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Occupation embedded in a real life: interweaving occupational science and occupational therapy. 1993 Eleanor Clarke Slagle Lecture.

This lecture presents an example of research in the genre of interpretive occupational science and demonstrates how occupational science can inform clinical practice. The innovative qualitative methodology used blended elements of the anthropological tradition of life history ethnography, ethnomethodology, the naturalistic methods used by Mattingly and Schön to study practice, and especially narrative analysis as described by Polkinghorne. The bulk of the paper is presented in the form of a narrative analysis that provides an account of a stroke survivor's personal struggle for recovery, a story that emerged from transcription, coding, and analysis of transcripts from approximately 20 hours of interview time. First, this narrative analysis provides an example of how the occupational science framework can evoke a particular kind of storytelling in which childhood occupation can be related to adult character. Storytelling of this kind is later shown to be therapeutic for the stroke survivor. Next, the narrative illustrates how rehabilitation can be experienced by the survivor as a rite of passage in which a person is moved to disability status and then abandoned. Finally, a picture is given of how occupational story making and occupational storytelling embedded in real life can nurture the human spirit to act and can become the core of clinical practice.

Persons with Disabilities↗

Medical informatics: between science and engineering, between academia and industry.

OBJECTIVE: To analyze the nature and appropriate role of the Medical Informatics research and practice area in the 21st Century, and to determine its links to academic environments versus industrial companies and health-care organizations. METHODS: A qualitative analysis of the state of the art of Medical Informatics, based on observation of current medical informatics programs and research in academic and industrial sites. RESULTS AND CONCLUSIONS: Medical Informatics is definitely a scientific and technological area of endeavor, although somewhat ill-defined in scope. It is situated between science and engineering, but much closer to the engineering world, and its multidisciplinary nature fits well the engineering paradigm. It is better viewed as a specialization of the informatics field rather than as a basic medical science. However, there are good arguments as to why Medicine should be the first among equals to have its own informatics domain. Medical Informatics must have extensions to both academia and industry to survive. Medical informaticians, whether implicitly or explicitly, exist in three different environments: academic, clinical (user), and industrial (informatics developer); all three environments must be considered when trying to predict the future of this new multidisciplinary area.

Engineering↗

Building effective partnerships: a national evaluation of the Cancer Information Service outreach program. Part 2.

The Cancer Information Service's (CIS) nationally coordinated, regionally focused outreach program establishes partnerships with government, nonprofit, and private organizations to reach underserved and minority populations. A national random sample telephone survey, conducted with 867 partner organizations who had contact with the CIS in early 1996, assessed the types of CIS assistance used, satisfaction with and usefulness of these services, organizational characteristics, and the overall impact on partners' cancer-related programs. CIS partners provide programs for the medically underserved (79%) and specific racial and ethnic groups (72%) and address a range of cancer control issues. Partners use and highly value an array of CIS assistance. Over 90% are satisfied with the CIS services. Diffusion of accurate and science-based information, materials and resources is a key element of the outreach assistance. Two out of three partners are receiving late-breaking news and scientific information from the CIS and 86% are disseminating it to their constituents. The majority of those partners surveyed reported that they rely on the CIS to assist with their most important cancer programs. Sixty-eight percent of the partners rated the CIS assistance as important or very important to their cancer-related programs. These survey results indicate that the CIS outreach program provides key support to partners' cancer programs and has an impact on their efforts. The results support the effectiveness of a regionally based outreach program working in partnership with existing organizations at the state, county, and local level who are addressing the needs of underserved populations.

Community-Institutional Relations↗

Nursing decision making and the science of the concrete.

Information systems are going to change our understanding of nursing as a discipline and as a practice. The act of decision making will be the focus of the impact of information systems on nursing. The article models types of nursing knowledge, organizing them into concrete and abstract knowledge. Information systems will allow the inclusion of concrete science data, which has not been possible previously. Role performance is seen as a mechanism for the integration of the two sciences, and a new understanding for nursing decision making is proposed.

Decision Making↗

Tree and loop as moments for measurement.

Biologically motivated computing presents us with a measurement process in science. It triggers an epistemological shift from state-oriented physics to measurement-oriented physics, in which we can find a parallelism with Wittgenstein's shift from rule following to a language game. We argue here that an approximation or computing process can be viewed as a language game and propose an idea of proto-computing which is metaphorically formalized through disequilibration between tree- and loop-program, as a model for measurement-oriented computing.

Computer Simulation↗

Information-seeking behavior: a survey of health sciences faculty use of indexes and databases.

This study investigated information-seeking behavior, including use of major bibliographic tools by medical, pharmacy, nursing, and science faculty at the University of Illinois at Chicago. The study assessed the impact of availability of locally mounted databases, determined needs for modification of instructional programs, identified the need for promotional material, and established a baseline for subsequent studies. Results reflected a wide variation in the number and format of secondary services used by faculty. Over 70% of all faculty from the colleges of medicine, pharmacy, and nursing used Index Medicus or MEDLINE. There were statistically significant differences between colleges in their use of mediated and end-user searching of MEDLINE. Colleges exhibited significant differences in use of Current Contents, PsycLIT, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chemical Abstracts, and Science Citation Index. Statistically significant differences also were found among several clinical departments. The study concluded that, as new formats to bibliographic tools become available, traditional formats continue to be used; training sessions must be tailored to the audience; and the availability of local resources and their use by faculty needs to be understood.

