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Despite the dictionary definition of "craving" (a strong desire), two studies indicate that a substantial percentage of persons with alcohol and drug problems use the word "craving" to mean any desire or urge, even a weak one, to use substances. Researchers and clinicians are advised to beware of this ambiguity of "craving" and to consider the conceptual status of "craving" in their work.
Because of a lack in drug evaluation in children, they receive many off license drugs prescription, which means drugs prescribed in an indication, dosage, formulation or age different from the license terms. However, drug evaluation is crucial in paediatrics population because of pharmacokinetics and pharmacodynamics modifications throughout organism development, which make usually wrong any extrapolation to children of data obtained in adults. Drug safety is generally better in infants except in newborns who are at a particularly high drug-related risk because of high frequency of off license drug use, many drugs association and drugs metabolism immaturity. The lack of evaluation in children, the fact that children are the unique target population of some drugs or the maturation phenomena explain some adverse effects more specific in children. The more the children are young, the more they are exposed to medication or drug utilization errors. Physician must take what the SPC, as found in the Vidal dictionary, mentions about children into account while prescribing. Drugs with a paediatric license must be preferred overall, however it should be kept in mind that a paediatric license means only that the drug is active in the indication of the license but it doesn't position it regarding other therapeutic alternatives. Off labeling prescription should be based on a supposed benefit, which had to be justified if a severe side effect occurred.
We introduce a novel method to analyse complete genomes and recognise some distinctive features by means of an adaptive compression algorithm, which is not DNA-oriented, based on the Lempel-Ziv scheme. We study the Information Content as a function of the number of symbols encoded by the algorithm and we analyse the dictionary created by the algorithm. Preliminary results are shown concerning regions showing a sublinear type of information growth, which is strictly connected to the presence of highly repetitive subregions that might be supposed to have a regulatory function within the genome.
Childhood cancers are rare, but incidence has risen modestly in countries with robust registration, partly reflecting improved diagnosis. In high-income countries, cancer is the leading cause of disease-related death in children. Marked inequities in incidence, survival, and research capacity underscore the need for large-scale collaboration to identify environmental, genetic, and contextual determinants of risk. The Childhood Cancer and Leukemia International Consortium (CLIC) was established in 2007 to study the etiology of childhood leukemia and later expanded in 2019 to include other childhood cancers, principally solid tumors. CLIC pools harmonized, individual-level data from case-control and cohort studies, obtained through interviews, record linkage (insurance claims, registries), or geographic information systems, and integrates germline genomic data where available. Membership has grown from 13 studies in 9 countries to 57 studies in 21 countries; recruitment spans the early 1960s to the present and encompasses approximately 150,000 cases across all tumor types and 300,000 controls with clinical, demographic, and exposure data, centralized via harmonized data dictionaries at the Data Coordination Center, established in 2014 at the International Agency for Research on Cancer, and supported by a secure analysis platform. Pooled analyses across diverse populations have implicated parental age, prenatal vitamin or folic acid use, mode of delivery, fetal growth, selected congenital anomalies, occupational or household exposures (e.g., pesticides), paternal smoking, and markers of early-life immune modulation (e.g., breastfeeding, daycare attendance) in leukemia risk, informing carcinogen evaluation and prevention. The integration of genetic ancestry and germline susceptibility data is clarifying ancestry-related differences in leukemia biology and outcomes, while confirming risk loci with population-specific effects. CLIC is now adding polygenic risk scores and exposomic data to refine etiologic subtyping and identify modifiable pathways, while broadening representation from underserved regions through partnership-building and capacity-strengthening.
Ambroise Tardieu was an outstanding French forensic physician of the 19th century. A century before American physicians discovered child abuse as a pediatric and public health problem, Tardieu studied and described almost all forms of child maltreatment. In his "Dictionnaire d'hygiene et de salubrite" (Dictionary of hygiene and salubrity, 1862a, 1862b), Tardieu described the terrible working conditions of children in factories and mines. He also reported the ill consequences of theses conditions on the children's physical and mental health. In his "Etude medico-legale sur les attentats aux moeurs" (Forensic study on offenses against morals, 1857), he analyzed 632 cases of sexual abuse in females (mostly children) and 302 cases in males, describing physical signs according to the severity of the abuse. His "Etude medico-legale sur les sevices et mauvais traitements exerces sur des enfants" (Forensic study on cruelty and the ill-treatment of children, 1860) is a classical description of the battered-child syndrome. Thirty-two cases, 18 of which resulted in death, are described in detail. He also published "Etude medico-legale sur l'infanticide" (Forensic study on infanticide, 1868), a book of his observations on infanticide, based on the study of 555 cases, of which 60 are discussed in detail. Unfortunately, Ambroise Tardieu was unable to convince the physicians of his time of the prevalence of the maltreatment of children in their own family. Furthermore, his successors in forensic medicine did not believe children's allegations of physical and sexual abuse. Child victims were condemned to suffer abuse and neglect for another century without the support of the medical community, despite the fact that a clear-sighted and renowned physician devoted a significant part of his career to trying to open the eyes of physicians and society to this horrendous reality.
