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A JAVA implementation of a medical knowledge base for decision support.

Distributed decision support is a challenging issue requiring the implementation of advanced computer science techniques together with tools of development which offer ease of communication and efficiency of searching and control performance. This paper presents a JAVA implementation of a knowledge base model called ARISTOTELES which may be used in order to support the development of the medical knowledge base by clinicians in diverse specialised areas of interest. The advantages that are evident by the application of such a cognitive model are ease of knowledge acquisition, modular construction of the knowledge base and greater acceptance from clinicians.

Artificial Intelligence↗

Neuroscience in middle schools: a professional development and resource program that models inquiry-based strategies and engages teachers in classroom implementation.

The Department of Neuroscience at the University of Minnesota and the Science Museum of Minnesota have developed and implemented a successful program for middle school (grades 5-8) science teachers and their students, called Brain Science on the Move. The overall goals have been to bring neuroscience education to underserved schools, excite students about science, improve their understanding of neuroscience, and foster partnerships between scientists and educators. The program includes BrainU, a teacher professional development institute; Explain Your Brain Assembly and Exhibit Stations, multimedia large-group presentation and hands-on activities designed to stimulate student thinking about the brain; Class Activities, in-depth inquiry-based investigations; and Brain Trunks, materials and resources related to class activities. Formal evaluation of the program indicated that teacher neuroscience knowledge, self-confidence, and use of inquiry-based strategies and neuroscience in their classrooms have increased. Participating teachers increased the time spent teaching neuroscience and devoted more time to "inquiry-based" teaching versus "lecture-based teaching." Teachers appreciated in-depth discussions of pedagogy and science and opportunities for collegial interactions with world-class researchers. Student interest in the brain and in science increased. Since attending BrainU, participating teachers have reported increased enthusiasm about teaching and have become local neuroscience experts within their school communities.

Adolescent↗

Sharing science: characteristics of effective scientist-teacher interactions.

Despite national guidelines to reform K-12 science education, our students are not learning science any better. Conducted under the auspices of the American Association for the Advancement of Science, a symposium examined several programs where professional scientists interact with classroom teachers to improve science education. Symposium participants described their projects and discussed the factors that contribute or detract from each project's success. The events of this symposium are critically analyzed. Four themes emerged as issues that affect the successful implementation and continuation of science education reform projects: scientific literacy as a primary goal, personal characteristics and commitment of project partners, curricular change built on social and developmental goals, and the incentive/reward structures in universities and school systems. This review of the emergent themes places the opinions of the symposium participants into the larger context of a growing science education research literature to inform others about synergy between professional scientists and classroom teachers. Our aim is to help others learn about the characteristics of effective partnerships to improve science education.

Cooperative Behavior↗

Chemical carcinogens: a review of the science and its associated principles. U.S. Interagency Staff Group on Carcinogens.

In order to articulate a view of chemical carcinogenesis that scientists generally hold in common today and to draw upon this understanding to compose guiding principles that can be used as a bases for the efforts of the regulatory agencies to establish guidelines for assessing carcinogenic risk to meet the specific requirements of the legislative acts they are charged to implement, the Office of Science and Technology Policy, Executive Office, the White House drew on the expertise of a number of regulatory agencies to elucidate present scientific views in critical areas of the major disciplines important to the process of risk assessment. The document is composed of two major sections, Principles and the State-of-the-Science. The latter consists of subsections on the mechanisms of carcinogenesis, short-term and long-term testing, and epidemiology, which are important components in the risk assessment step of hazard identification. These subsections are followed by one on exposure assessment, and a final section which includes analyses of dose-response (hazard) assessment and risk characterization. The principles are derived from considerations in each of the subsections. Because of present gaps in understanding, the principles contain judgmental (science policy) decisions on major unresolved issues as well as statements of what is generally accepted as fact. These judgments are basically assumptions which are responsible for much of the uncertainty in the process of risk assessment. There was an attempt to clearly distinguish policy and fact. The subsections of the State-of-the-Science portion provide the underlying support to the principles articulated, and to read the "Principles" section without a full appreciation of the State-of-the-Science section is to invite oversimplification and misinterpretation. Finally, suggestions are made for future research efforts which will improve the process of risk assessment.

