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The prediction of human clearance from hepatic microsomal metabolism data.

Human liver microsomal intrinsic clearance has become a commonly measured parameter during drug discovery, and such data are used to design compounds predicted to possess optimal drug disposition characteristics. Liver microsomal intrinsic clearance values can be scaled and used to predict hepatic clearance in humans. Clearance, when combined with the volume of distribution, determines the half-life of a drug. Hepatic clearance, when combined with absorption, determines the oral bioavailability of a drug. Half-life and oral bioavailability are key determinants of the dosing regimen, i.e., size of dose and frequency of administration. Thus, the accurate prediction of human clearance is important in the selection of new compounds for progression into development, as new drugs on the market must not only be efficacious and safe, but must also be convenient to use for patients and physicians. Over the past decade, exploring methods whereby human clearance can be predicted from in vitro data has been an area of active research in drug metabolism science. Human liver microsomes have been a key tool in this research. This in vitro system possesses many of the major drug metabolizing enzymes and is thus applicable to a wide variety of compounds. This review describes the theoretical and practical aspects of predicting clearance from human liver microsomal intrinsic clearance data, a summary of advantages and shortcomings of this in vitro system, a synopsis of recent applications of human liver microsomal intrinsic clearance data in clearance predictions, and a discussion of potential future directions for this field.

Animals↗

Prediction of survival in surgical unresectable lung cancer by artificial neural networks including genetic polymorphisms and clinical parameters.

Lung cancer, a common malignancy in Taiwan, involves multiple factors, including genetics and environmental factors. The survival time is very short once cancer is diagnosed as being in advanced stage and surgically unresectable. Therefore, a good model of prediction of disease outcome is important for a treatment plan. We investigated the survival time in advanced lung cancer by using computer science from the genetic polymorphism of the p21 and p53 genes in conjunction with patients' general data. We studied 75 advanced and surgical unresectable lung cancer patients. The prediction of survival time was made by comparing real data obtained from follow-up periods with data generated by an artificial neural network (ANN). The most important input variable was the clinical staging of lung cancer patients. The second and third most important variables were pathological type and responsiveness to treatment, respectively. There were 25 neurons in the input layer, four neurons in the hidden layer-1, and one neuron in the output layer. The predicted accuracy was 86.2%. The average survival time was 12.44 +/- 7.95 months according to real data and 13.16 +/- 1.77 months based on the ANN results. ANN provides good prediction results when clinical parameters and genetic polymorphisms are considered in the model. It is possible to use computer science to integrate the genetic polymorphisms and clinical parameters in the prediction of disease outcome. Data mining provides a promising approach to the study of genetic markers for advanced lung cancer.

Adult↗

Analysis of censored and incomplete survival data using flowgraph models.

Multi-state stochastic models are widely used to model stages of disease progression in survival analysis. This paper develops flowgraph models for data analysis in survival analysis. We illustrate these methods using data from a study of diabetic retinopathy consisting of 277 subjects with insulin-dependent (type I) diabetes mellitus (IDDM). These data were collected at the Eye-Kidney Clinic of the Barbara Davis Center for Childhood Diabetes at the University of Colorado Health Sciences Center.

Computer Simulation↗

What makes a tutor effective? A structural-equations modeling approach to learning in problem-based curricula.

PURPOSE: To test and further develop a causal model of the influence of tutor behaviors on student achievement and interest in the context of problem-based learning. METHOD: Data from 524 tutorial groups involving students participating in the four-year undergraduate health sciences curriculum at the University of Limburg in 1992-93 were analyzed. The tutorial groups were guided by 261 tutors. Overall, 3,792 data records were studied, with each student participating in an average of 2.3 groups. Correlations among tutors' social-congruence, expertise-use, and cognitive-congruence behaviors, small-group functioning, and student' self-study time, intrinsic interest in subject matter, and level of achievement were analyzed using structural-equations modeling. This statistical technique allows the investigator to test causal hypotheses on correlational data by comparing the structure of data with a theoretical model. RESULTS: After minor adaptations, the hypothesized causal model of the effective tutor fitted the data extremely will. Each tutor's level of expertise use and social congruence not only directly affected his or her level of cognitive congruence but also affected other elements of the model. Level of social congruence influenced group functioning in a direct fashion, while expertise use had a slightly negative effect on the students' level of self-study time and a slightly positive effect on level of achievement. As hypothesized, the level of cognitive congruence influenced tutorial-group functioning. Level of group functioning affected self-study time and intrinsic interest. Finally, time spent on self-study influenced level of achievement. CONCLUSION: The results suggest that subject-matter expertise; a commitment to students' learning and their lives in a personal, authentic way; and the ability to express oneself in the language used by the student are all determinants of learning in problem-based curricula. The theory of the effective tutor, presented in this article, merges two different perspectives prevalent in the literature. One perspective emphasizes the personal qualities of the tutor: his or her ability to communicate with students in an informal way, coupled with an empathic attitude that enables the tutor to encourage student learning by creating an atmosphere in which open exchange of ideas is facilitated. The other stresses the tutor's subject-matter knowledge as a determinant of learning. The data presented in this article suggest that what is needed, really, is much of both.

