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Marijuana motives: young adults' reasons for using marijuana.

Previous research has evaluated marijuana motives among adolescents and emerging adults using a predetermined set of motives, largely adapted from the alcohol literature. This research was designed to identify marijuana motives from the perspective of the user. Recent high school graduates who reported using marijuana (N=634) provided self-generated reasons for using. The most frequently reported reasons included enjoyment/fun, conformity, experimentation, social enhancement, boredom, and relaxation. Regression analyses revealed that experimentation was consistently associated with less use and fewer problems whereas enjoyment, habit, activity enhancement, and altered perception or perspectives were associated with heavier use and more problems.

Adult↗

A formal theory for spatial representation and reasoning in biomedical ontologies.

OBJECTIVE: The objective of this paper is to demonstrate how a formal spatial theory can be used as an important tool for disambiguating the spatial information embodied in biomedical ontologies and for enhancing their automatic reasoning capabilities. METHOD AND MATERIALS: This paper presents a formal theory of parthood and location relations among individuals, called Basic Inclusion Theory (BIT). Since biomedical ontologies are comprised of assertions about classes of individuals (rather than assertions about individuals), we define parthood and location relations among classes in the extended theory Basic Inclusion Theory for Classes (BIT+Cl). We then demonstrate the usefulness of this formal theory for making the logical structure of spatial information more precise in two ontologies concerned with human anatomy: the Foundational Model of Anatomy (FMA) and GALEN. RESULTS: We find that in both the FMA and GALEN, class-level spatial relations with different logical properties are not always explicitly distinguished. As a result, the spatial information included in these biomedical ontologies is often ambiguous and the possibilities for implementing consistent automatic reasoning within or across ontologies are limited. CONCLUSION: Precise formal characterizations of all spatial relations assumed by a biomedical ontology are necessary to ensure that the information embodied in the ontology can be fully and coherently utilized in a computational environment. This paper can be seen as an important beginning step toward achieving this goal, but much more work along these lines is required.

Anatomy↗

From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

OBJECTIVE: This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. MATERIAL: Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. CONCLUSION: With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory of fuzzy sets and relations (such as the Viennese "fuzzy version" of the Computer-Assisted Diagnostic System, CADIAG, which was developed at the end of the 1970s) were constructed. The development of fuzzy relations in medicine and their application in computer-assisted diagnosis show that this fuzzy approach is a framework to deal with the "fuzzy mode of thinking" in medicine.

Diagnosis↗

Image-detected 'probably benign' breast lesions: a significant reason for referral from primary care.

In Australia, and many health care provider systems, primary care physicians are the first to see women with breast symptoms and are responsible for making decisions on whether to investigate and when to refer to specialist teams. We present an audit of new patient referrals from primary care triaged to a 'low-risk' (low likelihood of cancer) clinic on the basis of benign findings. The most common reason for referral was 'breast lump' (38%) followed by 'image-detected' abnormality (26%.) We have identified that (outside of population screening services) many women are being referred from primary care to specialist clinics for management of screen-detected lesions considered benign on imaging. Further research is needed to identify the reasons for such referrals and to develop appropriate educational strategies and clinical policy, both for the primary care and the specialist breast practitioner.

Adolescent↗

Young infants' reasoning about hidden objects: evidence from violation-of-expectation tasks with test trials only.

The present research examined alternative accounts of prior violation-of-expectation (VOE) reports that young infants can represent and reason about hidden objects. According to these accounts, young infants' apparent success in these VOE tasks reflects only novelty and familiarity preferences induced by the habituation or familiarization trials in the tasks. In two experiments, 4-month-old infants were tested in VOE tasks with test trials only. The infants still gave evidence that they could represent and reason about hidden objects: they were surprised, as indicated by greater attention, when a wide object became fully hidden behind a narrow occluder (Experiment 1) or inside a narrow container (Experiment 2). These and control results demonstrate that young infants can succeed at VOE tasks involving hidden objects even when given no habituation or familiarization trials. The present research thus provides additional support for the conclusion that young infants possess expectations about hidden objects. Methodological issues concerning the use of habituation or familiarization trials in VOE tasks are also discussed.

Decision Making↗

Early and late processes in syllogistic reasoning: evidence from eye-movements.