Animals↗

Creating the integrated information infrastructure for the 21st century at the University of Washington Warren G. Magnuson Health Sciences Center.

Successful integrated information systems implementation requires an effective marriage of technology and information resources in response to critical institutional needs. The University of Washington technical infrastructure, developed over the past five years, includes ubiquitous, high-speed network access throughout the Health Sciences Center and hospitals, agreement on network standards and protocols, uniform interface to common databases (character-based and GUI) and network availability of a variety of databases and information resources at no charge to the individual. As a result of this heavy institutional investment in technical infrastructure, our implementation process will focus on expanding the number of available resources as well as developing and refining tools and services to enhance the utility of electronic information resources. Above all we will study and develop strategies for dealing with the myriad of information policy issues which confront and confound us all today.

Academic Medical Centers↗

A virtual instrument (VI) for haemodynamic management in ICU and during surgery.

Systolic pressure variations (SPV) during mechanical ventilation and its single components, related to short apnea, reflect changes of the volemic condition of the patient. To introduce their determination during clinical monitoring for different fluid states and for different tidal volumes, they must be computed on-line without introducing interference with standard activities. A system computing on-line systolic pressure variation during mechanical ventilation, connected to standard monitoring devices, has been proposed. It is based on a notebook PC implemented with graphical software comprising a user panel in the form of a virtual instrument and is able to acquire, process and present signals from different instruments utilized in ICU and during surgery. It can be used as a base to assess the ability of computed parameters helpful in clinical decision. The use of a notebook PC and open software allows operators, even if non-expert in computer science, to test and implement this, as well as other innovative tools in clinical practice.

Blood Pressure Determination↗

Assessing HIV prevention provider knowledge of behavior science theory: building on existing intuitive experience.

Behavioral science theory is recommended as a basis for prevention programs, yet many STD/HIV prevention providers have little academic background in this area and see no relevance of theory to their work. This study assessed STD/HIV prevention providers' intuitive insight about behaviors. Comparisons of behavioral determinants from providers "common sense" theories with determinants identified in formal theories are made through the use of Theoretical Domains, a teaching tool designed to enhance the understanding and use of behavioral science in planning and implementing interventions. Understanding how to effectively apply behavior change concepts, combined with prevention providers' basic, intuitive knowledge can enhance understanding, communication, and skills exchange between providers and researchers. Building capacity in local communities begins with a participatory process of community members, prevention providers, and researchers working together as equal partners. Better translation of research into practice using theory-based interventions will benefit the field of STD/HIV prevention.

Behavioral Sciences↗

Overcoming barriers to teaching the behavioral and social sciences to medical students.

Most U.S. medical schools offer courses in the behavioral and social sciences (BSS), but their implementation is frequently impeded by problems. First, medical students often fail to perceive the relevance of the BSS for clinical practice. Second, the BSS are vaguely defined and the multiplicity of the topics that they include creates confusion about teaching priorities. Third, there is a lack of qualified teachers, because physicians may have received little or no instruction in the BSS, while behavioral and social scientists lack experience in clinical medicine. The authors propose an approach that may be useful in overcoming these problems and in shaping a BSS curriculum according to the institutional values of various medical schools. This approach originates from insights gathered during their attempts to teach various BSS topics at four Israeli medical schools. They suggest that medical faculties (1) adopt an integrative approach to learning the biomedical, behavioral, and social sciences using Engel's "biopsychosocial model" as a link between the BSS and clinical practice, (2) define a hierarchy of learning objectives and assign the highest priority to acquisition of clinically relevant skills, and (3) develop clinical role models through teacher training programs. This approach emphasizes the clinical relevance of the BSS, defines learning priorities, and promotes cooperation between clinical faculty and behavioral scientists.

Behavioral Sciences↗

Implementing goals for non-cognitive outcomes within a basic science course.