Achievement↗

The promise of occupational science: a developmental assessment of an emerging academic discipline.

BACKGROUND: In the late 1980's, occupational science was introduced as a basic discipline that would provide a foundation for occupational therapy. As occupational science grows and develops, some question its relationship to occupational therapy and criticize the direction and extent of its growth and development. PURPOSE: This study was designed to describe and critically analyze the growth and development of occupational science and characterize how this has shaped its current status and relationship to occupational therapy. METHOD: Using a mixed methods design, 54 occupational science documents published in the years 1990 and 2000 were critically analyzed to describe changes in the discipline between two points in time. Data describing a range of variables related to authorship, publication source, stated goals for occupational science and type of research were collected. RESULTS: Descriptive statistics, themes and future directions are presented and discussed. PRACTICE IMPLICATIONS: Through the support of a discipline that is dedicated to the pursuit of a full understanding of occupation, occupational therapy will help to create a new and complex body of knowledge concerning occupation. However, occupational therapy must continue to make decisions about how knowledge produced within occupational science and other disciplines can be best used in practice.

Authorship↗

Participation in scientific meetings: a new prosopographical approach to the disciplinary history of science--the case of immunology, 1951-72.

To handle the enormous amount of sources in modern and contemporary science, the historian can use different quantitative methods, particularly varieties of citation analysis. So far, all these methods have been based on publication data. Taking as its point of departure the fact that meetings constitute a pervasive, yet neglected, aspect of science, this paper introduces analysis of participation in scientific meetings. The strength of this new prosopographical method is illustrated by an analysis of international immunological meetings in the period 1951-72. Frequency of participation in meetings seems to be correlated to professional standing in immunology. By means of cluster analysis of participation data, the subdisciplinary structure and dynamics of immunology can be reconstructed.

Allergy and Immunology↗

Snacking patterns influence energy and nutrient intakes but not body mass index.

OBJECTIVE: To study dietary intake and body mass index (BMI) patterns among US adults, stratified by snacking patterns. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the study sample. Snacking episodes were defined as a 'food and/or beverage break', and subjects were classified as morning, afternoon, evening, multiple or never snackers. SUBJECTS/SETTING: Our study included data from 1756 men and 1511 women who provided two nonconsecutive, multiple-pass 24-h dietary recalls. STATISTICAL ANALYSES: Mean values of each subject's two 24-h recalls were used for analyses, and data were analysed using the Statistical Package for the Social Sciences (SPSS) for Windows and SUDAAN. RESULTS: Compared with women, men were more likely to be evening, multiple or never snackers. Male multiple snackers had significantly higher energy intakes than did afternoon and never snackers, whereas female multiple snackers had higher energy intakes than did morning, evening and never snackers. At the same time, male and female multiple snackers had more prudent energy-adjusted intakes of protein, cholesterol, calcium and sodium. Coffee, cola, milk, ice cream and fruits were among the most frequently consumed snacks by men and women. The BMI did not differ significantly across snacker categories. CONCLUSIONS: These data indicate that snacking patterns have some effects on energy and nutrient intakes but not on BMI. Snack food choices remain a concern, especially beverages, including those that are sweetened. Vegetables and fruits as snacks should be encouraged.

Adult↗

Exercise testing scores as an example of better decisions through science.

INTRODUCTION: The application of common statistical techniques to clinical and exercise test data has the potential to become a useful tool for assisting in the diagnosis of coronary artery disease, assessing prognosis, and reducing the cost of evaluating patients with suspected coronary disease. Since general practitioners function as gatekeepers and decide which patients must be referred to the cardiologist, they need to optimally use the basic tools they have available (i.e., history, physical exam, and the exercise test). METHODS: Review of the literature with a focus on the scientific techniques for aiding the decision-making process. RESULTS: Scores derived from multivariable statistical techniques considering clinical and exercise data have demonstrated superior discriminating power when compared using receiver-operating-characteristic curves with the ST segment response. In addition, by stratifying patients as to probability of disease and prognosis, they provide a management strategy. While computers as part of information management systems can calculate complicated equations to provide scores, physicians are reluctant to trust them. Thus, these scores have been represented as nomograms or simple additive tables so physicians are comfortable with their application. Scores have also been compared with physician judgment and been found to estimate the presence of coronary disease and prognosis as well as expert cardiologists, and often better than nonspecialists. CONCLUSION: Multivariate scores can empower the clinician to assure the cardiac patient with access to appropriate and cost-effective cardiological care.

