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Dynamics of Salmonella contamination in a commercial quail operation.

Control of carcass contamination requires knowledge of the source and dynamics of spread of Salmonella in commercial poultry production. We examined Salmonella contamination at a U.S. commercial quail operation. Pulsed-field gel electrophoresis (PFGE) was used to type isolates in order to trace Salmonella throughout this production environment. During a 6-mo survey, Salmonella serotypes hadar, typhimurium, typhimurium variant Copenhagen, and paratyphi were encountered within this poultry operation. Ninety-four percent of the Salmonella isolated from breeder and production houses and from carcass rinses belonged to Salmonella serotypes typhimurium variant Copenhagen and hadar. There were six distinct S. typhimurium variant Copenhagen genetic types, as identified by PFGE, present within this particular poultry operation. Seventy-nine percent of S. typhimurium variant Copenhagen identified from the environment of the breeder and production houses produced the same PFGE pattern. Thirty-eight percent of S. typhimurium Copenhagen isolated from carcass rinses and the breeder house shared the same PFGE DNA pattern. This study demonstrates the transmission of salmonellae throughout this production environment, from the breeders to their progeny and to the birds ultimately processed for human consumption.

Animal Husbandry↗

Mapping the UMLS Semantic Network into general ontologies.

In this study, we analyzed the compatibility between an ontology of the biomedical domain (the UMLS Semantic Network) and two other ontologies: the Upper Cyc Ontology (UCO) and WordNet. 1) We manually mapped UMLS Semantic Types to UCO. One fifth of the UMLS Semantic Types had exact mapping to UCO types. UCO provides generic concepts and a structure that relies on a larger number of categories, despite its lack of depth in the biomedical domain. 2) We compared semantic classes in the UMLS and WordNet. 2% of the UMLS concepts from the Health Disorder class were present in WordNet, and compatibility between classes was 48%. WordNet, as a general language-oriented ontology is a source of lay knowledge, particularly important for consumer health applications.

Animals↗

Identifying and managing adverse environmental health effects: 3. Lead exposure.

Lead levels in North American children and adults have declined in the past 3 decades, but lead persists in the environment in lead paint, old plumbing and contaminated soil. There are also a number of occupations and hobbies that carry a high risk of lead exposure. There is no evidence for a threshold below which lead has no adverse health effects. Blood lead levels previously considered safe are now known to cause subtle, chronic health effects. The health effects of lead exposure include developmental neurotoxicity, reproductive dysfunction and toxicity to the kidneys, blood and endocrine systems. Most lead exposures are preventable, and diagnosing lead poisoning is relatively simple compared with diagnosing health effects of exposures to other environmental toxins. Accurate assessment of lead poisoning requires specific knowledge of the sources, high-risk groups and relevant laboratory tests. In this article we review the multiple, systemic toxic effects of lead and provide current information on groups at risk, prevention, diagnosis and clinical treatment. We illustrate how the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) and specific screening questions are useful tools for physicians to quickly obtain an environmental exposure history and identify patients at high risk of lead exposure. By applying effective primary prevention, case-finding and treatment interventions for lead exposure, both the individual patient and the larger community reap the benefits of better health.

Adult↗

The UMLS Semantic Network and the Semantic Web.

The Unified Medical Language System is an extensive source of biomedical knowledge developed and maintained by the US National Library of Medicine (NLM) and is being currently used in a wide variety of biomedical applications. The Semantic Network, a component of the UMLS is a structured description of core biomedical knowledge consisting of well defined semantic types and relationships between them. We investigate the expressiveness of DAML+OIL, a markup language proposed for ontologies on the Semantic Web, for representing the knowledge contained in the Semantic Network. Requirements specific to the Semantic Network, such as polymorphic relationships and blocking relationship inheritance are discussed and approaches to represent these in DAML+OIL are presented. Finally, conclusions are presented along with a discussion of ongoing and future work.

Programming Languages↗

A study of biomedical concept identification: MetaMap vs. people.

Although huge amounts of unstructured text are available as a rich source of biomedical knowledge, to process this unstructured knowledge requires tools that identify concepts from free-form text. MetaMap is one tool that system developers in biomedicine have commonly used for such a task, but few have studied how well it accomplishes this task in general. In this paper, we report on a study that compares MetaMap's performance against that of six people. Such studies are challenging because the task is inherently subjective and establishing consensus is difficult. Nonetheless, for those concepts that subjects generally agreed on, MetaMap was able to identify most concepts, if they were represented in the UMLS. However, MetaMap identified many other concepts that peo-ple did not. We also report on our analysis of the types of failures that MetaMap exhibited as well as trends in the way people chose to identify concepts.

