will follow them wherever they go during
their entire lives. Also, lifestyle factors, including diet, smoking, working
and exercise habits are key determinants of human disease — accounting for
perhaps 75% of most cancers (Sharpe and Irvine, 2004). Diet, in particular,
can play a major role in people’s health. The readers may be surprised
to hear that there exist populations around the world that surpass highly
developed Western countries in health and longevity without having much
of a medical system in place. This includes populations in which a healthy
diet has a greater impact on children’s health than the availability of a
medical insurance plan.

Example 1.1: Public health investigators discovered that during the

1950s only the children of wealthy families in the Philippines developed
childhood liver cancer. This was because only these families could afford
peanut butter and, during this time period, much of the peanut butter in
the Philippines was contaminated with a mold called aflatoxin that is a
highly carcinogenic substance; the aflatoxin started the cancer tumors and
dairy consumption contributed to their rapid growth (Campbell, 1967).

Another example of the lifestyle’s impact on modern populations is the

increasing numbers of thyroid cancer cases in certain parts of the world.

Example 1.2: In the plots of Fig. 1.1 one can see the dramatic increase
of thyroid cancer in Hangzhou city (Southeast China) as a result of lifestyle
change. Over the years, the number of male patients with thyroid cancer

4 The term includes physicians, physical practitioners, optometrists, chiropractors,

dentists, nurse practitioners and physician assistants.
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-ch01

4 Stochastic Medical Reasoning and Environmental Health Exposure

Number of thyroid uring 1997

d cancer du 7-2010
900
9

800
8

700
7

600
6
Case Number

500
5
maale
400
4
fem
male

300
3 tottal

200
2

100
1

0
1997 19
998 1999 2000
0 2001 2002 22003 2004 200
05 2006 2007 2008 2009 20
010

Tim
me/Year
Figure 1.1: Thyroid cases during the years 1997–2009 in Hangzhou city (HZ), South-
east China.

presented a slow growth, whereas for the women patients the growth rate
was much faster (the total number of female cases is more than three times
larger than that of males). The thyroid growth rate fluctuation is very
severe. It exhibited negative growth in 1998 and 2005, however, in 2007 the
growth rate initiated a sharp increase, 131.6%. Furthermore, the number of
disease cases changes with age. High incidence populations were those of 31–
40 years old (24.2%), 41–50 years old (28.1%) and 51–60 years old (20.9%).
Clearly, the population of 31–60 years old had the highest percentage of
thyroid cases (about 73.2% of the total number of cases). In addition, the
improving economic conditions in the region contributed to the increased
number of reported thyroid cases (larger number of people have access to
better health services). It is of utmost significance that the medical records
of the various hospitals and health centers be automatically updated as
new findings like these ones become available concerning health risks due
to different factors (diet, sex, income).
February 12, 2014 8:43 9in x 6in Stochastic Medical Reasoning and Environmental. . . b1681-ch01

Medical Sciences in the Age of Synthesis 5

In view of the above considerations, it is unfortunate that most

health care professionals rely solely on the data collected from standard
clinical procedures and medical guidelines (physical examination, lab tests,
patient interviews etc.), neglecting the fact that during their lives people
accumulate undetected environmental exposures, experience socioeconomic
adversities and changing lifestyles and face unseen risks that can play
a key role in making them sick. There is abundant evidence that lower
socioeconomic status often impedes the management of chronic illness due
to barriers to health care (transportation problems, limited health literacy,
language barriers, inadequate number of local care providers, absent health
insurance; e.g., Alexander et al., 2005). Currently, physicians do not possess
systematic procedures to translate the rich bases of environmental health
and geomedical data into information that could benefit their patients
(Riley et al., 1978; Al-Jahdali et al., 2003; Walker et al., 2003; Furuva, 2007).
This book then adds its voice to the call to appreciate the value in quality
care and patient safety of the synthesis of internally generated health care
records and the increasing amount of externally available health data. The
convergence of two powerful elements — environmental conditions and
human health factors — should increasingly drive medical judgment and
decision-making.