Adult↗

1990 AcroMed Award in basic science. Cauda equina anatomy. II: Extrathecal nerve roots and dorsal root ganglia.

Inconsistent data exist regarding the anatomy of the spinal nerve roots lateral to the thecal sac. A newly developed in situ technique was used to precisely define anatomic parameters on 20 fresh human cadavers. The take-off angle of the nerve roots from the thecal sac decreases from a mean of approximately 40 degrees from L1-L5 to 22 degrees at S1. The motor bundles are directly ventral to the sensory fibers within individual roots extrathecally. Dorsal root ganglia size varies with vertebral level. The majority of ganglia lie directly beneath the vertebral pedicles and one third overlie a portion of the lateral intervertebral disc. These previously undescribed relationships may aid in the understanding of lumbosacral neurocompressive disorders and are important to note during pedicle screw insertion, posterolateral decompression for spinal trauma, and paravertebral approaches for lateral disc herniations.

Aged↗

Air toxics regulatory issues facing urban settings.

Biomarker research does not exist in isolation. Its usefulness can only be realized when it is translated into prevention strategies to protect public health. In the context of air toxics, these prevention strategies begin with the development of regulatory standards derived from risk assessment schemes. The Clean Air Act Amendments of 1990 list 189 air toxics, including many volatile organics, metals, and pesticides. The National Institute of Environmental Health Sciences (NIEHS), through its affiliation with the National Toxicology Program, has generated toxicity and carcinogenicity data on more than 100 of these air toxics. The NIEHS extramural and intramural research portfolios support a variety of projects that develop and validate biomarkers for use in environmental health science and risk assessment. Biomarkers have a tremendous potential in the areas of regulating air toxics and protecting public health. Risk assessors need data provided by biomarkers of exposure, biomarkers of dose/pharmacokinetics, biomarkers of susceptibility or individual variability, and biomarkers of effects. The greatest benefit would be realized if biomarkers could be employed in four areas of primary and secondary prevention. The first is the use of biomarkers to enhance extrapolation of animal data to human exposure situations in establishing risk standards. The second is the use of biomarkers that assess noncancer, as well as cancer, end points. Important health end points include pulmonary dysfunction, immunotoxicity, and neurotoxicity. Third, biomarkers that serve as early waming signs to detect intermediate effects would enhance our ability to design timely and cost-effective intervention strategies. Finally, biomarkers used to evaluate the effectiveness of intervention strategies, both in clinical and regulatory settings, would enable us to ensure that programs designed to protect public health do, in fact, achieve the desired outcome.

Air Pollutants↗

Forensic analysis of hallucinogenic fungi: a DNA-based approach.

Hallucinogenic fungi synthesize two controlled substances, psilocin and psilocybin. Possession of the fungal species that contain these compounds is a criminal offence in North America. Some related species that are morphologically similar, do not contain the controlled substances. Therefore, unambiguous identification of fungi to the species level is critical in determining if a mushroom is illegal. We investigate a phylogenetic approach for the identification of species that contain the psychoactive compounds. We analyzed 35 North American specimens representing seven different genera of hallucinogenic and non-hallucinogenic mushrooms. We amplified and sequenced the internal transcribed spacer region of the rDNA (ITS-1) and a 5' portion of the nuclear large ribosomal subunit of rRNA (nLSU rRNA or 28S). ITS-1 locus sequence data was highly variable and produced a phylogenetic resolution that was not consistent with morphological identifications. In contrast, the nLSU rRNA data clustered isolates from the same species and separated hallucinogen containing and non-hallucinogen containing isolates into distinct clades. With this information, we propose an approach that combines the specificity of PCR detection and the resolving power of phylogenetic analysis to efficiently and unambiguously identify hallucinogenic fungal specimens for legal purposes.

Agaricales↗

Resolving inconsistencies in tutor expertise research: does lack of structure cause students to seek tutor guidance?

