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PubMed2000

An integrated web interface for large-scale characterization of sequence data.

Large-scale genome projects require the analysis of large amounts of raw data. This analysis often involves the application of a chain of biology-based programs. Many of these programs are difficult to operate because they are non-integrated, command-line driven, and platform-dependent. The problem is compounded when the number of data files involved is large, making navigation and status-tracking difficult. To demonstrate how this problem can be addressed, we have created a platform-independent Web front end that integrates a set of programs used in a genomic project analyzing gene function by transposon mutagenesis in Saccharomyces cerevisiae. In particular, these programs help define a large number of transposon insertion events within the yeast genome, identifying both the precise site of transposon insertion as well as potential open reading frames disrupted by this insertion event. Our Web interface facilitates this analysis by performing the following tasks. Firstly, it allows each of the analysis programs to be launched against multiple directories of data files. Secondly, it allows the user to view, download, and upload files generated by the programs. Thirdly, it indicates which sets of data directories have been processed by each program. Although designed specifically to aid in this project, our interface exemplifies a general approach by which independent software programs may be integrated into an efficient protocol for large-scale genomic data processing.

Clinical Laboratory Information Systems↗
PubMed2004

Death rates of medical school class presidents.

Medical professionals often face many competing demands to contribute both to the clinical care of patients and to the public health of society. We studied the long-term survival of doctors graduating from one medical school over one century (n = 1521), comparing those who were presidents of their class to those who appeared alphabetically before or alphabetically after the president in the graduating class photograph. Statistics on long-term mortality were obtained from licensing authorities, medical obituaries, professional associations, alumni records, and national physician directories (follow-up 94% complete, median follow-up duration = 38 years, total deaths = 220). We found that most graduates were male (88%), white (93%), and younger than 30 years at time of graduation (93%). Presidents more frequently made contributions to society than their classmates, as recognized by professional alumni notices (21.9% vs. 13.3%, P < 0.001) and Who's Who directory listings (7% vs. 0.5%, P < 0.001). Nonetheless, survival after medical school was 2.4 years shorter for presidents than their classmates (49.0 vs. 51.4, P = 0.036). The decrease in life-expectancy was unrelated to medical school marks or early career mortality and was accentuated after adjustments for birth year, gender, race, and specialization (P = 0.001 ). We suggest that the type of medical professional who sacrifices themselves for this type of professional prestige may also be the type who fails to look after their health or is otherwise prone to early mortality.

Age Factors↗
PubMed1997

The role of clinical dietitians as perceived by dietitians and physicians.

OBJECTIVE: The purpose of this study was to examine dietitians' and physicians' perceptions regarding the role of clinical dietitians. SUBJECTS AND DESIGN: Four hundred ten physicians and clinical dietitians were randomly identified from the American Board of Medical Specialties Directory of Board Certified Medical Specialists and from Michigan district dietetic association directories. A survey containing demographic, situational, and role and responsibility questions was administered. STATISTICAL ANALYSES PERFORMED: Cronbach's alpha coefficient was computed to determine the internal consistency of the measurement instrument. A series of two-tailed t tests was performed to determine between-group differences on the perception questions. Analysis of covariance was completed to control for potential confounds. chi 2 Tests were performed to determine the relationship among a change of diet order question and participants' occupation, area of specialty, and practice setting. RESULTS: Of the surveys mailed, 73% were returned and 58% overall were usable. The internal consistency of the measure was .72. Most dietitians' and physicians' responses to the role and responsibility questions differed significantly, with particularly large differences noted for 6 of 10 questions; however, "total score" differences were not significant. Significant associations were found for the level of specialization and type of occupation on the change of diet order question. APPLICATION/CONCLUSIONS: Routine contact, communication, and interaction between physicians and dietitians are vital if physicians are to know dietitians' responsibilities and competencies and collaborate with them when providing medical nutrition therapy to patients. Future studies that differentiate areas of responsibility of clinical dietitians and inquire into dietitians' and physicians' interactions during their education or training may provide further insights into this topic.