OBJECTIVE: An essential principle of competency-based education (CBE) is use of observable outcomes with assessments as judgments of competence based on defined criteria. Faculty are accustomed to using learning objectives as the defining criteria for knowledge, assessing students using written exams. Faculty are less familiar with how the principles of CBE are applied to other competencies. We recently adopted school-wide goals and objectives, modeled after the ACGME Outcomes Project. The present objective was to give faculty first-hand experience in CBE within a basic science course, including both cognitive and non-cognitive outcomes. DESCRIPTION: The format for the learner-centered, first-year Cell and Molecular Biology course was previously described.(1) Course goals were that students: (1) gain an understanding of the principles and concepts of cell and molecular biology, (2) develop an appreciation for how these principles and concepts are important to medicine, (3) demonstrate an ability to think critically using these principles and concepts. Goal 1 was measured by written exams. We assumed goals 2 and 3 were met through small-group problem-solving sessions, and outcomes were not assessed. The revised 2001 course goals were to prepare students for medical knowledge and lifelong learning and communication and professionalism. The goals for medical knowledge and lifelong learning were to: (1) demonstrate ability to use principles and concepts of cell biology, molecular biology, and genetics to analyze medically relevant data, solve problems, make predictions, and determine a course of action; (2) effectively use information technology to search, evaluate, and critically review scientific evidence related to principles and concepts covered in the course; (3) use appropriate techniques to teach peers in a conference setting. The goals for communication and professionalism were to: (1) use appropriate skills and attitudes to collaborate effectively with peers and faculty to accomplish learning goals; (2) maintain a personal learning portfolio to develop habits of reflective learning, broaden understanding of content beyond recall, and enhance communication with faculty; (3) demonstrate personal integrity in meeting course requirements and in interactions with peers and faculty throughout the course. Goals for medical knowledge and lifelong learning were assessed by written exams and by separate tools utilizing four-point Likert scales (novice, advanced beginner, proficient, distinguished) with specific observable criteria for a written research paper and a group PowerPoint presentation. Faculty and student assessments generated a number that was combined with exam grades for a lettered competency grade. A 19-item, five-point Likert scale was used by students to self- and peer-assess goals for communication and professionalism. Small-group faculty facilitators used the tool to give formative feedback midcourse, summative feedback at course conclusion, and competency grades. The tools may be viewed at: . DISCUSSION: Faculty achieved enhanced understanding of students, assisted by descriptive criteria, while suggesting improvements in forms. Better agreement on criteria definitions and consistency in form use is needed. Students developed understanding and improved communication/professionalism skills, based on repeated exposures to criteria and feedback. It remains to be seen whether the skills are used/developed in other courses. A majority of students did not use the learning portfolio as envisioned. Better design and implementation of school-wide rather than course-specific reflective portfolios may increase use and integrate learning in all courses with all six competencies.

Cognition↗

Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience.

Problem-based learning (PBL), as implemented in the health sciences, is an educational method in which the focus of learning is a small-group tutorial in which students work through health care scenarios. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion. Learning is student-centered rather than faculty-centered, and self-directed learning is emphasized. The method was developed in the McMaster University medical school program and has since been adopted by many health care professional schools around the world. The theoretical basis and suggested advantages and disadvantages of PBL are outlined. Three approaches to PBL have been identified in the literature: completely integrated PBL curricula, transitional curricula, and a single-course approach. The advantages and disadvantages of each approach are addressed. The physical therapist (PT) program at McMaster University is a completely integrated problem-based curriculum. The history and process of PBL in general and in the PT program are reviewed. The implications of our experience for the development of other PBL courses and curricula are discussed. Evidence for proposed differences in students' performance and outcomes in PBL versus traditional curricula is critically reviewed. Recommendations are made for implementing PBL in PT curricula.

Curriculum↗

Staff development planning in an academic health sciences library.

