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Homology modeling using parametric alignment ensemble generation with consensus and energy-based model selection.

The accuracy of a homology model based on the structure of a distant relative or other topologically equivalent protein is primarily limited by the quality of the alignment. Here we describe a systematic approach for sequence-to-structure alignment, called 'K*Sync', in which alignments are generated by dynamic programming using a scoring function that combines information on many protein features, including a novel measure of how obligate a sequence region is to the protein fold. By systematically varying the weights on the different features that contribute to the alignment score, we generate very large ensembles of diverse alignments, each optimal under a particular constellation of weights. We investigate a variety of approaches to select the best models from the ensemble, including consensus of the alignments, a hydrophobic burial measure, low- and high-resolution energy functions, and combinations of these evaluation methods. The effect on model quality and selection resulting from loop modeling and backbone optimization is also studied. The performance of the method on a benchmark set is reported and shows the approach to be effective at both generating and selecting accurate alignments. The method serves as the foundation of the homology modeling module in the Robetta server.

Amino Acid Sequence↗

Expanding the scientific basis of health technology assessment: a research agenda for the next decade.

OBJECTIVES: The complexity of health technology assessment (HTA) has increased, in part because of its evolution through three distinct phases: the machine, the clinical outcomes, and the delivery models. However, the theoretical foundation for the field remains underdeveloped. METHODS: It is high time for HTA to bring together aspects of conceptual and theoretical works from other fields to strengthen the foundation of HTA. RESULTS: Many challenges await the further development of HTA. They can be captured around three research themes: adapting HTA to an evolving analysis object; translating HTA results into policy, management, and practice decisions; and evaluating organizational models of HTA. CONCLUSIONS: Consolidating the scientific basis of HTA is essential if we are to succeed in increasing the relevance of HTA in some of the most challenging health-related decisions that we will make as individuals and societies.

Diffusion of Innovation↗

Demographics and the pension system.

"Italian demographic evolution closely resembles that of the other leading European countries, although with some distinctive features, such as a lower birth rate, more rapid population aging and fewer immigrants. Projections for the next two or three decades point to accelerating expansion of the aged population, especially of the very old, and a contraction of the working age population after the turn of the century. However, there are also unknowns involved in the demographic evolution of the aged population, turning on the speed of the decline in senile mortality in the decades to come and the possible effects on the health of the elderly population, hence on the demand for social services, considering among other things changing family patterns. There is broad agreement that the birth rate is now too low, that this could have serious long-run repercussions on relations between generations and on intergenerational transfers, and that there is room for social policy action to influence the reproductive choices of couples. This article examines several possible reproductive models and discusses the foundations for action and the potential policy contradictions."

Age Distribution↗

A model for public health workforce development using the National Public Health Performance Standards Program.

Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.

Efficiency, Organizational↗

Rethinking maternal-fetal conflict: gender and equality in perinatal ethics.

Practitioners who care for pregnant women face dilemmas when their patients use illicit drugs, reject medical recommendations, or cause fetal harm. Many ethics scholars characterize those situations as maternal-fetal conflicts. In conflict-based models, maternal rights are considered to conflict with fetal rights, or moral obligations owed to pregnant women are considered to conflict with those owed to their fetuses. I offer an alternative model of pregnancy ethics by applying relational and equality-based moral theories to situations of fetal harm by pregnant women. In this model, clinicians faced with ethical dilemmas should attempt to understand pregnant women and their decisions within their broad social networks and communities, ask how the clinician's personal standpoint influences outcomes judged to be ethical, and determine whether the clinician's ethical formulations reduce or enhance existing gender, class, or racial inequality. This model focuses on the mutual needs of pregnant women and fetuses rather than on their mutually exclusive needs. It also avoids many pitfalls of traditional ethical formulations, specifically their tendency to neglect gender-specific modes of moral reasoning, their implicit assumptions that application of universal principles like autonomy and beneficence results in objective ethical solutions, and their failure to account for the ways that projecting fetal needs perpetuates social inequalities. This model provides the ethical foundations for moving law and policy away from criminalization and toward prevention of prenatal harm.

Conflict, Psychological↗

Crack propagation directions in unfilled resins.