CD-ROM↗

Medical informatics: searching for underlying components.

OBJECTIVE: To discuss unifying principles that can provide a theory for the diverse aspects of work in medical informatics. If medical informatics is to have academic credibility, it must articulate a clear theory that is distinct from that of computer science or of other related areas of study. RESULTS: The notions of reusable domain antologies and problem-solving methods provide the foundation for current work on second-generation knowledge-based systems. These abstractions are also attractive for defining the core contributions of basic research in informatics. We can understand many central activities within informatics in terms defining, refining, applying, and evaluating domain ontologies and problem-solving methods. CONCLUSION: Construing work in medical informatics in terms of actions involving ontologies and problem-solving methods may move us closer to a theoretical basis for our field.

Information Science↗

Philosophical conceptions of the self: implications for cognitive science.

Several recently developed philosophical approaches to the self promise to enhance the exchange of ideas between the philosophy of the mind and the other cognitive sciences. This review examines two important concepts of self: the 'minimal self', a self devoid of temporal extension, and the 'narrative self', which involves personal identity and continuity across time. The notion of a minimal self is first clarified by drawing a distinction between the sense of self-agency and the sense of self-ownership for actions. This distinction is then explored within the neurological domain with specific reference to schizophrenia, in which the sense of self-agency may be disrupted. The convergence between the philosophical debate and empirical study is extended in a discussion of more primitive aspects of self and how these relate to neonatal experience and robotics. The second concept of self, the narrative self, is discussed in the light of Gazzaniga's left-hemisphere 'interpreter' and episodic memory. Extensions of the idea of a narrative self that are consistent with neurological models are then considered. The review illustrates how the philosophical approach can inform cognitive science and suggests that a two-way collaboration may lead to a more fully developed account of the self.

Journal Article↗

Hunger in California: what interventions are needed?

OBJECTIVE: Although research exists on the nutritional status of individuals and families who seek emergency food, there is little guidance on what to do about it. Our purpose was to develop effective nutrition interventions to assist individuals and families seeking emergency food. DESIGN AND SUBJECTS: Two survey instruments were used to collect data on 697 emergency food providers and 3,365 emergency food clients in 20 California counties between 1986 and 1990. STATISTICAL ANALYSES PERFORMED: Data were analyzed using the Statistical Package for the Social Sciences. RESULTS: Information from the food providers who staff the emergency food sites revealed insufficient food to meet the growing demand, client difficulties in using the donated food, and the need for information to improve the safety and nutritional quality of the donated food. Information from the emergency food clients documented that 70.4% of them were families with children, 84% had incomes below the poverty level, and 20% reported no income at all. In addition, most clients (70%) were not enrolled in the food stamp program. APPLICATIONS/CONCLUSIONS: In response to the surveys, counties initiated a variety of interventions, including public awareness campaigns, community development activities, and nutrition education programs. Important strategies are to teach recipients ways to optimize food resources, encourage eligible individuals to enroll in federal nutrition programs, and link individuals with agencies that offer assistance.

California↗

JAT's impact factor--room for improvement? Journal of Analytical Toxicology.

The impact factor of a scientific journal is simply the ratio of the number of citations to the number of citable items (articles and reviews) over a given time period, usually two years after the year of publication. Trends in the impact factor of Journal of Analytical Toxicology (JAT) are reviewed and compared with other leading journals in the forensic sciences and toxicology. In particular, the journals that frequently cite JAT articles (citing journals) and the journals cited in articles published in JAT (cited journals) are compared and contrasted. The reasons for citing a particular article are considered, and some suggestions are made for improving the impact factor of JAT, if this is deemed necessary. This could be achieved in a number of ways, such as speeding the editorial-handling and peer-review processes, by including one or more invited review articles in each issue of the journal, or by increasing the number of references cited so the references/article ratio increases. Regardless of journal impact factor, an article should be judged by its usefulness to the field and not the prestige of the journal where it is published.

Bibliometrics↗

Relevance of some of the theories of Ibn Khaldoun in his "Al Muqaddimah" to contemporary medicine. A personal interpretation.

The subjects in this paper include Ibn Khaldoun's thoughts on writing, and their implications on today's medical writing. This paper discusses why people write, plagiarism, "Original" and "Copied' writings and where history writing goes wrong and how this can be applied to Medical writing today. The paper also discusses the nature of Science and Knowledge as viewed by Ibn Khaldoun, the anatomy of intelligence, types of thought processes, and effects of environment and craftsmanship on intellect. Ibn Khaldoun's definition of the "Medical" profession and its social standing is discussed as well as his emphasis of the importance of exercise, diet and climate on healthy living. Ibn Khaldoun has clear and advanced concepts on education and methodology of education. He emphasizes 3 stages of coaching, and the importance of travel in consolidating and clarifying knowledge attainment. He abhors coercion as a method of educating the young. Developing the interest of the pupil in the art he is studying, is thought by Ibn Khaldoun to be the central theme of good education. Relevance of all this to contemporary medical education is discussed. Ibn Khaldoun has fascinating ahead-of-time views on the influence of peer pressure and what is now known as "Emotional Intelligence" and he rejects the idea that intelligence is ethnically determined. Instead, he emphasizes the environmental, social and craftsmanship influence on human behavior. He stresses that the method of education has a lot to do with the "apparent" intelligence or "stupidity" of pupils.