PURPOSE: To investigate under what conditions tutors' subject-matter expertise influences student achievement. METHOD: Data were analyzed from 1,800 University of Limburg Faculty of Health Sciences students who in 1989-90 participated in tutorial groups led by content-expert staff tutors, non-expert staff tutors, or student tutors. Each student participated in an average of 4.1 tutorial groups. Overall, 4,111 data records were available for analysis. The basic analyses were of (1) students' achievement scores as a function of tutors' levels of subject-matter expertise and students' prior knowledge; (2) students' achievement scores as a function of tutors' levels of subject-matter expertise and educational units' levels of structure; and (3) differences in achievement between students guided by tutors of different levels of expertise in either high- or low-structure units. Statistical methods included analyses of variance. RESULTS: The level of subject-matter expertise of tutors had a positive influence on student achievement. Similar results were found for the students' prior knowledge and the levels of structure of the units; the more prior knowledge students had, the better were their performances on the end-of-unit test; and the higher the level of structure of the unit, the better the achievement. More important, interactions were found between tutor expertise on the one hand and prior knowledge and unit structure on the other, tutor expertise being mainly important if the unit was poorly structured or students reported lack of prior knowledge. CONCLUSION: The results suggest that students need a minimum level of structure in order to profit from problem-based instruction. This structure can be internally provided through prior knowledge available for understanding the new subjects, or offered by the environment in the form of cues of what is relevant and what should be the focus of the activities. If prior knowledge falls short, or if the environment lacks structure, students will turn to their tutors for help and direction. Under those conditions, students who are guided by a subject-matter expert tutor may benefit more than students guided by a non-expert staff tutor or by a student tutor. These findings may explain the widely divergent results of tutor-expertise research.

Achievement↗

Interventions to improve school attendance: a systematic review and meta-analysis of evidence from randomised controlled trials.

BACKGROUND: Poor school attendance adversely affects youth behaviour and health trajectories. We reviewed and synthesised the evidence from randomised controlled trials (RCTs) on interventions to improve school attendance. METHODS: This systematic review and meta-analysis updates the Education Endowment Foundation (EEF) 2022 review on attendance interventions. We synthesised RCT data to inform recommendations. We searched ERIC (via EBSCOhost), PsycINFO, Web of Science and Google Scholar for publications 1 January 2020-16 October 2024 to identify attendance interventions delivered to students, parents/guardians or school staff. We also extracted and analysed RCTs identified in the EEF review. Two reviewers independently extracted data from published articles and assessed risk of bias and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation, GRADE assessment). We synthesised and meta-analysed data per our protocol (PROSPERO: CRD42024610037). RESULTS: We screened 9366 titles and abstracts and included 61 articles (2000-2024): 43 articles published 2020-2024 plus 18 articles from the previous review (2000-2020), reporting 57 trials of 54 interventions. Pooled mean difference and 95% CIs for days of school attended was 0.63 (-0.34 to 1.61), I2=64.0%, low certainty, for mentoring interventions and 0.43 (0.10 to 0.76), I2=91.9%, moderate certainty, for parental engagement interventions. Other intervention areas including targeted approaches, behavioural programmes and social-emotional interventions had smaller, heterogeneous evidence bases. Risk of bias was moderate-to-low in most trials. CONCLUSION: A large range of interventions exist to address the diverse causes of school absence. Parental engagement demonstrated a small positive effect on attendance, particularly among younger age groups. Most trials were from the USA; implementation and evaluation in other countries will inform effectiveness.

CHILD↗

The tact of teaching RN-to-BSN students.

Despite the increased need for highly educated clinical registered nurses (RNs), recruitment and retention of RN-to-Bachelor of Science in Nursing (BSN) students have steadily declined since 1999. To explore the context of this problem in relation to faculty who teach these students, the following research question was addressed: How do faculty perceive the context of their teaching experiences with RN-to-BSN students? By using a hermeneutic phenomenological approach, unstructured interviews were conducted with 17 faculty teaching RN-to-BSN students. Data were analyzed with van Manen's (1997) approach to human science research analysis. One overarching pattern, "providing the fertile soil for teaching and learning," was revealed. Integrated into this pattern were three different characteristics faculty brought to their teaching: (1) cultivating, (2) pruning, and (3) drought-ridden. Fluidity was evidenced by faculty using more than one teaching approach. A defining factor for faculty using the cultivating approach was the "tact" that created pedagogical moments of connecting with a student. Data suggested that the accumulation of these pedagogical moments laid the foundation for a faculty member's connection with students. This tact of teaching provides an educational context that might help to recruit and retain RNs returning for a BSN.