Posterior composite restorative materials undergo accelerated wear in the occlusal contact area, primarily through a fatigue mechanism. To facilitate the timely development of new and improved materials, a predictive wear model is desirable. The objective of this study was to develop a finite element model enabling investigators to predict crack propagation directions in resins used as the matrix material in composites, and to verify these predictions by observing cracks formed during the pin-on-disc wear of a 60:40 BISGMA:TEGDMA resin and an EBPADMA resin. Laser confocal scanning microscopy was used to measure crack locations. Finite element studies were done by means of ABAQUS software, modeling a cylinder sliding on a material with pre-existing surface-breaking cracks. Variables included modulus, cylinder/material friction coefficient, crack face friction, and yield behavior. Experimental results were surprising, since most crack directions were opposite previously published observations. The majority of surface cracks, though initially orthogonal to the surface, changed direction to run 20 to 30 degrees from the horizontal in the direction of indenter movement. Finite element modeling established the importance of subsurface shear stresses, since calculations provided evidence that cracks propagate in the direction of maximum K(II)(theta), in the same direction as the motion of the indenter, and at an angle of approximately 20 degrees. These findings provide the foundation for a predictive model of sliding wear in unfilled glassy resins.

Composite Resins↗

Recent developments in experimental bone marrow transplantation.

Animal models have been a mainstay for the preclinical evaluation of the principles of bone marrow transplantation. In addition to evaluation of the therapeutic effectiveness of bone marrow transplantation in oncologic, hematologic, immunologic, and genetic diseases, experimental animal models provide insights into the immunobiology of bone marrow transplantation, including engraftment kinetics, tolerance, immune reconstitution, and graft-versus-host and graft-versus-tumor reactions. Many recent developments in experimental bone marrow transplantation resulted from not only the discovery of new spontaneously occurring models of human diseases but also the induction of neoplastic diseases, eg, chronic myelogenous leukemia, by transplantation of syngeneic marrow cells into which foreign genes were introduced and expressed. Murine bone marrow transplantation systems are an exemplary format for the study of clinically relevant basic aspects of hematopoiesis, including identification and elucidation of the biology of hematopoietic stem cells. Finally, the application of molecular biologic techniques in animal bone marrow transplantation models provides the preclinical foundations of gene-insertion therapy by transplantation of syngeneic or autologous marrow-derived stem cells into which functional genes were inserted.

Animals↗

Predictors of physical activity in older adults with borderline hypertension.

BACKGROUND: Physical activity (PA) is effective in controlling blood pressure (BP) and is important in the treatment and prevention of hypertension in the elderly. Reasons for engaging in regular PA are complex and are influenced by personal, interpersonal, and environmental factors. OBJECTIVE: To test a predictive model of PA in older adults with borderline hypertension. METHODS: Data were collected from a multiethnic nonprobability sample of 267 men and women 60-75 years of age. The predictor variables were gender, ethnicity, income, previous exercise experience, self-efficacy for PA, perceived health status, awareness of BP, barriers to PA, intrinsic motivation for health, motivation for PA, interpersonal influence, and environmental influence. RESULTS: The hypothesized model was tested and modified using path analysis. The final model explained 44% of the variance in PA. The variables that directly predicted PA were gender, income, previous exercise experience, self-efficacy for PA, and motivation for PA. Variables that indirectly predicted PA were perceived health status, barriers to PA, self-efficacy for PA, intrinsic motivation for health, and environmental influence. CONCLUSIONS: The significant associations between the cognitive appraisal and motivation concepts extend previous research and add to the understanding of the complex factors that influence regular PA. The PA model can be a foundation for further research and practice.

Aged↗

Role modeling in physicians' professional formation: reconsidering an essential but untapped educational strategy.

Forming technically proficient, professional, and humanistic physicians for the 21st century is no easy task. Mountains of biomedical knowledge must be acquired, diagnostic competence achieved, effective communication skills developed, and a solid and applicable understanding of the practice and role of physicians in society today must be reached. The central experience for learners in this complex and challenging terrain is the "modeling of" and "learning how to be" a caregiver and health professional. Role modeling remains one crucial area where standards are elusive and where repeated negative learning experiences may adversely impact the development of professionalism in medical students and residents. The literature is mainly descriptive, defining the attributes of good role models from both learners and practitioners' perspectives. Because physicians are not "playing a role" as an actor might, but "embodying" different types of roles, the cognitive and behavioral processes associated with successfully internalizing roles (e.g., the good doctor/medical educator) are important. In this article, the authors identify foundational questions regarding role models and professional character formation; describe major social and historical reasons for inattention to character formation in new physicians; draw insights about this important area from ethics and education theory (philosophical inquiry, apprenticeship, situated learning, observational learning, reflective practice); and suggest the practical consequences of this work for faculty recruitment, affirmation, and development.

