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Psychosocial factors related to adolescent smoking: a critical review of the literature.

OBJECTIVE: To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking. DATA SOURCES: General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files. STUDY SELECTION: Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking. DATA SYNTHESIS: Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables. CONCLUSIONS: Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy.

Adolescent↗

Distributed data mining on grids: services, tools, and applications.

Data mining algorithms are widely used today for the analysis of large corporate and scientific datasets stored in databases and data archives. Industry, science, and commerce fields often need to analyze very large datasets maintained over geographically distributed sites by using the computational power of distributed and parallel systems. The grid can play a significant role in providing an effective computational support for distributed knowledge discovery applications. For the development of data mining applications on grids we designed a system called Knowledge Grid. This paper describes the Knowledge Grid framework and presents the toolset provided by the Knowledge Grid for implementing distributed knowledge discovery. The paper discusses how to design and implement data mining applications by using the Knowledge Grid tools starting from searching grid resources, composing software and data components, and executing the resulting data mining process on a grid. Some performance results are also discussed.

Algorithms↗

Structural aspects of glycomes with a focus on N-glycosylation and glycoprotein folding.

The pace of data accumulation in glycobiology has lately rapidly increased, largely due to high-throughput technologies. In this increasingly data-rich environment, computer science started to play a central role in handling the data, extracting significant biological information, and probing the missing parts of the 'scenery' by prediction, modelling or simulation. Investigating and comparing glycomes by bioinformatics and structural methods has great practical value and sharply increased in popularity in the past couple of years. In this context, advances have also been made with regard to structural aspects of protein N-glycosylation and consequences for glycoprotein folding. In these areas, however, an approach that integrates glycobiology with protein science is necessary.

Animals↗

Observations on health information in developing countries.

Based on personal experiences, observations are offered on health information in developing countries, ways in which information systems can be strengthened, and opportunities for health-information science graduates. Although data collection consumes a significant portion of the health worker's day, information systems are often a low priority in developing countries. Health-information systems can be strengthened by focusing on local solutions, by building skills in health workers, by utilizing appropriate technology, and by integrating information systems into health programs. Health-information science graduates can assist in improving systems in developing countries, but this will require a broad and flexible definition of health information science, which is much more than computing technology; it is supporting health workers to define, manage, and apply the information they need.

Developing Countries↗

Perforation of the great vessels during central venous line placement.

BACKGROUND: Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided. METHODS: We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome. RESULTS: Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation. CONCLUSIONS: Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.

Adult↗

Usability of multimedia technology to help caregivers prepare for a crisis.

The objective of the research was to evaluate the usability of a multimedia software application that provides information on coping with difficult situations, dealing with everyday caring problems, and first aid for emergency situations. Casual users (family caregivers, professional caregivers, and older people) were invited to use the software application and complete a questionnaire measuring quality and efficiency in utility and usability. Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) and qualitative data were analyzed by content analysis. Findings indicated the software application to have high global usability, correspond to user expectations, respond quickly, and be visually pleasant and easily understood. The authors conclude that software applications of this type have the potential to increase the quality of life of family caregivers, enhance their coping capacity, and enable them to continue for a longer period in their caring role.

Caregivers↗

Quality of life and coping styles in Chinese nasopharyngeal cancer patients after hospitalization.

The objective of the study was to describe the quality of life (QOL) and coping style of nasopharyngeal carcinoma (NPC) patients after hospitalization and to explore the relationship between coping style and health-related QOL of NPC patients. A descriptive correlational design was used in this study. Ninety-eight NPC patients were investigated by a convenient sampling method. Three instruments were employed for data collection. Demographic Information Sheet was used to collect the subjects' demographic characteristics. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H & N) was used to measure health-related QOL. The Jalowiec Coping Scale (JCS) was used to measure coping styles. Descriptive analysis and Spearman correlation analyses were performed using the Statistical Package for Social Science (SPSS) 10.0. Data collection was done from September 2002 to December 2002. The standard score of FACT-H & N for subjects was 67.83%. Patients scored lowest on the Head and Neck subscale. With a mean score of 2.09 +/- 0.53, patient scored the "optimistic" highest on JCS. Some other coping styles scored were "self-reliant"(1.68 +/- 0.49), "palliative" (1.51 +/- 0.60), "emotive"(0.84 +/- 0.59), "fatalistic"(0.92 +/- 0.70), and "evasive"(1.27 +/- 0.44). There were positive correlations between "optimistic," "palliative," and QOL; the coefficient r were 0.456 and 0.324, respectively. There were negative correlations between "emotive," "fatalistic," "evasive," and QOL; the coefficient r were -0.465, -0.427, and -0.271, respectively. No significant correlations were found among "confrontative," "self-reliant," "supportive," and QOL, P > .05. The adverse effects of radiation remain the major problems that affect the health-related QOL of NPC patients posttherapy. Positive emotion-focused coping styles were positively correlated to QOL, and negative emotion-focused ones negatively correlated. Problem-focused coping styles were not statistically correlated to QOL among NPC patients posttherapy. The findings of this study suggest that nurses need to pay attention to the QOL of NPC patients posttherapy, including appropriate education to minimize ongoing adverse effects and support the use of effective coping styles.