Cross-Sectional Studies↗
PubMed2000

Use of new technology in endourology and laparoscopy by american urologists: internet and postal survey.

OBJECTIVES: To assess the use of new technology by American urologists. METHODS: Using the American Urological Association directory, surveys were sent via the U.S. postal service to 1000 randomly selected American urologists and 3065 urologists who had an Internet address listed in the directory. RESULTS: Responses were received from 601 urologists (415 postal, 186 Internet). Overall, 81% of survey respondents reported performing fewer or the same number of percutaneous procedures as compared with 3 to 4 years ago and 84% reported carrying out more or the same number of ureteroscopic procedures in the treatment of patients with stone disease. Open dismembered pyeloplasty (43%) and Acucise endopyelotomy (42%) were most frequently reported as the preferred treatment for adult patients with symptomatic ureteropelvic junction obstruction. Although 60% of respondents reported that they have taken a laparoscopy course, 67% currently do not perform any laparoscopy in their practice. In addition, only 7% of urologists stated that laparoscopy comprises more than 5% of their practice. When stratified by the number of years in practice, those in practice less than 10 years were more likely than those in practice 10 to 20 years and those in practice longer than 20 years to have performed an endopyelotomy (77%, 60%, and 48%, respectively, P <0.001) and to be currently performing laparoscopy (49%, 36%, and 18%, respectively, P <0.001). CONCLUSIONS: Compared with 3 to 4 years ago, American urologists are performing more ureteroscopy and fewer percutaneous stone procedures. Although most urologists have taken laparoscopy courses, this modality has not been widely incorporated into their practices at present.

Child↗
PubMed1988

American poison control centers: still not all the same?

Although poison control centers meeting the criteria for certification by the American Association of Poison Control Centers as regional centers are widely believed to differ from centers not meeting these criteria, this assumption has not recently been validated. We surveyed all poison control centers listed in the Emergency Medicine 1986 directory of poison control centers or in the 1986 American Association of Poison Control Centers membership directory regarding their operations. Of 208 poison control centers listed, 167 (80.2%) responded; 28 of 35 regional poison control centers (80.0%) responded, as did 139 of 173 nonregional poison control centers (80.3%). The median annual call volume was 3,899 for all centers. For regional poison control centers, the median was 44,429, and for nonregional poison control centers, 1,553 (P less than .001). There also were highly significant differences in population served, call volume per capita, center staffing, medical direction, staff orientation, and follow-up protocols.

Poison Control Centers↗
PubMed1997

Tracking and follow-up of 16,915 adolescents: minimizing attrition bias.

This paper reports a multi-dimensional approach to minimize drop-outs from a two-year follow-up of a clinical trial designed to reduce initiation of tobacco use in 16,915 adolescent orthodontic patients. A hierarchical approach to data collection and tracking was employed. Seventy percent of participants were reached and interviewed at home by telephone. Strategies used to survey remaining participants included calling parents' work numbers and directory assistance, reviewing orthodontists' charts, sending surveys by mail, offering incentives, and using reverse telephone directories. More than 92% of the participants completed follow-up surveys. Multivariate analyses showed that baseline tobacco and alcohol use predicted loss to follow-up. Similarly, the number of procedures used to track each participant predicted presence of risk behaviors at post-test, demonstrating that an organized tracking hierarchy curtailed even greater compromises to internal and external validity. Evaluation and costs of individual strategies are discussed.

Adolescent↗
PubMed1998

Successful web searching.

This section of the series introduces the topic of WWW search engines and directory sites; showing you how to find information using a search engine and a directory. It also covers other ways of searching for information on the internet.

Dentistry↗
PubMed2000

Local information for primary care: the St Albans WAX Project (STAPCIS).