Academic Medical Centers↗

Robust optimization of total joint replacements incorporating environmental variables.

Direct search techniques for the optimal design of biomechanical devices are computationally intensive requiring many iterations before converging to a global solution. This, along with the incorporation of environmental variables such as multiple loading conditions and bone properties, makes direct search techniques infeasible. In this study, we introduced new methods that are based on the statistical design and analysis of computer experiments to account efficiently for environmental variables. Using data collected at a relatively small set of training sites, the method employs a computationally inexpensive predictor of the structural response that is statistically motivated. By using this predictor in place of the simulator (e.g., finite element model), a sufficient number of iterations can be performed to facilitate the optimization of the complex system. The applicability of these methods was demonstrated through the design of a femoral component for total hip arthroplasty incorporating variations in joint force orientation and cancellous bone properties. Beams on elastic foundation (BOEF) finite element models were developed to simulate the structural response. These simple models were chosen for their short computation time. This allowed us to represent the actual structural response surface by an exhaustive enumeration of the design and environmental variable space, and provided a means by which to validate the statistical predictor. We were able to predict the structural response and the optimal design accurately using only 16 runs of the computer code. The general trends predicted by the BOEF models were in agreement with previous three-dimensional finite element computer simulations, and experimental and clinical results, which demonstrated that the important features of intramedullary fixation systems were captured. These results indicate that the statistically based optimization methods are appropriate for optimization studies using computationally demanding models.

Algorithms↗

Networks and epidemic models.

Networks and the epidemiology of directly transmitted infectious diseases are fundamentally linked. The foundations of epidemiology and early epidemiological models were based on population wide random-mixing, but in practice each individual has a finite set of contacts to whom they can pass infection; the ensemble of all such contacts forms a 'mixing network'. Knowledge of the structure of the network allows models to compute the epidemic dynamics at the population scale from the individual-level behaviour of infections. Therefore, characteristics of mixing networks-and how these deviate from the random-mixing norm-have become important applied concerns that may enhance the understanding and prediction of epidemic patterns and intervention measures. Here, we review the basis of epidemiological theory (based on random-mixing models) and network theory (based on work from the social sciences and graph theory). We then describe a variety of methods that allow the mixing network, or an approximation to the network, to be ascertained. It is often the case that time and resources limit our ability to accurately find all connections within a network, and hence a generic understanding of the relationship between network structure and disease dynamics is needed. Therefore, we review some of the variety of idealized network types and approximation techniques that have been utilized to elucidate this link. Finally, we look to the future to suggest how the two fields of network theory and epidemiological modelling can deliver an improved understanding of disease dynamics and better public health through effective disease control.

Animals↗

A model for ethical problem solving in medicine, with practical applications.

Despite the dramatic increase over recent years in the research and teaching of medical ethics, there exists no theoretical framework within which to conceptualize ethical problems in medicine, to say nothing of solutions to these problems. The model proposed here attempts to fill this void by developing a conceptual understanding of the nature of moral dilemmas that can be applied to both theoretical and practical problems in medicine. Practical applications are demonstrated in three areas: personal ethical problem solving, hospital ethics committees, and the teaching of medical ethics. Suggestions are offered for the extension of these and other applications of the model, a model proposed as a foundation to be built upon through further research and daily experiences in a world of conflicting values.

Bioethical Issues↗

Rapid approximation of confidence intervals for Markov process decision models: applications in decision support systems.

OBJECTIVE: Develop the methodological foundation for interactive use of Markov process decision models by patients and physicians at the bedside. DESIGN: Monte Carlo simulation studies of a decision model comparing two treatments for benign prostatic hypertrophy: watchful waiting (WW) and transurethral prostatectomy (TUR). MEASUREMENTS: The 95% confidence interval (CI) for the mean of the Markov model; the correlation of a linear approximation with the full Markov model; the predictive performance of the approximation; the information index of specific utilities in the model. RESULTS: The 95% CI for the gain in utility with initial TUR was -1.4 to 19.0 quality-adjusted life-months. A multivariate linear model had an excellent fit to the predictions of the Markov model (R2 = 0.966). In an independent data set, the linear model also had a high correlation with the full Markov model (R2 = 0.967); its predictions were unbiased (p = 0.597, paired t-test); and, in 96.4% of simulated cases, its treatment recommendation was the same. CONCLUSION: Using the linear model, it was possible to efficiently compute which health state had the largest contribution to the variance of the decision model. This is the most informative utility value to elicit next. The most informative utility at any point in a sequence changed depending on utilities previously entered into the model. A linear model can be used to approximate the predictions of a Markov process decision model.