An eye-movement monitoring experiment was carried out to examine the effects of the difficulty of the problem (simple versus complex problems) and the type of figure (figure 1 or figure 4) on the time course of processing categorical syllogisms. The results showed that the course of influence for these two factors is different. We found early processing effects for the figure but not for the difficulty of the syllogism and later processing effects for both the figure and the difficulty. These results lend support to the Model Theory (Johnson-Laird, P. N., Byrne, R. M. J. (1991). Deduction. Hillsdale, New Jersey: LEA.) as opposed to other theories of reasoning (Chater, N., Oaksford, M. (1999). The probability heuristics model of syllogistic reasoning. Cognitive Psychology, 38, 191-258; Rips, L. J. (1994). The psychology of proof. Cambridge, MA: MIT Press; Rips, L. J. (1994). The psychology of proof. Cambridge, MA: MIT Press).

Cognition↗

Mifepristone and prostaglandin for termination of pregnancy: contraindications for use, reasons and rationale.

Drug therapies are usually contraindicated in specific patient populations where evidence suggests that administration may result in a serious reaction or may seriously and negatively alter the risk benefit of treatment. There are few absolute contraindications to licensed regimens of mifepristone and prostaglandin for termination of pregnancy. However, those that are specified on "summary of product characteristics" [product labeling (PL)] differ from country to country. Differences reflect the dynamic environment of emerging scientific evidence, local experience and guidelines, and local regulatory processes, which all influence the resultant PL. The reasons and rationale for specific contraindications for mifepristone and prostaglandin for the termination of pregnancy are detailed, and the reasons for the differences between PL in different countries are explained.

Abortifacient Agents, Steroidal↗

Reasons for dropout in an in vitro fertilization/intracytoplasmic sperm injection program.

OBJECTIVE: To gain more insight into psychological aspects of dropping out from IVF-ICSI. DESIGN: Prospective cohort study. SETTING: University hospital-based tertiary care fertility clinic. PATIENT(S): Women entering their first treatment cycle of IVF or ICSI. INTERVENTION(S): Standardized psychological questionnaires were administered before the start of the treatment and after treatment. MAIN OUTCOME MEASURE(S): Reasons for dropout, state and trait anxiety, depression, and marital and sexual satisfaction. RESULT(S): Baseline psychological factors and the probability of dropout after IVF-ICSI treatment were found to be associated in the group that stopped treatment for psychological reasons. Those who were denied further treatment by the medical team, the "actively censored" group, did not show pretreatment differences regarding psychological measures in comparison with those who continued treatment. After treatment, the group that was denied further treatment showed higher levels of anxiety and depression compared with those that continued. CONCLUSION(S): Dropout, being a well-known phenomenon in IVF-ICSI, is related to preexisting psychological factors in IVF-ICSI. Actively censored patients were psychologically well-adjusted before treatment, but this changed after censoring.

Adult↗

The decline in 'free' general practitioner care in Australia: reasons and repercussions.

The Australian public insurer, Medicare, allows general practitioners (GPs) to bulk bill patients, or accept the government rebate as full payment for their services. The percentage of GP consultations bulk billed, however has declined from 78.6% in June 2000 to 65.7% in December 2003. The immediate impact of a declining level of bulk billing is a decrease in the availability of free GP health care for patients. This has implications for copayments and access to GPs for low income groups in particular. In this paper, we explore the reasons for and repercussions of the decline in bulk billing. We analyse two main reasons for the decline. The first is a failure of the rebate to maintain a level consistent with increases in medical practice costs. The second is a decline in GPs in some regional and rural areas resulting in a decrease in price competition. The government has recently made changes to deal with the decline in bulk billing and based on three quarters of data, there has been a modest improvement in bulk billing.

Australia↗

A prognostic model for temporal courses that combines temporal abstraction and case-based reasoning.

Since clinical management of patients and clinical research are essentially time-oriented endeavours, reasoning about time has become a hot topic in medical informatics. Here we present a method for prognosis of temporal courses, which combines temporal abstractions with case-based reasoning. It is useful for application domains where neither well-known standards, nor known periodicity, nor a complete domain theory exist. We have used our method in two prognostic applications. The first one deals with prognosis of the kidney function for intensive care patients. The idea is to elicit impairments on time, especially to warn against threatening kidney failures. Our second application deals with a completely different domain, namely geographical medicine. Its intention is to compute early warnings against approaching infectious diseases, which are characterised by irregular cyclic occurrences. So far, we have applied our program on influenza and bronchitis. In this paper, we focus on influenza forecast and show first experimental results.