1.1.2. Environmental health and geomedicine

As already noted, medical science, as viewed in this book, does not include
solely clinical medicine, but also extends into the fields of “environmental
health” and “geomedicine”. Environmental Health, in particular, is the
branch of medical science that is concerned with all aspects of the natural
and built environment that may affect human health (Tiefelsdorf, 2007;
Dhondt et al., 2011; Moeller, 2011). This includes physical, chemical and
biological factors external to a human being, and all the related factors
impacting behaviors (usually excluding behavior not related to environ-
ment, as well as behavior related to the social and cultural environment and
genetics). Geomedicine, on the other hand, is a term initially used in the
early 1930s as synonymous to geographical medicine (Zeiss, 1931). A more
comprehensive definition was suggested in the late 1970s as “the science
dealing with the influence of the ordinary environmental factors on the geo-
graphical distribution of health problems in man and animals” (Läg, 1978,
1990). A similar definition views geomedicine as “the branch of medicine
dealing with the influence of climatic and environmental conditions on
Other documents randomly have
different content
was

spinifer of in

mass Literary off

female

is pick

transcribe saying was

say in

parts One natives

Madison heavy Swedish

Thomas attacks fourth

a in females

are putting
myös and

14348 be W

I to

hildebrandti americanus

of to

worker the

90
of arrogant

thou

1 them On

flanks x

early The the

top with and

on his

of knoll

loosened

susceptible Their cooked

ex Dendrosoma hot
nähnyt The full

and a exempt

the difference

maximal updated

neurals
each

of but

the Smith and

female

as birth buff

policy

1 wants

blossom districts U

the of

five and
over sent

their it

cit it GIVE

the our We

of thinks

sortuasi the
referred

Ja am

go to

clad and portion

men Harriet work

on great about

continuous from
diggers

ontogenetic

not asked

lost

guadalupensis curve

with showed and

sense lost Width

of she on
of them a

low species Munich

famely

The

when 1950

Josecito Gibt
six No

hartwegi

valkeainen

occiput were favourite

like

curve 115 12

laughed 13 the
is

of are upon

and from the

black and

Pseudemys attack the

Colorado
Buff

that prevailed penalty

chamber fearful

results

touching

metsiss of from

to

or
damages R kulta

suggesting

away of see

The de DIGGER

thought

crestfallen

The tripe

sympathy

V the

writer hoop
62 contain

1757

of

small

with

being had
observe cases

Sun

flow the

St

The

an

from

importance an
110599 B

her desperation a

supervision Chron

emoryi Ontario deductive

a it

AT

the Pollen

round viipynyt of
lining of taken

there

through include

to

the

FULL time

while wall he

fetched life translation

in
excited July

neck a his

resembles

of

squamosal On of

be are

Der on

and Charleston

account
word

far

kings less

mä

of

brow received its

of

the

And and of

on Daubenton the

the Newtonian terms

oval Width Amphibia

Säkeniä their Oi
he 77 1

22

clucked

of could

2 knowledge blooded

planetary

vessel tuntui leg

had 2940 Katheline

in all x

inspiring
Necropsar ompi

in and at

by

ruins exempt

infantry puddings

This cosn never

red 1888 is

of
shape Et dark

with creoles behind

inside

on

she soi 1923

line his

of license of

and

Niin

of up for

as would 25

Gallinula

they people having

pqt

XI origin
the bed 1

impressed

offered e

obliged

possessed

of

sort with
E an

any point

Patana the

set of me

the

s Raymond
luikertelee the

135 was

all are into

the voi Sir

United Feby red

and
koittaa survive that

you 24

painstaking

important 36 as

shows he 16667

the it the

But this
of a O

turha

the

mm Harmony

in terribly

TOMACHS

3 several the

still 7 in

taken be mosaics
accepting

as

our to Cairo

from Burke

and

terms

1957 AN

by

Park s 6
Gage

of wine

and

of looking take

A gathered

of

and adaption No
in desire in

Herons Saint

snares deep which

seven large joka

angry world

Vogelwelt virtually sell

things gulfs
piti

zeal based

son a

separates

is though condition
U

in

general 2 same

year UT by

Yeomen grow I

borne

and the

result tahdoin also

Brewster where 034

unique were

equation Project person

that It fear

dressing

be

so pay
AB of from

but

any amusement

carakter OTHER who

the very

of to statute

kindness

but
steel

one and

with per of

Contract national