Abstracting and Indexing↗

A framework for classifying decision support systems.

BACKGROUND: Computer-based clinical decision support systems (CDSSs) vary greatly in design and function. A taxonomy for classifying CDSS structure and function would help efforts to describe and understand the variety of CDSSs in the literature, and to explore predictors of CDSS effectiveness and generalizability. OBJECTIVE: To define and test a taxonomy for characterizing the contextual, technical, and workflow features of CDSSs. METHODS: We retrieved and analyzed 150 English language articles published between 1975 and 2002 that described computer systems designed to assist physicians and/or patients with clinical decision making. We identified aspects of CDSS structure or function and iterated our taxonomy until additional article reviews did not result in any new descriptors or taxonomic modifications. RESULTS: Our taxonomy comprises 95 descriptors along 24 descriptive axes. These axes are in 5 categories: Context, Knowledge and Data Source, Decision Support, Information Delivery, and Workflow. The axes had an average of 3.96 coded choices each. 75% of the descriptors had an inter-rater agreement kappa of greater than 0.6. CONCLUSIONS: We have defined and tested a comprehensive, multi-faceted taxonomy of CDSSs that shows promising reliability for classifying CDSSs reported in the literature.

Classification↗

[Interleukin 2 receptor--the structure, function and clinical significance in malignant diseases of adults and children].

The paper summarizes the up-to-date knowledge on structure, source, biological function and clinical significance of Interleukin-2 receptor measurements in patients suffering from neoplastic diseases. The authors review the role and clinical usefulness of soluble IL-2R alpha in neoplasms' diagnostics, prognosis and treatment monitoring both in adult patients and in children.

Adult↗

The applicability of experimental experience with the total artificial heart to its clinical use.

Long-term experiments with the total artificial heart (TAH) are a source of valuable knowledge for later clinical application. Our observations result from 66 long-term experiments on calves and one goat ranging from 30 to 314 days, which have shown the main possible complications in the early period (one month) and later in the experiment. Problems until the second month of pumping concern the clinical pendant of the TAH as a bridge for transplantation, i.e. surgical problems, blood coagulation disorders, infection etc. Later problems are high venous pressure or arterial hypertension, infection with septic thromboembolization, mineralization of the driving diaphragm, etc., and are more closely comparable to the conditions of permanent clinical use of the TAH. Faultless surgery, device function and the regimen of pumping are essential factors in every long-term experiment, just as in clinical application. Infection is a threat throughout any experiment, as in clinical cases. The TNS-BRNO-VII/clin/80 TAH has been implanted in six patients.

Adult↗

[Our profession--as much an art as a science--Tidsskriftet 1881 - 1906].

The Norwegian journal entitled The Journal of Practical Medicine: (Tidsskrift for praktisk Medicin) was established in 1881. From the eighth volume and onwards, publishing responsibility was taken over by the Norwegian Medical Association. In 1890, the name of the journal was changed to the Journal of The Norwegian Medical Association (Tidsskrift For Den norske laegeforening):, which this year celebrates its 125th anniversary. Why did a new medical journal emerge in the 1880s and why did it survive? How was the journal influenced by its time and how did it itself influence time, profession and field? Investigating the 25 first years of the history of the journal might give us some answers to these questions. The journal was more or less established as a protest against the strong theorisation of medicine and the dominant role of the natural sciences. The aim of the "founding fathers" was, through practical examples, to strengthen the art and practice of medicine. Practical experience is, the editors proclaimed, an essential source of medical knowledge and understanding. Under the auspices of the Medical Association, a new editorial line was established. From now on hygiene and social medicine were highlighted as key issues within medicine. In this the journal reflected dominant traits within society in general. Around 1900 there was an increasing demand for the competence of the professions in solving general problems. Steadily more areas were politicised and theorised. The journal reflected these traits and played an important role in the process of professionalisation and education in citizenship--in raising doctors' attention and responsibility towards societal issues.

Editorial Policies↗

[Ukhtomskiĭ and the nature of the human "ego"].