Computer Simulation↗

Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel.

Based on two research projects in Sweden during the 1990s, the aim of this study was to identify former nursing personnel's main reasons for leaving nursing care, and to find out under what circumstances they would consider returning. Two open-ended questions in a questionnaire were analysed. The results showed that different aspects of working conditions, mainly working schedule, management and status of profession were the dominating reasons both for leaving and considering a return. The findings indicate that interventions required for retaining personnel in nursing care need to be addressed both at the political and at the local level.

Adult↗

Stages of change in adolescents: an examination of self-efficacy, decisional balance, and reasons for relapse.

PURPOSE: The purpose of this study was to test selected constructs of the transtheoretical model (TTM) of behavior change in relation to exercise behavior with an adolescent sample. A further purpose was to examine reasons why adolescents stop physical activity and to relate these to stages of exercise change. METHODS: Participants were 15 to 17 year old students at a private high school (N = 327). Participants completed a questionnaire consisting of an exercise measure, measures of the TTM variables, and an open-ended question that asked if they used to exercise in the past but currently did not, why they had stopped. The TTM data were analyzed using ANOVA F-tests with post-hoc Scheffe tests. To evaluate the ability of the TTM variables to discriminate between stages of exercise behavior, standard discriminant function analyses were performed. Open-ended answers to the relapse question were themed according to a model which categorizes barriers preventing youth's participation in recreational activities as infrastructural, superstructural, and procedural. The relationship of perceived barriers to stage of behavior change was assessed using cross-tabulation and chi-square analyses. RESULTS: Moderate support for the TTM constructs were found, with the strongest discriminator between stages being strenuous exercise, and self-efficacy being the most supported construct. Infrastructural, superstructural, and procedural barriers were all evident. CONCLUSION: Over 30% of previously active adolescents in this study reported barriers precluding extracurricular physical activity. Interventions should target the most often cited reasons for relapse: time and limits relating to the nature of the adolescent self.

Adolescent↗

Reasons for miniplate removal following maxillofacial trauma: a 4-year study.

INTRODUCTION: There is still no consensus on the need for routine removal of titanium miniplates in the maxillofacial skeleton. The purpose of this 4-year prospective study was to evaluate the reasons for removal of titanium miniplates ("2.0mm") following maxillofacial trauma. MATERIAL AND METHODS: Records of 280 patients were evaluated concerning the number of plates inserted, the site of plating, the number of patients in whom plates were removed, the site of removal and the reasons for which removal of plates was indicated. RESULTS: In the 280 patients with facial trauma, 599 miniplates were used during this period. Thirty-seven miniplates were removed from 27 of these patients. The main causes for removal were infection and exposure of the plate in the oral cavity, patients' request and/or the plates being palpable. The nasofrontal region, the area around the anterior wall of the antrum and the body of the mandible proved to be the commonest regions where plate removal was required. CONCLUSION: The number of miniplates removed was small but not insignificant. There is no evidence from this study to support advice for the routine removal of titanium miniplates from the maxillofacial skeleton.

Adolescent↗

An examination of the characteristics and traffic risks of drivers suspended/revoked for different reasons.

PROBLEM: Prior research has demonstrated that suspended/revoked drivers pose a significant traffic risk, but until now little has been known about whether, and if so how, this risk varies as a function of the reason for suspension/revocation. METHOD: This study classifies suspended/revoked drivers into subgroups based on their reason for suspension/revocation, and then develops demographic and driving record profiles for each group. Separate driving record profiles are developed for the following traffic safety indicators, measured 3 years prior to the suspension/revocation action: (a) total crashes, (b) fatal/injury crashes, (c) total traffic convictions, and (d) total incidents (crashes + convictions). RESULTS: The findings clearly show that: (a) suspended/revoked drivers are a heterogeneous group, both demographically and in their driving behavior; (b) some suspended drivers, such as those suspended/revoked for a non-driving offense, have low traffic risks that are not much higher than those of validly-licensed drivers, and; (c) all suspended groups have elevated crash and conviction rates, compared to validly-licensed drivers. DISCUSSION: The implications of these findings for current laws and policies targeting suspended/revoked drivers are discussed, and recommendations for improving these laws/policies are presented. IMPACT ON INDUSTRY: None.