Education, Nursing, Baccalaureate↗

Inside the triple helix: technology transfer and commercialization in the life sciences.

The transfer and subsequent application of academic research results has demonstrable benefits for health care, researchers, universities, companies, and local economies. Nonetheless, at least three general concerns exist: bias in the reporting of results, limited revenues from these activities, and the lack of data to evaluate technology transfer activities. Future efforts with regard to technology transfer in the life sciences will need to recognize its importance without ignoring concerns or overestimating benefits. Next steps include better monitoring of university-industry relationships, the development of a better data system, the dissemination of best practices in technology transfer management, and evaluation of national technology-transfer policies.

Biological Science Disciplines↗

Continuous versus categorical data for ROC analysis: some quantitative considerations.

RATIONALE AND OBJECTIVES: Several authors have encouraged the use of a quasi-continuous rating scale for data collection in receiver operating characteristic (ROC) curve analysis of diagnostic modalities, rather than rating scales based on five to seven ordinal categories or levels of suspicion. Although many investigators have gone over to this method, a discussion of the issues continues. The present work provides a quantitative analysis from the viewpoint of measurement science. MATERIALS AND METHODS: A simple model of the effect of data discretization or quantization on the measurement of the variance of noisy data was developed. Then Monte Carlo simulations of multiple-reader, multiple-case ROC experiments were performed and analyzed in terms of components-of-variance models to investigate the effect of data quantization in that more complex setting. RESULTS: For single-reader studies, discretization into five categories can reduce the precision of ROC measurements by a large amount. The effect may be attenuated in multireader studies. CONCLUSION: More precise measurements of diagnostic detection performance and thus more efficient use of resources are served by good measurement methods. These are promoted by the use of a quasi-continuous rating scale in ROC studies.

Data Collection↗

The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment.

BACKGROUND: This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. METHODS: Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers. RESULTS: A lateral curvature of the spine-'scoliosis'-can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading. CONCLUSION: Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity.Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine 1.

Journal Article↗

Capacity building in rural health research: a Canadian perspective.

INTRODUCTION: The need to build capacity in rural health research is recognized in Canada. During its formative stage, the Canadian Rural Health Research Society (established in 2002), performed a nation-wide survey of the research teaching and training opportunities available to students interested in rural and remote health issues. Intended as a cross-sectional 'snapshot,' and to provide base-line data, the survey involved a comprehensive list of educational programs in health and science disciplines at all Canadian Universities offering graduate-level programs. The present project report gives an overview of the results, documenting the current strengths, but also the noticeable gaps that exist. METHODS: Data were collected via an Internet survey, developed according to Dillman's email survey design principles. Although multiple contacts are recommended, due to time constraints only two were made. The instrument included both open- and closed-ended questions designed to determine institutional commitments to rural health research training generally, as well as specific information about course offerings, infrastructure supports for students, financial assistance for studying specific topics, and future plans. Health was defined broadly and included a number of disciplines beyond those usually considered under the health rubric. Individuals in administrative positions for 462 programs in 24 distinct disciplines at 56 institutions were sent the survey. Responses were received from 120 programs at 40 universities. Due to budget constraints the instrument was not translated into French. Descriptive statistics were used to analyse the data, combined with a thematic analysis of written comments. Ethical approval was obtained from the Lakehead University before the study was conducted. RESULTS: Despite the fact that one-third of Canadians live in rural, remote and northern areas, there is a paucity of research that addresses rural health issues. Moreover, Canadian universities have very limited rural health offerings in their curricula. There are few formal courses available on rural health topics generally or rural health research specifically. Although students can take rural-related independent studies or reading courses, very few actually take advantage of the option. Of all disciplines, nursing faculty are most likely to pursue rural health research and to offer rural health courses. Moreover, nursing faculty most often indicate an intention to expand their rural health offerings. In the social sciences, geography and environmental science programs, relatively few students choose to study rural health. Similarly, in medicine, the number of students exploring rural health issues is small. There is some specific financial assistance available to students who are interested in rural health research and, as well, they have access to general pools of funding. CONCLUSION: The survey results demonstrate the limitations of current educational programs. However, they also indicate areas of potential growth and show widespread interest in increasing the offerings available at universities across Canada. The article concludes by giving an overview of the mandate and initiatives being taken by the new research society to augment training, and to enhance student participation. In addition, it notes the positive developments linked to a new Strategic Plan by the Canadian Institutes of Health Research (CIHR) to enhance rural health research in Canada.

Journal Article↗