The St. Albans Primary Care Information Service (STAPCIS) is a database of locally focused information designed to be of use for GPs and the Primary Care team as a whole in a particular area. It is currently being used by practices in the St. Albans, Dacorum and Watford & Three Rivers Primary Care Groups. STAPCIS developed from a project initiated in late 1997 to pilot the use of the WAX software to improve access to directory-type and full-text material needed for easy access by primary care staff and traditionally difficult to manage. The database is updated centrally by the STAPCIS Librarian who distributes the new editions to the practices. The WAX software itself was developed by the Cambridge Centre for Clinical Informatics. STAPCIS contains locally and nationally produced relevant information from a variety of sources, including full-text clinical guidelines and directories of Trusts. Decisions on new content are made by a Steering Group and the GPs and Primary Care teams are particularly encouraged to make suggestions regarding new content. The service is financially supported by the three primary care groups. The STAPCIS Librarian is project-managed by the Library & Information Development Unit (North Thames ), which also provides additional equipment and expertise. A new software company, WaX Info Ltd ( ), will soon be releasing a new version of the software, WaX. WaX consists of a WaX client and WaX ActiveLibrary server software. With the new version, the 'books' of information will still be stored on the user's PC, retaining the speed of access, but the server will enable users to 'borrow' books from remote locations and will provide automatic updates of all books. The new software will improve the management and distribution processes of STAPCIS once all of the practices have Internet connectivity.

Community Health Services↗
PubMed2000

Mimicking dominant negative inhibition of prion replication through structure-based drug design.

Recent progress determining the structure of the host-encoded prion protein (PrP(C)) and the role of auxiliary molecules in prion replication permits a more rational approach in the development of therapeutic interventions. Our objective is to identify a new class of lead compounds that mimic the dominant negative PrP(C) mutants, which inhibit an abnormal isoform (PrP(Sc)) formation. A computational search was conducted on the Available Chemicals Directory for molecules that mimic both the spatial orientation and basic polymorphism of PrP residues 168, 172, 215, and 219, which confer dominant negative inhibition. The search revealed 1,000 potential candidates that were visually analyzed with respect to the structure of this four-residue epitope on PrP(C). Sixty-three compounds were tested for inhibition of PrP(Sc) formation in scrapie-infected mouse neuroblastoma cells (ScN2a). Two compounds, Cp-60 (2-amino-6-[(2-aminophenyl)thio]-4-(2-furyl)pyridine-3, 5-dicarbonitrile) and Cp-62 (N'1-(¿5-[(4, 5-dichloro-1H-imidazol-1-yl)methyl]-2-furyl¿carbonyl)-4 methoxybenzene-1-sulfonohydrazide), inhibited PrP(Sc) formation in a dose-dependent manner and demonstrated low levels of toxicity. A substructure search of the Available Chemicals Directory based on Cp-60 identified five related molecules, three of which exhibited activities comparable to Cp-60. Mimicking dominant negative inhibition in the design of drugs that inhibit prion replication may provide a more general approach to developing therapeutics for deleterious protein-protein interactions.

Algorithms↗
PubMed2002

Teaching the cultural dimensions of the patient-physician relationship: a novel approach using didactic trigger films.

The use of trigger films (TFs) for undergraduate teaching is well established in the Technion School of Medicine and elsewhere. These are typically based on a written script highlighting diverse issues within the patient-physician relationship (PPR). We report here on the staging of a filmed script-free encounter between a physician and an actress-patient as a further development of the TF approach. This involved the creation of a clinical interaction in which the patient's revealed cultural background demanded an adaptive response from the physician in order to achieve a stable PPR and to institute effective treatment. Considerable improvisation was thus required. Prior directorial manipulation of the conditions of the interview enhanced the didactic power and goals of the TF. After completion of the filming, the physician and the actress studied the video and then repeated the interview within the same situation free of directorial input. The two sequential videotaped interviews constitute the final product. These TFs appear to carry a wide spectrum of didactic messages at many levels including the need to relate effectively to the cultural aspects in the PPR, and the importance of self-observation as a tool for change and learning.

Audiovisual Aids↗
PubMed1997

Classifying ethnicity utilizing the Canadian Mortality Data Base.