Accidents, Traffic↗

The interpretation of experience and its relationship to body movement: a clinical reasoning perspective.

In this paper, we present findings from literature which suggests an intrinsic relationship in patients with chronic pain between the development of rigid and limited perspectives based on the interpretation of experience and the development of decreased repertoires of movement patterns. We present a research-based clinical reasoning model for conceptualising the teaching of movement for patients with chronic pain and contend that therapists can intentionally teach movement using fundamentally different reasoning and learning processes. We propose that these different kinds of learning will assist clinicians to translate the findings of diverse and complex pain research to clinical practice and, in particular, the teaching of these patients both new perspectives and movement patterns.

Chronic Disease↗

Reasons patients present to the emergency department might change during epidemics and be a valuable component of a disease surveillance system.

We hypothesize that the frequency of reasons patients present to the emergency department will change during epidemics and might be a valuable component of a disease surveillance system. We found support for this hypothesis over a two-year period with high frequency days of fever clustering during two periods of increased hospital influenza activity, but not during any other period during the two-years. This methodology appears to be superior to the previous use of triage nurses defining patients with symptom complexes. Such a system could result in online monitoring, be independent of the medical personnel (use of admission secretary), and might be able to identify various epidemics including increased hospital disease activity due to bio-terror attacks, influenza, and food poisoning. This would have important implications for limiting the spread of disease and for the acute planning of distribution of medical resources. Studies are warranted in various settings to determine whether or not changes in the daily frequencies of reasons patients present to the ED will allow identification of epidemics.

Disease Outbreaks↗

The dawn of science-based moral reasoning.

In 1998, Edward O. Wilson discussed the biological basis of morality, pointed out that the analysis of its material origins should enable us to fashion a wise ethical consensus, and predicted the dawn of science-based moral reasoning. This article testifies that his prediction was right. Morality, being based on altruism and collaboration, evolved as a socially advantageous biological phenomenon aimed at ensuring the survival of our species, which was structured in small groups at high risk of extinction for the 99.5% of its existence. In the last 0.5%, the advent of agriculture resulted in a demographic explosion that impaired human beings' moral discernment, because the socially detrimental consequences of immoral actions, which had been recognised and condemned promptly in small groups consisting of a few tens of members, were diluted among millions of untouched individuals, thereby becoming less easily recognisable. Nowadays, to test the supposed morality of individual actions and government policies, we should use reason or, in doubtful cases, mathematical modelling to determine their predictable effects on the survival of small theoretical communities. Unless we untenably claim that the unlikelihood of extinction of today's immense societies entitles us to overturn the meaning of morality, all actions and policies that would cause the extinction of small communities should be regarded as indisputably immoral. This article also presents some examples of science-based moral arguments showing the immorality of restrictions and bans on research with human embryonic stem cells and demonstrates that the old concept of the "naturalistic fallacy", which philosophers frequently invoke to dismiss any scientific approach to morality, is no longer tenable, because it increasingly emerges to be a proof of what may well be defined the "philosophical fallacy".

Biological Evolution↗

Reasons for post registration learning: impact of the learning experience.

This exploratory study is the second stage of a multi-method approach to explore some of the reasons why registered nurses take part in formal and informal learning and higher education. Also under exploration is the extent to which their various learning experiences met their expectations. The sample consists of 25 registered nurses, randomly selected from a population (N=162) of 1st and 2nd Level nurses employed in public and private clinical settings, who have taken part in continuing education to obtain a Diploma or a Degree in Nursing. The data gathering was achieved by three focus group interviews. Formal learning included mandatory and non-mandatory in house teaching. Mandatory input was regarded as a self-protection measure by the employer, not related to personal development and with no perceived benefit on client care. Regarding the achievement of additional clinical competences, the overwhelming reason is to improve client care, although the motives of the employer and medical staff are viewed with some suspicion as a measure to saving doctors' time. Higher education pursuits appears to be triggered by a perceived need to increase the participants' level of existing knowledge in line with that of current students on placement, but adjustment to adult life transition period also appear to be an influencing factor. In terms of learning experiences, the relevance and quality of mandatory sessions came under criticism, whilst a measure of surprise was expressed at the unexpected benefits, at a personal and a professional level, gained by taking part in academic learning.

Adult↗