A. Ukhtomskiĭ is one of those Russian naturalists of the beginning of the 20th century (K. Tsiolkovskiĭ, V. Vernadskiĭ, K. Timiriazev, I. Pavlov), whose scientific work is characterized by a combination of the valuable contribution to a specific field of science and deep philosophical conceptualizations. Ukhtomskiĭ enriched modern neurophysiology by the ideas on dominant--a stable focus of enhanced excitability, determining the organism reactions to the environmental stimuli. Unlike artificial experimental models, natural dominant--vector of the goal-directed behaviour--represents the needs of immediate satisfaction, dominating at the present moment. Formation of needs hierarchy, characteristic of the given personality, occurs during the process of people communication. Namely, another man serves to the subject a mirror, looking into which he realizes himself as a human being (K. Marx). By his teaching on the dominant, Ukhtomskiĭ has revealed the dual nature of the personality's self-consciousness in the process of its perception of the surrounding people. He showed that involuntary projection of its dominating vital and social needs (motives, intentions) to the image of another man makes the latter only the "double" of the observer, which does not promote the development and enrichment of personality. Actually productive is only the perception which is motivated by the ideal need of learning another personality, sincere interest in him, what makes another person a "well-deserved colocutor", a source of new knowledge about people and himself. The ideas of Ukhtomskiĭ on the nature of human "self" are close to ideological searchings of L. Tolstoĭ and F. Dostoevskiĭ.(ABSTRACT TRUNCATED AT 250 WORDS)

Ego↗

[Dental educational level of teachers in three primary schools in Iaşi].

METHOD: We assessed the level of dental education of 120 teachers from 3 primary schools using a 13 question interview. RESULTS: The information on the etiology of dental decay is more accurate in female than in male teachers (53.15% vs 47.56%). Knowledge of prevention is also better in female teachers. Nutrition information level is average, older teaching staff possesses a higher level of knowledge. The main sources that are used in order to access the information are represented by television, books and journals. The teaching staff's involvement in dental education varies widely, from non-involvement to almost 80%. CONCLUSION: The level of teaching's staff dental education is average and a greater involvement is needed in order to improve the dental health of school children.

Adult↗

Structural visualization of expert nursing: Development of an assessment and intervention algorithm for delirium following abdominal and thoracic surgeries.

An assessment and intervention algorithm for delirium following abdominal and thoracic surgeries was developed based upon the current knowledge-base. The sources of information included literature and clinical expertise. The assessment and intervention algorithm was structured and visualized so that patient-tailored and risk-stratified prediction/prevention, assessment, and intervention could be carried out. Accumulation of clinical outcome data is necessary in the future validation study to identify the relative weight of risk factors and clinical utility of the algorithm.

Abdomen↗

"At times these ancient facts seem to lie before me like a patient on a hospital bed'--retrospective diagnosis and ancient medical history.

Research in ancient medical history, Greek and Roman as well as Mesopotamian and Egyptian, is usually done by philologically trained scholars; the ability to read texts in their original language is fundamental (though not sufficient) for any substantial work. There is, however, in such works the notion that something may be missing in fully understanding medicine of a certain time and culture. Does a medical historian of ancient medicine need, in addition to his philological and historical skills, a medical education? And in what way is a 'medical approach' to ancient medicine useful? Is it possible to stand at the bedside of a Hippocratic patient as a clinician or reconstruct the 'pathocoenosis', as Mirko D. Grmek (+ 2000) coined it, of ancient Greece? The present paper outlines the problem of applying present medical knowledge to ancient sources and touches on the topic of primary perception of disease and illness. An important aspect is that disease entities change in their socio-cultural setting. Examples ranging from the supposed Lupus erythematodes of the Assyrian king Esarhaddon to cases in the Hippocratic Epidemiae and plague descriptions of Greek authors illustrate the problem of retrospective diagnosis.

Ancient Lands↗

Complications of foot surgery. Laser surgery.

The carbon dioxide laser, when used surgically, is a possible source of complications. Knowledge of laser physics, tissue effects, and target tissue anatomy are of the utmost importance for minimizing complications. This article seeks to elucidate the factors involved in laser beam physics and the effect of these factors on target tissue, based on specific tissue anatomy. Common tissue complications and specific procedure-oriented complications that may arise as a result of laser surgery will be discussed and reviewed.

Burns↗

Basic mechanisms in vascular headache.