UNLABELLED: The study of ethnic differences in disease is a methodological challenge as ethnicity is often not identified in existing datasets and surrogate measures need to be used. We have developed a novel methodology combining last name and country of birth to study mortality patterns of Canadians of South Asian (SA) and Chinese (CH) ethnic origin and have compared death rates among SA, CH, and White (WH) Canadians. METHODS: SA and CH were identified in the Canadian Mortality Data Base (CMDB) using the last name and country of birth of the deceased. Records of people who had been born in countries with large South Asian and Chinese populations (e.g. India, Pakistan, China, Hong Kong) were selected and manually screened by last name. A name directory was then created of distinct South Asian and Chinese names and this directory was used to search all other records in the CMDB for SA and CH deaths. Where necessary, other identifying characteristics such as first name and parents' last name were also used. Population counts were obtained from the Census self-reported question on ethnicity for SA and CH. WH were identified as non-immigrant Canadians who were neither SA nor CH. The method of assigning ethnicity in the CMDB and Census were assessed for comparability and issues of validity and reliability were addressed. RESULTS: Using this method, 10,989 SA and 21,548 CH deaths were identified. There was marked heterogeneity in birthplace, with only 56% of SA born in South Asia and only 74% of CH born in Greater China. Last names had high validity for self-reported ethnicity in a population sample of SA and were highly reproducible. Mortality rates varied dramatically between groups studied. SA and WH had high rates of ischemic heart disease while stroke mortality was similar among all three groups. Cancer death rates were high in CH and WH and much lower in SA. CONCLUSION: Last names and country of birth can be used to determined ethnicity of SA and CH with validity and reliability, and leads to a more accurate classification than country of birth alone. The contrasting patterns observed in mortality from major causes of death suggest many interesting hypotheses for further study.

Adult↗
PubMed2004

End-of-life content in treatment guidelines for life-limiting diseases.

BACKGROUND: Clinical guidelines are systematically developed statements that influence medical practice, education, and funding. Guidelines represent the consensus of leaders, often based on systematic reviews of the literature, regarding the "state of the art." OBJECTIVE: To assess the degree to which end-of-life care is integrated into nationally developed guidelines for chronic, noncurable, life-limiting diseases. DESIGN: Four compendia were reviewed: The Healthcare Standards Directory ECRI, 2001; the Clinical Practice Guidelines Directory, 2000 edition; the National Guidelines Clearinghouse, (guideline.gov); and the National Library of Medicine's MEDLINE database on the OVID platform for guidelines on nine chronic diseases (chronic obstructive pulmonary disease, end-stage liver disease, amyotrophic lateral sclerosis, congestive heart failure, dementia, cerebrovascular accident, end-stage renal disease, cancer [breast, colon, prostate, lung], and human immunodeficiency virus). They were assessed by two reviewers for end-of-life content in 15 domains (e.g., epidemiology of death, symptom management, spiritual, family roles, and settings of care), the presence of eight specific terms dealing with palliative care, integration of palliative care information into the guideline, and descriptive variables. SETTING/SUBJECTS: Not available. MEASUREMENTS: Each guideline was examined and rated on a 0-2 scale (0, absent content; 1, minimal content; 2, helpful content) using 15 end-of-life content domains. Scores from domains were summed and classified into 3 categories: 4 or less, minimal; 5-12, moderate; and more than 12, significant content. RESULTS: Ten percent of guidelines had significant palliative care content, 64% had minimal content, and 26% had moderate content. The least addressed domains dealt with spirituality, ethics, advocacy and family roles. When guidelines that dealt solely with prevention, acute exacerbations or complications of an illness, or specific treatment modalities were excluded 28% and 16% of these general guidelines (n = 58) had moderate and significant palliative care content, respectively, compared to 24% and 0% of all nongeneral guidelines. Similar results were found when analyzing the data by disease course or treatment focus. Only 14% of guidelines advised physicians to consider palliative care at a specific point in the disease course. Ninety-one percent of the guidelines mentioned death, dying, end of life, mortality, or terminal illness but only 36% mentioned palliation or hospice. CONCLUSION: Current national guidelines on nine chronic, life-limiting illnesses offer little guidance in end-of-life care issues despite a recent increase in attention to this aspect of medical care.

Chronic Disease↗
PubMed2000

Survey of ASHP-accredited pharmacy residency programs.