Homogeneous gels represent a new type of (electro)chromatographic media possessing unique separation properties unmatched with any other chromatographic beds. It is important to emphasize that they principally differ from continuous beds, polymer rods (better known as monoliths), which are particulate separation media with pores permitting hydrodynamic flow through the columns. Monoliths, thus, are more similar to beds conventionally packed with beads, although the particles building up monolithic columns are usually smaller in size (few submicometers) and covalently linked together. Consequently, homogeneous gels deserve better the term "monoliths" having a non-particulate structure formed by crosslinked free polymer chains (according to a dictionary a monolith is a non-modularized column). The goals of this minireview are to clarify the position of homogeneous gels among the separation media (including polymer solutions), to explain and to exemplify their outstanding (electro)chromatographic properties. This review gives hopefully a complete list of references to homogeneous gels developed for capillary electrochromatography.
Close blood relatives of MS patients have MRI changes suggestive of MS despite the absence of any symptoms. They have also been seen when an MRI is obtained for various reasons in unrelated persons. This raises questions regarding their clinical significance, if any, since typical MS plaques have been found at autopsy in eloquent parts of the nervous system in completely asymptomatic individuals. Do these people have MS and should immunomodulatory treatment be considered? Because they are not ill according to various dictionary definitions, no to both. A higher rate of MS in close blood relatives would be expected due to the known genetic susceptibility, but suggestive MRI changes are quite uncommon, even in unaffected twins. Finally, a review of the four published studies of MS lesions unexpectedly found at autopsy in neurologically asymptomatic persons revealed a prevalence of the disease of 0.1%, the same as the estimated prevalence of clinical MS in the United States.
It is necessary to remove the noise in EEG before further EEG analysis and processing. For EEG is deeply masked in the noise background, it is very difficult to denoise EEG effectively. Proposed in this paper is a novel realistic head model based sparse decomposition algorithm to denoise EEG, which is an iterative procedure combining the subject's physiology of EEG generation into the denoising procedure. In this algorithm, the lead field overcomplete dictionary is numerically calculated according to the realistic head model firstly, and then the instantaneous EEG spatial potential is decomposed into one sparse combination of atoms in the lead field matrix by matching pursuit, and the sparse combination of atoms is to be regarded as the denoised EEG signal. The realistic head based sparse decomposition was tested by the simulated noisy potential and a real EEG recording collected in an oddball stimulus experiment, the results consistently confirmed the new method removed the uncorrelated noise in EEG effectively.
Ontology construction requires an understanding of the meaning and usage of its encoded concepts. While definitions found in dictionaries or glossaries may be adequate for many concepts, the actual usage in expert writing could be a better source of information for many others. The goal of this paper is to describe an automated procedure for finding definitional content in expert writing. The approach uses machine learning on phrasal features to learn when sentences in a book contain definitional content, as determined by their similarity to glossary definitions provided in the same book. The end result is not a concise definition of a given concept, but for each sentence, a predicted probability that it contains information relevant to a definition. The approach is evaluated automatically for terms with explicit definitions, and manually for terms with no available definition.
Automated signal generation in pharmacovigilance implements unsupervised statistical machine learning techniques in order to discover unknown adverse drug reactions (ADR) in spontaneous reporting systems. The impact of the terminology used for coding ADRs has not been addressed previously. The Medical Dictionary for Regulatory Activities (MedDRA) used worldwide in pharmacovigilance cases does not provide formal definitions of terms. We have built an ontology of ADRs to describe semantics of MedDRA terms. Ontological subsumption and approximate matching inferences allow a better grouping of medically related conditions. Signal generation performances are significantly improved but time consumption related to modelization remains very important.