Adaptation, Psychological↗

The Functional Magnetic Resonance Imaging Data Center (fMRIDC): the challenges and rewards of large-scale databasing of neuroimaging studies.

The Functional Magnetic Resonance Imaging Data Center (fMRIDC) (http://www.fmridc.org) was established in the Autumn of 1999 with the objective of creating a mechanism by which members of the neuroscientific community may more easily share functional neuroimaging data. Examples in other sciences offer proof of the usefulness and benefit that sharing data provides through encouraging growth and development in those fields. By building a publicly accessible repository of raw data from peer-reviewed studies, the Data Center hopes to create a similarly successful environment for the neurosciences. In this article, we discuss the continuum of data-sharing efforts and provide an overview of the scientific and practical difficulties inherent in managing various fMRI data-sharing approaches. Next, we detail the organization, design and foundation of the fMRIDC, ranging from its current capabilities to the issues involved in the submitting and requesting of data. We discuss how a publicly accessible database enables other fields to develop relevant tools that can aid in the growth of understanding of cognitive processes. Information retrieval and meta-analytic techniques can be used to search, sort and categorize study information with a view towards subjecting study data to secondary 'meta-' and 'mega-analyses'. In addition, we detail the technical and policy challenges that have had to be addressed in the formation of the Data Center. Among others, these include: human subject confidentiality issues; ensuring investigator's rights; heterogeneous data description and organization; development of search tools; and data transfer issues. We conclude with comments concerning the future of the fMRIDC effort, its role in promoting the sharing of neuroscientific data, and how this may alter the manner in which studies are published.

Brain↗

Use of Wearable Sensors in Angelman Syndrome: A Systematic Review.

BACKGROUND: Wearable sensors are a promising method for collecting clinical trial outcome data for people with Angelman syndrome (AS). However, there has yet to be a systematic probe into the ways in which wearable sensors have been successfully used in AS. The current study aims to provide a quantitative summary of wearable sensors used in AS, including contexts of use and psychometric properties, and to present key narrative highlights. METHOD: Literature searches were performed in three electronic databases: APA PsycInfo, PubMed and Web of Science Core Collection. Data items were categorized into four categories: sample characteristics, study methodological details, wearable sensor characteristics and psychometric properties assessed. Sample characteristics included sample size, age, biological sex, race/ethnicity and cognitive/developmental functioning. Study methodological details were subdivided into study design and setting. Wearable sensor characteristics included sensor type, placement site, means of attachment, assessed construct and sensor-related data loss. Psychometric properties assessed included reliability and validity of sensor-derived data. RESULTS: We identified 16 articles through our systematic review. Wearable sensors were used to study sleep (n = 10, 62.5%), language (n = 2, 12.5%), gait (n = 2, 12.5%), caregiver proximity (n = 1, 6.3%), EEG power (n = 1, 6.3%), and arousal (n = 1, 6.3%) in AS through actigraphs, vocalization recorders, inertial sensors, radio-frequency identification watches, wireless EEG caps, and functional near-infrared spectroscopy caps, respectively. Findings from these studies broadly indicate that wearable sensors are feasible, reliable and valid for assessing a range of behaviours relevant to AS. CONCLUSIONS: Wearable sensors are a promising solution to enhance assessments in AS. However, with the small extant literature characterized by small sample sizes and restricted focus on a few relevant features in AS, there remains ample opportunities to explore the use of wearable sensors in people with AS. Additional studies will better inform clinical decision-making and ultimately improve the lives of people with AS and their families.

Humans↗

Methodological rigor and citation frequency in patient compliance literature.

An exhaustive bibliography which assesses the methodological rigor of the patient compliance literature, and citation data from the Science Citation Index (SCI) are combined to determine if methodologically rigorous papers are used with greater frequency than substandard articles by compliance investigators. There are low, but statistically significant, correlations between methodological rigor and citation indicators for 138 patient compliance papers published in SCI source journals during 1975 and 1976. The correlation is not strong enough to warrant use of citation measures as indicators of rigor on a paper-by-paper basis. The data do suggest that citation measures might be developed as crude indicators of methodological rigor. There is no evidence that randomized trials are cited more frequently than studies that employ other experimental designs.