OBJECTIVE: A staff development committee (SDC) was convened to implement staff development opportunities for an academic health sciences library system comprised of three separate facilities. The charge for the SDC was to: (1) develop programs to enhance workplace skills and personal growth, (2) communicate the availability of existing programs at the university and medical center, and (3) encourage the staff to participate in these opportunities. PROGRAM: The committee created goals and objectives and developed a survey designed to give staff the opportunity to provide input for this initiative. With an 80% response rate, the survey results were used to plan 15 events based on staff needs and preferences. First-year attendance for SDC-sponsored events was 459. Committee members served as liaisons for each event. Two forms were developed to facilitate event planning. A monthly announcement sheet, email reminders, and the library's local area network are used to communicate upcoming SDC events and encourage attendance. CONCLUSION: This approach can serve as a useful model for similar program planning in any organization.

Academies and Institutes↗

Development and implementation of a microcomputer-based multi-user MEDLINE system.

The Health Sciences Libraries Consortium, a group of health sciences libraries based in Philadelphia, PA, has implemented a MEDLINE database retrieval system based on the CD Plus PlusNet2 system. The system provides access to the entire MEDLINE database file through three centralized servers and four distributed servers, and is accessible over the HSLC wide-area network linking all of its members. This article describes the implementation process, from selection of the system to future development.

CD-ROM↗

Preliminary investigation of voice onset time production in persons with dysphagia.

The purpose of this study was to determine whether voice onset time (VOT) values of persons with dysphagia differed from those of a person with normal swallow function. Five male subjects with dysphagia (average age = 80.6 years) and a control subject (age = 79 years) read 18 consonant-vowel-consonant words in quasi-random order. These syllables began with the voiced and voiceless cognates from the three stop places of articulation (i.e., bilabial, alveolar, and velar). These consonants were followed by the vowels /i/, /a/, and /u/. Digital audio tape recordings were performed and speech was digitized onto disk. Measurements were completed using BLISS software (Mertus J: BLISS User's Manual. Providence: Department of Cognitive and Linguistic Sciences, Brown University, 1989) implemented on a 486 microcomputer. Averages and standard deviations of the VOT measures for the six stop consonants were compared between the two experimental groups. For the dysphagic speakers, average VOT values for voiceless stops were shorter, and there were larger negative VOT values for voiced stops. Standard deviations for the VOT productions pf the dysphagic subjects were smaller. Statistical comparisons showed significant differences between individual dysphagic speakers and the normal control for three of the five subjects. These preliminary data suggest that dysphagia affects the fine motor control required for accurate VOT production in speech.

Aged↗

Microbial forensics: the next forensic challenge.

Pathogens and toxins can be converted to bioweapons and used to commit bioterrorism and biocrime. Because of the potential and relative ease of an attack using a bioweapon, forensic science needs to be prepared to assist in the investigation to bring perpetrators to justice and to deter future attacks. A new subfield of forensics--microbial forensics--has been created, which is focused on characterization of evidence from a bioterrorism act, biocrime, hoax, or an inadvertent release. Forensic microbiological investigations are essentially the same as any other forensic investigation regarding processing. They involve crime scene(s) investigation, chain of custody practices, evidence collection, handling and preservation, evidence shipping, analysis of evidence, interpretation of results, and court presentation. In addition to collecting and analyzing traditional forensic evidence, the forensic investigation will attempt to determine the etiology and identity of the causal agent, often in a similar fashion as in an epidemiologic investigation. However, for attribution, higher-resolution characterization is needed. The tools for attribution include genetic- and nongenetic-based assays and informatics to attempt to determine the unique source of a sample or at least eliminate some sources. In addition, chemical and physical assays may help determine the process used to prepare, store, or disseminate the bioweapon. An effective microbial forensics program will require development and/or validation of all aspects of the forensic investigative process, from sample collection to interpretation of results. Quality assurance (QA) and QC practices, comparable to those used by the forensic DNA science community, are being implemented. Lastly, partnerships with other laboratories will be requisite, because many of the necessary capabilities for analysis will not reside in the traditional forensic laboratory.

Bioterrorism↗

An overview of human-computer interaction.

This article presents an overview of the field of human-computer interaction. This branch of computer science concerns the design, implementation and analysis of interactive computer systems. We show that this field is multidisciplinary in essence, involving social scientists as well as computer scientists, experts of application domains, graphics designers, etc. Once the fundamental aspects of human-computer interaction are presented, we take a practical approach in order to introduce the methods, tools and techniques that are available today for the design and implementation of interactive computer systems. Finally, we present the main directions of research in this domain.