Education, Medical↗

Patient safety initiatives in Brazil: a nursing perspective.

The science development and technology application improvement in all areas of knowledge, including health care, represent an advance in patient care. The health care providers face challenges to accomplish complex procedures and treatments, which demand infrastructure, defined framework, constant process establishment and redesign of nursing care, based on a continuous outcomes evaluation. Therefore, this development requires nurses with advanced knowledge and skills. As the main health care provider in Brazilian hospitals, the nursing staff perform and control the majority of direct patient care procedures, and as such, nursing professionals can be responsible for triggering adverse events that can compromise patient safety. Research conducted in Brazil showed that the quality of health care delivery system and the results of care have significant variation nationwide. Health care professionals should be valued as the one who can promote patient safety, providing high quality care within cost-effective services. Technology is a key element to support and enhance the professional's performance. However, it is also important to promote and facilitate its implementation and development to retain a creative, engaged, skilled, satisfied, competent, and accountable professional capable of identifying and using technology resources in order to assure the quality of care for the population.

Adult↗

Privacy and confidentiality of genetic information: what rules for the new science?

This review covers the ethical, legal, and policy issues associated with the generation and dissemination of genetic information. First, conceptual issues, such as the definition of terms and the description of two modes of analysis, are addressed. Research findings on public attitudes toward privacy and genetics and other factors relevant to policy making are also reviewed. Second, the example of genetic research is used to highlight the importance of attention to the intrinsic harms associated with violations of genetic privacy. Subtopics include national databases and biobanks, gene brokers, and pharmacogenomics. Third, the example of insurer access to genetic information is used to highlight the importance of attention to discrimination and other instrumental harms associated with failures of regulation. Fourth, a summary of the preceding sections leads into an outline of a program for realizing the benefits of the new science in a manner that affirms rather than erodes privacy and other important values.

Confidentiality↗

Planning for the information age: a survey of microcomputer use in a faculty of health sciences.

Microcomputers can greatly enhance information processing by clinicians and improve the quality of health care. We surveyed 983 full- and part-time faculty members to assess the state of microcomputer use in the Faculty of Health Sciences at McMaster University, Hamilton, Ont. The ratio of faculty members to microcomputers was close to 1; however, 29% of the full-time and 52% of the part-time members who responded indicated that they did not use a computer. Among those who did, the range of applications was generally limited. There was no mention of more advanced uses such as diagnosis, treatment and patient records. Only about 30% of the respondents had taken a computer course, but all indicated a desire to take courses (on average, three of the seven listed in the questionnaire). Our results showed an extensive but unequal distribution of microcomputers and revealed the need for planning and education to put them to optimal use.

Computers↗

[Reflexions on the usage of information theory in biology].

For living beings, information is as fundamental as matter or energy. In this paper we show: a) inadequacies of quantitative theories of information, b) how a qualitative analysis leads to a classification of information systems and to a modelling of intercellular communication. From a quantitative point of view, the application in biology of information theories borrowed from communication techniques proved to be disappointing. These theories ignore deliberately the significance of messages, and do not give any definition of information. They refer to quantities, based upon arbitrarily defined probabilistic events. Probability is subjective. The receiver of the message needs to have 'meta-knowledge' of the events. The quantity of information depends on language, coding, and arbitrary definition of disorder. The suggested objectivity is fallacious. In common language, the word 'information' is synonymous with knowledge of order. Following common sense a message (letters, coded signals, etc.) is information just in case it is interpretable, i.e. if it fits to a previously acquired meaning (the words of an available language, etc.). The consequence is that calculation of quantities in the sense of Shannon can be used for transmissions, but it is itself meaningless (has no significance). In linguistics and semantics, information is composed of a 'signifier', a physical medium (letters, coded signals, etc.), and a 'signified' or significance. The nature of information is complex. The laws of linguistics and semantics are valid not only at the human, organismic level, but also at the cellular and molecular level. The physiology of sensations gives us many examples for application of a concept of information An electromagnetic wave of 0.7% give us the sensation of a red colour. Sensations have no physical reality. They are purely subjective. At the cellular level communication operates by means of chemical messengers (first messengers), which generally do not penetrate the plasmic membrane. Specific captors operate as transductors: external factors are converted into secondary messengers (cyclic AMP, Ca ion, etc.). Sometimes, electric signals (like depolarization waves) may also play a part in the intercellular communication. Such processes are characterized by changes in a sequence of different molecules carried by a physical signal. What is transmitted is the meaning of the message (significance) which can be memorized by the cell, providing a possible following use. At the molecular level one can find also the processes of linguistic nature. We know that the significance of a word is changed with changing the order of letters (ADD-->DAD, etc.).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