Data Collection↗

Impact of different variables on the outcome of patients with clinically confined prostate carcinoma: prediction of pathologic stage and biochemical failure using an artificial neural network.

BACKGROUND: The advent of advanced computing techniques has provided the opportunity to analyze clinical data using artificial intelligence techniques. This study was designed to determine whether a neural network could be developed using preoperative prognostic indicators to predict the pathologic stage and time of biochemical failure for patients who undergo radical prostatectomy. METHODS: The preoperative information included TNM stage, prostate size, prostate specific antigen (PSA) level, biopsy results (Gleason score and percentage of positive biopsy), as well as patient age. All 309 patients underwent radical prostatectomy at the University of Colorado Health Sciences Center. The data from all patients were used to train a multilayer perceptron artificial neural network. The failure rate was defined as a rise in the PSA level > 0.2 ng/mL. The biochemical failure rate in the data base used was 14.2%. Univariate and multivariate analyses were performed to validate the results. RESULTS: The neural network statistics for the validation set showed a sensitivity and specificity of 79% and 81%, respectively, for the prediction of pathologic stage with an overall accuracy of 80% compared with an overall accuracy of 67% using the multivariate regression analysis. The sensitivity and specificity for the prediction of failure were 67% and 85%, respectively, demonstrating a high confidence in predicting failure. The overall accuracy rates for the artificial neural network and the multivariate analysis were similar. CONCLUSIONS: Neural networks can offer a convenient vehicle for clinicians to assess the preoperative risk of disease progression for patients who are about to undergo radical prostatectomy. Continued investigation of this approach with larger data sets seems warranted.

Adult↗

The role of omega-3 fatty acids in cardiac protection: an overview.

There have been increasing research efforts in recent years to evaluate the role of various dietary supplements, such as antioxidant vitamins, L-arginine, glucan, isoflavones, soy estrogens, omega-3 fatty acids, etc., in cardiovascular health. Although there is not adequate evidence of the beneficial effects of many nutriceuticals on cardiac function, in the case of omega-3 fatty acids, the evidence has been more convincing. Fish oil has historically been thought to be good for cardiovascular health; however, data have revealed a stronger cardioprotective role of fish oil in recent years. Fish oil and specifically omega-3 fatty acids exhibit cardioprotective effects by mainly improving mortality in coronary artery disease patients. This is achieved through multiple mechanisms with the antiarrhythmic mechanism being the most prominent one. Effects on sodium and calcium channels and heart rate variability are well-accepted mechanisms of how omega-3 fatty acids exercise antiarrhythmic effects. In this review we will address some of the basic science and clinical data regarding omega-3 fatty acids and their direct cardiovascular protective role with details on the proposed mechanisms of this role. We will also address fish pollutants and their significance and finally, the current recommendations about using these fatty acids for cardiovascular protection.

Animals↗

Let the data speak for themselves?

No medical discipline has been more shaped, driven, and scrutinized by outcomes data than cardiac surgery. Unlike high-volume operations for acquired heart disease, congenital heart disease is considerably more heterogeneous, many anomalies are rare, and outcomes after surgical correction are highly variable. How, then, can outcome of institutional programs be compared fairly? Growing in popularity among congenital heart surgeons are methods of comparison that rely fundamentally on expert opinion about perceived complexity of treatment. They may be broadly calibrated using administrative or registry outcomes data. This approach, one of two suggested by Aristotle, characterized pre-Newtonian science, in which observed data played a secondary role. This contrasts sharply with the second approach suggested by Aristotle and revived by Newton in the 18th century that places data at its center: "Let the data speak for themselves." The latter is the basis for contemporary methods of risk-adjusted comparisons. The proposed international collection of a uniform set of congenital heart surgery data elements, a well-conceived and internationally accepted ontology of congenital heart disease, accurate understanding of established incremental risk factor concepts and their role in risk adjustment, advent of powerful data analysis techniques that include new types of predictive modeling, and wide understanding of risk-adjusted comparison suggest there is ample motivation and opportunity for letting data speak for themselves. There is no evidence that a data-centric approach, based on Aristotle's and Newton's ideas that liberated 18th century science, has failed and should be abandoned.

Cardiac Surgical Procedures↗

Positioning a medical school for modern biomedical research: the department of genome sciences at the University of Washington School of Medicine.