Safety monitoring is a critical element of clinical trials evaluating treatment for substance dependence, but is complicated by participants' high levels of medical and psychiatric comorbidity. This paper describes AEs reported in a large (N = 286), 29-week outpatient study of behavioral interventions for heroin and cocaine dependence in methadone-maintained outpatients. A total of 884 AEs were reported (3.1 per patient, 0.12 per patient-week), the most common being infections (26.8%), gastrointestinal (20.5%), musculoskeletal (12.3%), and general (10%) disorders. Serious AEs were uncommon (1.6% of total). Female participants reported significantly higher rates of AEs (incidence density ratio, IDR = 1.38, p < 0.0001); lower rates of AEs were reported by African Americans (IDR = 0.73, p<0.0001) and participants over age 40 reported lower rates of AEs (IDR = 0.84, p = 0.0095). AE incidence was not associated with the study intervention or with psychiatric comorbidity. Further work is needed to adapt AE coding systems for behavioral trials for substance dependence; the standard Medical Dictionary for Regulatory Activities, International Federation of Pharmaceutical Manufacturers Associations (MedDRA) coding system used in this report did not contain a separate category for one of the most common types of AE, dental problems. Nonetheless, the data reported here should help provide a context in which investigators and IRBs can interpret the patterns of AEs they encounter.
OBJECTIVES: The objective of the study was to make an economic evaluation of in vitro fertilization and to determine the impact of some factors on its cost, particularly the choice between recombinant follicle stimulating hormone (r-FSH) and urinary FSH (u-FSH) for ovarian stimulation. PATIENTS AND METHODS: Costs were calculated in a Public Health view, by studying two phases: the stimulation cycle (including down-regulation) and the pregnancy (including the neonatal period). The calculation has included the side effects and the frozen embryos transfers. Economic data came from various sources: the French nomenclature on medical treatments (NGAP), the French drugs dictionary (Vidal) and the French Information system medical plan (PMSI). FSH costs were computed according to the currently marketed products, i.e., Fostimon (Laboratoires Genévrier, Sophia-Antipolis, France) for urinary FSH, and Gonal-F (Laboratoires Serono, Boulogne-Billancourt, France) and Puregon (Laboratoires Organon, Puteaux, France) for recombinant FSH. Two different ways of efficacy between u-FSH and r-FSH were considered for the calculations, those reported in Daya's meta-analysis (3.7% in favour of r-FSH for the clinical pregnancy rate per initiated cycle) and in the only double-blind study (Frydman et al., no difference). RESULTS: The annual cost of ART reaches approximately 130 million Euros in France, for the cycles only, and 170 million Euros when including the pregnancy costs. Urinary FSH is much cheaper than recombinant FSH. Whereas the number of administered FSH units was higher in u-FSH, this results in a mean lower cost of 500 Euros per cycle (2422 Euros for u-FSH and 2959 Euros for r-FSH). For one complete year, in France, the potential over cost of recombinant products reaches 24 million Euros when considering only the cycles (128.4 vs. 104.0 million Euros) and 24-31 million Euros when pregnancies and babies (neonatal period) are considered (171.4 vs 140.7 and 147.0 million Euros, respectively). The IVF per baby cost can be estimated at 16 463 Euros for r-FSH and at 14 116 Euros (in case of equivalence between the two drugs) to 15 805 Euros (in case of a difference of 3.7% pregnancy per oocyte recovery) for u-FSH. CONCLUSION: This gives Public Health lighting to the choices in the matter of ovulation stimulation. It shows the economic impact of the choice in the FSH type.
DICOM 3 is a very elaborate standard for the communication between medical image devices. It is published in several parts by the National Electrical Manufacturers Association (NEMA). To adequately visualize the data structure defined in parts 3, 5 and 6 of the DICOM standard, we implemented the web based Dicom Search Engine (DicoSE). It allows for querying the DICOM standard data dictionary for defined data fields and visualizes the topology of the data which is inherently present in DICOM datasets. For the administration of the underlying data a web based administration interface is provided. The service is entirely based on freely available software.
Today, the economic and regulatory environment, involving activity-based and prospective payment systems, healthcare quality and risk analysis, traceability of the acts performed and evaluation of care practices, accounts for the current interest in clinical and hospital information systems. The structured gathering of information relative to users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysts. We used a modelling technique designed for manufacturing processes (IDEF0/SADT). We enhanced the basic model of an activity with descriptors extracted from the Ishikawa cause-and-effect diagram (methods, men, materials, machines, and environment). We proposed an object data model of a process and its components, and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary of a given process from the description of its elements and to locate documents (procedures, recommendations, instructions) according to each activity or role. Aimed at structuring needs and storing information provided by directly involved teams regarding the workings of an institution (or at least part of it), the process-mapping approach has an important contribution to make in the analysis of clinical information systems.