To better understand and treat painful conditions, one needs to identify the cause, discover the source, and develop knowledge of peripheral and central pain transmission; headaches are no exception. The development of appropriate animal models is important. Accordingly, we have reviewed the anatomy, neurochemistry, electrophysiology, and pharmacology of the trigeminovascular system in experimental animals and emphasized whenever possible the relevance of this final common pathway to migraine, cluster, and other headache syndromes in humans. For example, based on recent anatomic dissections, the pericarotid cavernous sinus plexus was suggested as an important focus to investigate cluster headache pathophysiology. This plexus is an anatomic point of convergence for the nerves giving rise to the signs of sympathetic and parasympathetic activity and sensory symptoms that develop in cluster patients. As in other nociceptive systems, trigeminovascular axons assume at least two important roles. One concerns the transmission of nociceptive information. Electrophysiologic evidence supports the trigeminal nucleus caudalis as an important site for the convergence of visceral (vessel) and somatic (forehead) inputs to mediate the referral of vascular pain to superficial tissues. A second important role concerns the initiation of local increases in blood flow and enhanced protein permeability (sterile inflammation) via the axonal release of vasoactive neuropeptides. Plasma extravasation develops within the dura mater following trigeminal stimulation. Extravasation can be blocked by the administration of ergot alkaloids or sumatriptan, a new serotonin-like agonist, and a prejunctional (neuronal) mechanism of action for these drugs (such as blockade of release) was suggested based on experimental evidence. Whether vasoconstriction also relates to the therapeutic efficacy remains to be determined. As in other organ systems, real or threatened tissue injury provides an important stimulus for depolarizing sensory fibers. The stimulus may come from external conditions such as reduced blood flow or hypoglycemia. The brain may also possess intrinsic neuronal mechanisms by which nociceptors may be synthesized (e.g., glutamate-induced neurotoxicity, seizures). Molecules of relevance include bradykinin, prostaglandins, leukotrienes, and potassium. Experimental evidence was presented demonstrating that the trigeminal nerve mediates hyperemia within cortical gray matter by axon-reflex like mechanisms. An important role for this nerve was established during the hyperemic period of recirculation after ischemia or during severe hypertension above the limits of autoregulation.(ABSTRACT TRUNCATED AT 400 WORDS)

Axons↗

Addressing the issue of cataloging and making chiropractic literature accessible: Part I: Defining the problem.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A review of the literature shows there is a trend toward database management for cataloging and accessibility of other, nonchiropractic, literature. Most notable of these is an endeavor by National Technical Information Service, commonly referred to as MEDLARS (Medline). It is interesting to note that a computer-assisted library database program does not exist on any chiropractic campus. This is in contrast with the trend on campuses of other health care fields. Manual search strategies within the chiropractic literature are time consuming, subject to a high failure rate, and even if the search produces citations, there is no assurance the journal can be accessed unless a chiropractic campus is nearby. Furthermore, difficulties exist when a chiropractic literature search is attempted in any computerized database, e.g., MEDLARS (Medline). Journals/articles that are unique to chiropractic (national, international or on the state level) are not specifically included in these computerized databases. Aside from these difficulties, there exists the problem of finding those articles that contain valid and relevant information from among those that are less valid or informative.

Cataloging↗

Addressing the issue of cataloging and making accessible chiropractic literature: Part II. Pilot software development program.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty, and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A solution to those problems of accessing, obtaining, and storing article citations from the chiropractic literature come from a pilot computerized program developed for use on the Los Angeles College of Chiropractic (LACC) campus. The Chiropractic Literature Archive and Search Program (CLASP) is dedicated to chiropractic literature. It provides rapid access to the literature and directs the user to one of the participating chiropractic campuses where the article can be found. Because of its ease of operation, the program is a useful tool for nearly all areas of chiropractic, ranging from education and research to clinical patient management. The program would be inexpensive to fully implement, and the hardware needed is minimal. Important protocols have been developed for database input, use and maintenance. Testing of this program on the LACC campus reveals that such a program is capable of making citations of the chiropractic literature available within days of their publication.

Abstracting and Indexing↗

The prevention of adolescent pregnancy.

Adolescent pregnancy is best prevented. Prevention, however, is problematic, because adolescents become biologically mature at an earlier age today than in past generations. Most adolescents are still psychologically immature when they initiate sexual activity. Delayed initiation of sexual activity during adolescence, therefore, is the ideal solution. Physicians are an important resource in encouraging responsible sexual behavior and preventing adolescent pregnancy and in guiding the patient and her family when adolescent pregnancy does occur. Physicians can provide age-appropriate contraceptive services and adolescent prenatal and postpartum services. They can also participate actively in community-based sex and family life educational programs as knowledgeable and respected sources of information and guidance.

Adolescent↗