The availability of genome sequences from a multitude of organisms, which began about a decade ago, has had enormous impact throughout the biomedical sciences. These sequence data have changed the way research studies are carried out and have led to the explosive growth of computational biology as an approach to analyze biological processes and evolution. In medicine, the completion of the human genome sequence has illuminated the function of many genes, facilitated the correlation of mutant genes to disease phenotypes, and provided a basis for the study of human variation. At the University of Washington, the two academic departments whose overall programs were most centrally affected by the sequencing revolution were Genetics and Molecular Biotechnology. These departments were fused in 2001 to form the Department of Genome Sciences in order to best exploit these developments and to become a prototype for the basic biomedical science department of the future. The department's goal is to address leading-edge questions in biology and medicine through the application of genetics, genomics, proteomics, and computational approaches to the increasing collection of known genome sequences and their encoded products. The authors review the events that led up to the founding of this department and discuss the initiatives that have been undertaken, which include the recruitment of faculty, the establishment of a new interdisciplinary graduate program, the continued development of an outreach program, and the construction of a building to house the department. Lessons learned in crafting this department are also discussed, as well as how these might apply to other medical schools.

Biomedical Research↗

Two third-year medical student-level laboratory shock exercises without large animals.

BACKGROUND: Historically, medical schools have taught principles of hemodynamic shock using large animal models. Such exercises are infrequent today due to the increasing aversion of students and the wider community to the use of large animals in teaching. Herein, we describe two alternative exercises that communicated basic science and clinical principles of shock effectively. METHODS: We developed two complementary, distinct single-afternoon laboratory exercises for third-year medical students. The first exercise (lab) demonstrated three principles: (1) in vitro cytokine-induced apoptosis (illustrating mechanisms and consequences of sepsis), (2) the hemodynamic manifestations of hypovolemia and septic shock in rats, and (3) the effects of fluid resuscitation or vasopressor administration in these same rat models. In the second exercise, students managed the diagnosis, initial resuscitation, surgical treatment, and ICU care of a "patient" with abdominal sepsis, using a manikin-based patient simulator and actual patient test data. Current basic science and clinical literature were incorporated. RESULTS: Efficacy was evaluated by polling students in one of four rotations (n = 25). Educational value of the lab exercise was rated 3.70 (1, worst rating; 5, best rating), whereas its applicability to clinical care was rated 4.35. Educational value and clinical applicability of the patient simulator were rated 4.52 and 4.76, respectively. CONCLUSIONS: These exercises combining laboratory demonstrations of the pathophysiologic mechanisms and manifestations of shock with simulation were judged effective and clinically relevant while fulfilling the National Institutes of Health (NIH) mandate to reduce use of experimental animals.

Animals↗

Graduate education in the biomedical sciences: critical observations on training for research careers.

Several aspects of the processes for the pre- and postdoctoral training of PhDs and the postdoctoral research training of MDs are critically examined. The size of the predoctoral pipeline, the sources of support for the students in it, trends in the annual production of bioscience PhDs, and prospects for growth in opportunities, as defined in increases in availability of public and private funds for research, are catalogued. Evidence for the existence of a surplus of research scientists--based on the size and growth of the pool of postdoctorals, the success rates now being experienced by young postdoctorals in competing for National Institutes of Health (NIH) grants, and the success of young postdoctorals in securing career employment--is evaluated, and the conclusion that the nation is producing too many research scientists is suggested. The pros and cons of "downregulating" the production of scientists are explored, the difficulties of reaching a national consensus on the degree of reduction and the partition of reduction among fields of science and academic institutions and academic departments are described, and the mechanisms conceivably available for accomplishing the task--reducing NIH training funds, autoregulation by academic institutions and/or scientific disciplines, and reliance on the decisions of well-informed (probably by the National Academy of Sciences) degree candidates--are enumerated; a preference for the last of these mechanisms is indicated. The NIH's formal training programs are compared with its informal support of training under research grants; questions that the latter practice raises are identified. The striking disparity between the duration of training for conventional predoctoral PhD candidates and that for dual-degree (MD-PhD) aspirants is noted. The measurement problems of assessing the duration of postdoctoral training are highlighted. The fact that dual-degree scientists seem to compete little, if any, more successfully for the great bulk of NIH research grants than do singly-degreed MDs or PhDs is noted, suggesting the advisability of a fresh and objective review of these dual-degree programs, especially the NIH's Medical Scientist Training Program, to reassess their value in the light of their cost. Some characteristics of careers in the biomedical sciences are outlined. Data are presented on the high turnover rates of first-time-ever entrants into the pool of NIH grantees or, stated otherwise, the relatively low rates of survival of principal investigators (PIs) in the NIH research grant system; a method of estimating the steady-state number of NIH ex- PIs "around" at any given moment is proposed.(ABSTRACT TRUNCATED AT 400 WORDS)

Biological Science Disciplines↗