Aged↗

A computer reconstruction of the entire coronary arterial tree based on detailed morphometric data.

A rigorous analysis of blood flow must be based on the branching pattern and vascular geometry of the full vascular circuit of interest. It is experimentally difficult to reconstruct the entire vascular circuit of any organ because of the enormity of the vessels. The objective of the present study was to develop a novel method for the reconstruction of the full coronary vascular tree from partial measurements. Our method includes the use of data on those parts of the tree that are measured to extrapolate the data on those parts that are missing. Specifically, a two-step approach was employed in the reconstruction of the entire coronary arterial tree down to the capillary level. Vessels > 40 microm were reconstructed from cast data while vessels < 40 microm were reconstructed from histological data. The cast data were reconstructed one-bifurcation at a time while histological data were reconstructed one-sub-tree at a time by "cutting" and "pasting" of data from measured to missing vessels. The reconstruction algorithm yielded a full arterial tree down to the first capillary bifurcation with 1.9, 2.04 and 1.15 million vessel segments for the right coronary artery (RCA), left anterior descending (LAD) and left circumflex (LCx) trees, respectively. The node-to-node connectivity along with the diameter and length of every vessel segment was determined. Once the full tree was reconstructed, we automated the assignment of order numbers, according to the diameter-defined Strahler system, to every vessel segment in the tree. Consequently, the diameters, lengths, number of vessels, segments-per-element ratio, connectivity and longitudinal matrices were determined for every order number. The present model establishes a morphological foundation for future analysis of blood flow in the coronary circulation.

Algorithms↗

Murine model of implantable glucose sensors: a novel model for glucose sensor development.

Although implantable glucose sensors have existed for over 30 years, their function deteriorates in hours to days, in large part as a result of tissue responses to the implanted sensor (i.e., acute and chronic inflammation, fibrosis, and vessel regression). Little is known about the mediators and mechanisms that control these tissue responses to implantable glucose sensors. In the present study, we developed and validated a murine model for implantable glucose sensors, which suitably parallel sensor function in humans. Using special care in implantation and implant retaining techniques, we demonstrated that (1) sensor function deteriorates rapidly within days post-implantation and (2) loss of glucose sensor function correlated with tissue reactions at the sites of sensor implantation, especially in the vicinity of the glucose oxidase-based working electrode. These studies establish a murine model that can be used to evaluate implantable glucose sensors in vivo. This model should provide the foundation for future studies to understand the factors and mechanisms that control sensor function in vivo.

Animals↗

Neural circuitry of anxiety: evidence from structural and functional neuroimaging studies.

Present understanding of the neural circuitry of anxiety has come from a variety of sources, including animal, clinical, and most recently, neuroimaging studies. Evidence from these sources has converged to form a translational bridge from animal models to human pathophysiology. In particular, the classical fear conditioning paradigm has served as a foundation for this bridge. Proposed models for the neural circuitry of normal anxiety as well as the anxiety disorders are discussed. A brief review of specific findings from neuroimaging studies of posttraumatic stress disorder, specific phobia, social phobia, obsessive-compulsive disorder, and generalized anxiety disorder is also provided.

Anxiety↗

Authenticity as a foundational principle of medical ethics.

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.

Cultural Diversity↗

Using serial imaging data to model variabilities in organ position and shape during radiotherapy.

A model is proposed for incorporating the effects of organ motion into the calculation of dose in a statistical fashion based on serial imaging measurements of organ motion. These measurements can either come from a previously studied population of patients, or they can be specific to the particular patient undergoing therapy. The statistical distribution underlying the measurements of organ motion, including the changes in organ shape, is reconstructed non-parametrically without requiring any assumptions about its functional form. The model is thus capable of simulating organ motions that are not present in the original measurements, yet nonetheless come from the same underlying statistical distribution. The present model overcomes two particular limitations of many organ motion models: (a) the fact that they do not account for changes in organ shape, and (b) the fact that they make physically unrealistic assumptions about the functional form of the statistical distribution of organ motion, such as assuming that it is Gaussian. The present model can form the foundation of methods for the more accurate and clinically relevant calculation of the dose to the target volume and normal tissues.

Algorithms↗