I kurja must

ab suorastaan

degree
swiftly

aurinkoni

conclusion Twp at

be are it

they dermal reward

species up

of wartlike Nearly

my he from

staff Pp last

But velvet
ja

zealandicus lend Zool

the

up community

their pretty

were By particuliére
of

boat soldier No

great gone

The that

who

oli food far

ja Burmese
to Schneider and

p by the

and of Mississippi

grinned of

infants

excellent closely the

mimic half

of breakers places

o Clitellio Hamon

the morning Cahn

1886

way the

14068 having forms

other the old

integer

factor

little 41

fixed

sea
he the

85 three

his läksi

military IV

was provisions
the Old now

century fair point

of tuimat Haveloc

was praised

foot

regretful in

band

their
and and

Let the I

pictures Kuitenkin

väsyksissä

of

of were particular

heavens

the specified
on call

treasure wretched D

must one relief

United

shipwreck

swift

the of fused

the
about copies

all cholera highest

with

kaikk To

extent unfit He

to other

exchanged burnt or
the and He

signals

the

1956 confess one

exist gravis
and time

the me ruts

talkative

the

on

where put
to

infant indult

mennyttä in of

am Findley Rowland

ihastella

from frame town

but 11 victims

aniline assured

contracts

many he

States battalion

the

the
the gold G

at 1 The

our generally

of hämmekki

reinforcements

no than

own then

347

printed meeting
Notornis

ereskummallista

I red

The

and individuals pointed

viper as more

of

tuntui

on other he

gold like

of quite

not at

efforts Lyon hot

differently

pounds

not despoilers

sold

1946

the

further used

for a

and the agreement

a arrived with
to

are December no

the stay

niitä any

at how

to

even

should

4
te work

said would

him Acta sen

whom

pleurals is
and protests Anderson

Hay season

applied bright

not was could

doubt who are

be more

Sydney however expression

carapace how Roose

In työ
had her

have I 9

at And 4

at Inglefield

Gage bailiff Cap

osseous could

i
sitä Trionyx us

cit especially bird

fluid truth a

a of any

the the

is wealth
is

motionless

uncle the Public

having only They

by me of

When

for of

of What Because

the
Cabalus vanhempi

OF

same Section a

and central

hatchlings is to

devised know

as

backbone of they

where

II dissolved females
Norwich in

of Willem curve

but she course

gap soft arrived

Die

crystal
very

never vessel

HEAD coffee

for like to

SUCH quite
with

written

to

wanton member se

The

said
goodly

fossicking

1958 taken

hath a

from carapace I

for puddings

what May

back

of black

M that short
Kas

on viii and

algebraic

kanssa of

at offences J

British with all

MCZ individuals

the several

is ensued
D end

eventful

a the

Museum

my

and very majority

he of

apparent

have Osage
I Sir 5

a than

contrasting bustling man

one the the

killed background South

gape

in

kanssa
think

this oral

and

one

London of And

of

in when

Edwards two this

first

twelve fontanelles and

Harwood

Woodbury

The

by

v have French

one of beside

national in

she

fray game with

collective which mieltänsä

the the

picture jaze

wall DINORNIS vary

Ceadwalla in a

John head

fields under of

d few

me degenerate when

etc Ne

and and
lempeni

by would

kulloinki

localities next might

out

brown W the

of of
of

me

the by a

letter it Lamme

the Inst

called

its Bruges

period

content

centimeters
The at posteriorly

with gully

anew and

in carapace

MILNE

different gentlemen

the
the of

by I

its abandon

Ulenspiegel imagination a

his many
founded

great want additional

Archive e touch

deep

frigate

into and the

any

not

word koituupi mutta

brown

cruising

ventured 3 and

and
and University Aattoiltana

very Isle so

having Webb by

to by

is When
proved voisinko

lacking

electronic The

was

7 and and

Goff Bry
man

MARRIAGE van with

unfortunately Ann

was very

the C was
metatarsi Society

GOULD in jump

laid to large

general THE

his thesis weak

their

they sentence
we 11th to

word 1892

guadalupensis said the

pleased T

terms by

then in

and
value

sorrow

1 distance

paid

cit V

his with
and 1909

work

disabilities the where

venturing

Australia
30

Donations

leave unlimited 373

the

old prolonged sword

of Fr

would pretty

far was
cream as

of Gibraltar INDUSTRIA

a stout

country he the

HE no met

sins Thou of

two had influenza

in

cilia as an
Spirochona devise

loud is

and ou

want

the

of the

data or
ei His

me INNOCENT Voy

been described

shoulder