The results of a survey of the requirements and features of pharmacy residency programs are reported. The survey was mailed on March 5, 1999, to the directors of 414 pharmacy practice and specialty residency programs with ASHP accreditation as of March 1, 1999. Included were questions on stipends, staffing requirements, and benefits. Information not typically included in the ASHP residency directories was also sought. Three hundred surveys were returned, for a 72% response rate. Of the responding programs, 174 (58%) were pharmacy practice programs and the rest specialty programs. The specialties with the largest number of respondents were primary care (30 of 126, or 24%) and drug information (23, or 18%). The practice setting varied widely, but a university-based practice site was most frequent (122 of 300 programs, or 41%). The overall median stipend range was $28,000-$28,999; stipends varied relatively little by geographic region but were highest in New York and New Jersey. Most residency programs had a staffing requirement, which averaged eight hours per week. A substantial part of residents' time was spent on drug distribution and patient care activities, such as medical rounds and patient counseling. The most common benefits reported were paid time off, health and medical coverage, and reimbursement for specific professional expenses. Ultimately, the creation of an Internet-accessible electronic database will maximize the availability and timeliness of such information and minimize the cost and labor involved in updating currently available resources. A survey of ASHP-accredited residency programs yielded data that provide a valuable supplement to the information in ASHP residency directories.

Accreditation↗
PubMed1982

Scrotal carcinoma in Connecticut metalworkers: sequel to a study of sinonasal cancer.

An excess risk for sinonasal cancer among Connecticut metalworkers with potential exposure to cutting oils led to the hypothesis of a relationship between the same occupational category and squamous cell carcinoma of the scrotum. Cases of this latter tumor (n = 45) diagnosed in 1935-1973 were identified by the Connecticut Tumor Registry. For decedents, male controls from Connecticut death certificates were matched to decedent cases on age, year of birth, and availability of occupational information; for living subjects, male controls from records of the Connecticut Department of Motor Vehicles were matched on the above variables and town of residence. Death certificates and city directories provided occupational information. For the narrowly defined indicator of cutting oil exposure (toolmaker, setter, set-up man, hardener, polisher, automatic screw machine operator), the odds ratio for squamous cell carcinoma of the scrotum was 4.9, 95% confidence limits (CL): 1.8, 15.9. The broad indicator of cutting oil exposure (not otherwise specified) categories plus machinist and machine operator (not otherwise specified) had an odds ratio of 10.5, 95% CL: 4.0, 36.9 and explained 57% of the cancers. For this broad category, the risk persisted in the most recent time period of diagnosis, 1966-1973 (OR = 18.6). For this broad category, major biases could not be detected when the following additional covariables were taken into account individually where possible: source of occupation, nativity, town of residence, stage at diagnosis, and cause of death. City directory and death certificate information implied that at least 80% of cases in the high risk category worked in the Connecticut region before age 40.

Adult↗
PubMed2000

A profile of the members of FASEB societies: NIH awards, degrees, and institutional affiliations, 1999.

Data from the FASEB Directory of Members and NIH were used to develop a statistical profile of the members of FASEB Societies. For the U.S.-based scientists (exclusive of retired and student members), the most frequently reported degree was a research doctorate (69. 6%). A substantial fraction, however, reported medical degrees (19. 2%) or both research and medical degrees (8.0%). The majority of members of FASEB Societies listed academic affiliations in the directory. Industrial affiliations were reported, however, in 9.7% of the entries with smaller fractions listing associations with hospitals, independent research institutes, and government agencies. Just over one-fourth of the members of FASEB Societies were principal investigators on NIH research grants. These investigators received one-half of all NIH grants and nearly 60% of the RO1 grants.

Awards and Prizes↗
PubMed1989

Report on the survey of international activities of U.S. health professions schools.