Computer Simulation↗

N-tuple Regression Network.

N-tuple neural networks (NTNNs) have been successfully applied to both pattern recognition and function approximation tasks. Their main advantages include a single layer structure, capability of realizing highly non-linear mappings and simplicity of operation. In this work a modification of the basic network architecture is presented, which allows it to operate as a non-parametric kernel regression estimator. This type of network is inherently capable of approximating complex probability density functions (pdfs) and, in the limiting sense, deterministic arbitrary function mappings. At the same time, the regression network features a powerful one-pass training procedure and its learning is statistically consistent. The major advantage of utilizing the N-tuple architecture as a regression estimator is the fact that in this realization the training set points are stored by the network implicitly, rather than explicitly, and thus the operation speed remains constant and independent of the training set size. Therefore, the network performance can be guaranteed in practical implementations. Copyright 1996 Elsevier Science Ltd

Journal Article↗

Electrophoresis: the march of pennies, the march of dimes.

The present review encompasses ca. 65 years of history of developments in electrokinetic separations, taking as a starting point the year 1937, i.e. the official launching of Tiselius' moving boundary electrophoresis (MBE). The 1950s have been particularly rich in introducing novel methodologies in zone electrophoresis (ZE), thus bringing about the decline of MBE. Among them of extraordinary importance was the development of electrophoresis on agar gels coupled to immuno-diffusion at right angles, which brought a big revolution not only in biochemistry but also in clinical chemistry. Also the by now forgotten paper electrophoresis was a landmark in separation science, in that it implemented, in its "fingerprinting" version, the first genuine two-dimensional (2D) map, coupling orthogonally a charge to a hydrophobic scale separation, while permitting for the first time the detection of spot mutations, i.e. single amino acid replacements in a polypeptide chain, that paved the way to modern genetic analysis. Equally important was the introduction of starch-block electrophoresis, that brought about the notion of sieving and the first discontinuous buffers, refined, in the 1960s, by Ornstein and Davies with their classical papers combining multiphasic buffer systems to polyacrylamide gels, that went down to history as disc-electrophoresis. The 1960s also contributed with two fundamental techniques, isoelectric focusing (IEF) and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) that permitted to discriminate proteins solely on the basis of surface charge and molecular mass, respectively. The 1970s gave other fundamental contributions, such as isotachophoresis, the first example of a fully instrumental approach to electrophoresis, both in its analytical and preparative version (Tachophor and Tachofrac), 2D maps combining IEF to SDS-PAGE at right angles and silver staining techniques, that incremented sensitivity by 3 orders of magnitude. The 1980s generated immobilized pH gradients and capillary zone electrophoresis (CZE), two big players that dominated the electrokinetic horizon for all the 1990s and still in vigorous use in present days. The review terminates with a glimpse, in the third millennium, onto microchip technology and hyphenated techniques, notably direct interfacing of various electrophoretic separation methods with mass spectrometry (MS).

Electrophoresis↗

Specific issues in health risk assessment of endocrine disrupting chemicals and international activities.

Specific issues in health risk assessment of EDCs and correlated international activities thereof are discussed. Risk characterization is a synthesis of all information including hazard assessment, dose-response relationship, and exposure information to identify clearly the strengths and weaknesses of the database, the criteria applied to evaluation and validation of all aspects of methodology, and the conclusions reached from the review of scientific information. In the case of EDCs, new models need to be developed taking into account possible new kinds of information, e.g., effects of EDCs on gene activation in response to hormonal challenge or effects on receptor expression. Such models should also account for homeostatic adaptive responses and consider the possibility of having windows of exposure for given effects. Work to compile and harmonize the definitions and terms appropriate to endocrine disruption will be conducted within the joint IPCS/OECD project on harmonization of risk/hazard assessment terminology reviews. The ICPS is the process of preparing a "State of the Science" report, and is implementing a global inventory of ongoing research on ECDs.

Animals↗