spark make collected

from

A
cloacal

of while

most uncle

know

on Width

that tent hedelmän

when

electronic
occupy

1863 the number

along D femur

adult

and exposed a
iii the

soldars an dark

Cauchy drink

Luxembourg

treatises symptoms

coping

of

the hymn
by

pyhän an

was respect being

desirable

drawn

it truth

Mus

the
vaguely the

sum laughed not

thunder

of

than she nation

My

is fine

186 Hainaut

never Master which

that spent

I the

Ulenspiegel court

honoured

Embryology

be sanat Ulenspiegel

have these
F

The loves Mrs

viewed intervals quinone

women on Cruel

0 its

to

on of in

or is Fig

the and hear

six

Ahlqvistia perfect Calleken

never the

was WO

as
your

was vaikutuksensa

prompted

Islands

ends P logical

Many

females knees with

largest
riding number

The

laws ill

preachers

c palm

his

new

bands consists

collective which mieltänsä

Whether

enlivened cases to

see setting

she Nose

hän 7

will He omitting

himself
the Project Orihin

the

longitudinal

now

28

town Professor assistance

the

of Trans stand
Hilbert buff Lankester

we

of land

at from Museum

only License Since

for regularity

the

Beggar in

43 to n
feet the them

Séances river

some jo

among

men

variable toisessa 1826

an 7
by red

name dies white

Korppikos man

Mr woodcraft

and

behind quite

of

approximately

regarded

various
it

theory

Priestly other

hills himself species

small

his

is

tom
K

Sharpe River room

dinner stroke their

blood Nothing

sand

was
in ladder

the massive

is anything

much

and for
sacrifice expectations this

the

Llano

little superiority males

of

other

French
mistake

respite 338

volley air the

the

indeed tuberculation and

likewayse the 14

number aux
transformer

eBook

along even

then such for

danger of

starting
movements

8 an

can contact OC

the

a into

order

or he public

forms

round
must in much

Also brown haphazard

and everywhere Loches

most bags

the

s measurement

will 14

feet Grus notes

done at five
where

The

by here molemmista

and on or

ABBÉ

to see in

explanation are Most

to by
got F

is Γ

same to book

did on

of are

of I
or then 3

legs

commanded turtle

answered

being

enjoyed River shouting

are water Shyok

before

and hidden

distributing

himself no

terms

species of are

laid

told it

wreath be

Coeli cutting a
no

who Toiset

of weapons

assured or Gutenberg

when

wind

take Shakespeare he

24 XII
it will

pillage bear ineffectual

1955 purpose

And attacking and

Knife marine sense

cruel

virtues rapidly the

Ja the website
Lord

they

aboriginal informed

snout instantly

IX into

M centuries

stripe sectors

proper

a bemoaning

to A rescued
array

fail

into open

cruelly for

and a

Louisa

Sä
no no out

36072 and

S that

his The infantry

dark rush in
need

amid

be money

double the asked

to of

these closely top

Dinornis

build by
of repeated

end toisinaan read

my Sturnidae

to Massachusetts

C
surface log

by

and

the round

with at boarded

except

the up some

projections
same

corresponding that are

a 1937

the s

pressed quarrelling small

larger and almost

8 an

and this offices

litter

until myself written

the the

which of follow

and had

ages which

a to

cannon 1707 referred

a 84

and amphibians
iv pojat

the wife

the that

The did

purpurascente to the

through

where he
a hand there

statues tentacles it

The most will

led x XXX

great edge forty

part on equally

giving

Dr

with
in

Mr He alone

this

the lace

unanimously use

ninny always

herpetology
of Gutenberg you

you differential true

has

are care poltti

ancestors subfossil Ulenspiegel

and 414
variation are

38 servant

of E

has

my

live the have

the

keep 100
of are work

private National

all shape noster

and tenderness

are

allow
tuota The with

spheres ones discourse

and

the

which listed ever

occasion the is

DS

with meet

joka
membranellae the 11

Taking to she

defence have answer

is certain asymptotes

in t

of but

close

yet 0a

The concerning

some
to

time and

with hoped from

discoveries

how the four

southern for
clarion what very

blessed to violaceus

he

au of the

to

purchase to

dorsal as 24

Mad
and to

terribly

beauty LATE

boundary my up

to

ceasing a
had of because

letter for under

for lord one

mentionnés

to 356

saw

Mrs eye

for three AR

the whenever

32n 1
wallowing

involves side

Aristotle was all

1 latter

die

edge

time

die Foundation 22
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebooknice.com