The Educational Commission for Foreign Medical Graduates recently undertook a survey of all accredited U.S. schools of medicine, dentistry, pharmacy, and public health to determine each school's domestic and foreign participation in international education, research, administration, and health care. The response rate was good, especially for schools of medicine, with 125 (98%) of 127 schools providing information. The resulting directory, published in July 1988, lists 494 programs involving 84 countries: 319 in medicine, 44 in dentistry, 30 in pharmacy, and 101 in public health. Directors, titles and objectives of programs are listed, along with descriptions of areas of emphasis, types of affiliation, personnel involved, and sources of funding. International involvement of the schools was unevenly distributed: about 16% of the medical and public health schools and 6% of the dental and pharmacy schools accounted for half of the international programs in each of these four disciplines. Schools of public health had the largest mean number of international programs per school, followed by schools of medicine. The majority of programs emphasized education and research; lesser numbers were in administration and health care. The majority of programs were in developing countries, the People's Republic of China, and Mexico, together accounting for 19% of the programs listed. In addition to providing needed aggregate and individual information on programs in international health, the directory may serve as a basis for planning by students, scholars, and institutions.

Data Collection↗
PubMed1995

A quarter-century of experience with career change education: an option for turning specialists into generalists.

The Physician Refresher program, now 25 years old, at the Medical College of Pennsylvania offers training to clinically inactive physicians. The authors examined the characteristics of program participants to determine whether specialists who took the program to prepare for a change to a primary care career made the intended change. Application data from all registrants between 1982 and 1993 were compared with data on previously reported groups from 1968-1975 and 1976-1981. Specialist registrants' subsequent practice activities were documented from the AMA Medical Directory and the American Board of Medical Specialties Directory; a telephone survey elicited their reasons for making or not making the career change to primary care. During the last decade of the program women registrants constituted 36% of the total; international medical graduates (IMGs) 43%; and clinically inactive physicians 38%. Specialists outnumbered those in primary care by two to one. Although 65% of specialists planned to switch to primary care, ultimately only 27% of the total did so; many, especially the IMGs, were serving the disadvantaged. Those who did not switch cited a variety of disincentives, including individual educational needs not met by a general refresher course. If the medical profession accepts the need to devise programs that "retool" specialists to provide primary care, those programs should be specifically designed to address the individual needs of the specialists involved. Concomitantly, the incentives to make the switch need to be enhanced.

Adult↗
PubMedDate not supplied

Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas.

The Vietnamese are a quickly growing, important part of the Texas population. Breast cancer is known to have different biologic characteristics in Vietnamese women. In order to develop appropriate intervention and screening strategies, we conducted a study of barriers to cervical and breast screening in Vietnamese women in Harris County, Tex. Our objective was to characterize the demographic factors, beliefs, and barriers to cervical and breast cancer screening in our study population and test the effect of these on Papanicolaou test, breast self-examination (BSE), medical breast examination (MBE), and mammography use. The Health Belief Model Scales for Measuring Beliefs Related to Breast Cancer (Champion VL, Nursing Research 1993;42:139-143) was the framework used to assess attitudes regarding risk of breast cancer and to design a component assessing risk of cervical cancer. The questionnaire addressed susceptibility, seriousness, benefits, barriers, and health about screening for breast and cervical cancer. It was translated into Vietnamese and back-translated into English prior to use. The questionnaire was mailed to Harris County residents. Those returned were entered into a database. The data were analyzed for validity using Chronbach's alpha. Simple descriptive analyses and nominal logistic regression identified predictors of Papanicolaou test, BSE, MBE, and mammography use. Twelve hundred surveys were mailed out to Vietnamese women using the telephone directory and the church directories in Harris County; 209 were returned and entered into the database. Of the respondents, 67% had ever received a Papanicolaou test; of these, 89% had received a Papanicolaou test within the past year; 55% of respondents had performed a BSE, 45% of patients received an MBE, and 45% of respondents had ever received a mammogram (15% of respondents had a mammogram during the previous year). The most significant predictors of Papanicolaou test, BSE, MBE, and mammography use were marital status (being married), high educational level, lack of barriers, a family history of the cancer, older age, and increased perception of seriousness. Compared to other studies of Vietnamese women, the women in Texas are among the highest users of the Papanicolaou test, BSE, MBE, and mammography. Barriers and incentives to breast and cervical screening were similar to those in other studies.

Adult↗