PURPOSES: The development of a national protocol to formalize the screening of Dutch cancer survivors on potential late cancer treatment effects and the medical terminology used in describing the patient follow up procedures. METHODS: A combined evidence-based and qualitative approach, the Glaser's State of the Art Strategy, was used to reach consensus on how to screen Dutch cancer survivors on late cancer treatment effects. A core working group set up a first proposal of a screening protocol and a handbook of medical term definitions by incorporating available research evidence (1980-2003), clinical expertise and definitions from Dutch medical dictionaries and textbooks. External experts reviewed this proposal in a cycle of two postal and two discussion rounds. The follow-up procedures and medical term definitions described in the draft screening protocol were to be accepted if consensus among external experts was > or =50%. RESULTS: A protocol for screening cancer survivors on late cancer treatment effects was developed describing the follow-up procedures for cancer survivors according to previous therapeutic exposures. Four hundred and twenty one medical terms were used in describing these follow-up procedures. One hundred and fifteen of these terms were classified as multi-interpretable and 101 of these terms were defined. No definitions could be found for the remaining 14 medical terms. CONCLUSIONS: We succeeded in reaching consensus throughout The Netherlands on a protocol to screen cancer survivors on late cancer treatment effects. This protocol is now in use by all Dutch outpatient clinics and warrants that the screening of cancer survivors is consistent across The Netherlands. The screening protocol specifies in detail how screening of cancer survivors should take place and can therefore be used by clinicians who were not involved in the consensus study.
PURPOSE: We present a method for the automated acquisition of a multilingual medical lexicon (for Spanish, French and Swedish) to be used within the framework of a medical cross-language text retrieval system. METHODS: For the lexical acquisition process, we incorporate seed lexicons and lists of trusted term translations derived from the UMLS Metathesaurus. The seed lexicons for Spanish, French and Swedish are automatically generated from (previously manually constructed) Portuguese, German and English sources by simple string transformations. Lexical and semantic hypotheses are then validated by processing pairs of term translations. In a last step, we use the cleaned list of "approved" translations in order to augment, step by step, the target dictionaries by processing the parallel corpora in terms of co-occurrence patterns of hypothesized translation equivalents which cannot be derived by simple character substitutions. RESULTS: An existing multilingual lexicon for the medical domain with about 60,000 entries for English, German, and Portuguese was automatically augmented by more then 17,000 new lexemes for Spanish, French, and Swedish. CONCLUSIONS: Our approach constitutes a promising method for the automated creation of new lexicon entries and their linkage to semantic identifiers.
BACKGROUND: This research into the concept of support was undertaken because of the recurrent use of the concept in nursing research and especially because of the vital importance of support to family carers of older persons. AIM: To inductively develop a definition of support, specifically in the context of family care of frail aged persons. METHOD: The study followed the evolutionary method of concept analysis. The study was based on data from scientific publications, encyclopaedias and dictionaries. In order to secure a representative sample, highly systematic means of sampling were used. RESULTS: Working with the data underpinning this study, it was possible to put forward a definition of support for family carers who care for a frail aged person at home. The two major dimensions, as described under attributes, were merged into the following definition: "Support entails the provision of general tangibles such as information, education, economic aid, goods and external services. They are prerequisites for facilitating the family carers' competence or capacity in care. Moreover it entails necessary qualities such as individualization, adaptability, lastingness, room for verbalizing emotions as well as an idea of reciprocal symmetrical exchange between involved parties.
BACKGROUND: Although several changes were implemented in the 1998 update of the abbreviated injury scale (AIS 98) versus the previous AIS 90, both are still used worldwide for coding of anatomic injury in trauma. This could possibly invalidate comparisons between systems using different AIS versions. Our aim was to evaluate whether the use of different coding dictionaries affected estimation of Injury Severity Score (ISS), New Injury Severity Score (NISS) and probability of survival (Ps) according to TRISS in a hospital-based trauma registry. MATERIALS AND METHODS: In a prospective study including 1654 patients from Ulleval University Hospital, a Norwegian trauma referral centre, patients were coded according to both AIS 98 and AIS 90. Agreement between the classifications of ISS, NISS and Ps according to TRISS methodology was estimated using intraclass correlation coefficients (ICC) with 95% CI. RESULTS: ISS changed for 378 of 1654 patients analysed (22.9%). One hundred and forty seven (8.9%) were coded differently due to different injury descriptions and 369 patients (22.3%) had a change in ISS value in one or more regions due to the different scoring algorithm for skin injuries introduced in AIS 98. This gave a minimal change in mean ISS (14.74 versus 14.54). An ICC value of 0.997 (95% CI 0.9968-0.9974) for ISS indicates excellent agreement between the scoring systems. There were no significant changes in NISS and Ps. CONCLUSIONS: There was excellent agreement for the overall population between ISS, NISS and Ps values obtained using AIS 90 and AIS 98 for injury coding. Injury descriptions for hypothermia were re-introduced in the recently published AIS 2005. We support this change as coding differences due to hypothermia were encountered in 4.3% of patients in the present study.