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PubMed2003

Autopoiesis: a review and a reappraisal.

The aim of the paper is to review critically the notion of autopoiesis as presented by Maturana and Varela. In particular, recognizing that there are difficulties in obtaining a complete and clear picture from the primary literature, an effort is made to present a coherent view-also based on many years of personal contact with Francisco Varela. The paper begins with a few historical notes to highlight the cultural background from which the notion of autopoiesis arose. The basic principles of autopoiesis as a theory of cellular life are then described, emphasizing also what autopoiesis is not: not an abstract theory, not a concept of artificial life, not a theory about the origin of life-but rather a pragmatic blueprint of life based on cellular life. It shown how this view leads to a conceptually clear definition of minimal life and to a logical link with related notions, such as self-organization, emergence, biological autonomy, auto-referentiality, and interactions with the environment. The perturbations brought about by the environment are seen as changes selected and triggered by the inner organization of the living. These selective coupling interactions impart meaning to the minimal life and are thus defined by Maturana and Varela with the arguable term of "cognition". This particular view on the mutual interactions between living organism and environment leads these authors to the notion of "enaction", and to the surprising view that autopoiesis and cognition are two complementary, and in a way equivalent, aspects of life. It is then shown how cognition, so defined, permits us to build a bridge between biology and cognitive science. Autopoiesis also allows one to conceive chemical models of minimal cellular life that can be implemented experimentally. The corresponding work on "chemical autopoiesis" is then reviewed. The surprising impact of autopoiesis in the social sciences ("social autopoiesis") is also briefly discussed. This review also comments on why the theory of autopoiesis had, and still has, a difficult time being accepted into the mainstream of life-science research. Finally, it is pointed out that the new interest in system biology and complexity theories may lead to a reappraisal of autopoiesis and related notions, as outlined also by other authors, such as Tibor Ganti and Stuart Kauffmann.

Cell Cycle↗

PubMed2002

Astronomy. Laser telemetry from space.

Space missions currently on the drawing boards are expected to gather data at rates exceeding the transmission capabilities of today's telemetry systems by many orders of magnitude. Even on current missions, onboard data compression techniques are being implemented to compensate for lack of transmission speed. But while data compression can minimize the loss of data, it is no substitute for transmitting all of the data through a faster communications link. The transmission problem will soon reach crisis proportions and will affect astronomical, Earth resources, geophysical, meteorological, planetary and other space science missions. To overcome this communications bottleneck, the authors advocate the implementation of telemetry systems based on near-infrared laser transmission techniques. The fiber-optics communications industry has developed most of the basic components required for signal transmission in this wavelength band, which should make such a system affordable on scales relevant to the cost of anticipated space science missions.

Journal Article↗

PubMedDate not supplied

[Medical practice with regard to physicians' mistakes and disease complications].

This study gives a historical background on regulations implemented by Islamic scholars to codify medical practice, and highlights the advance of science and technology in the modern era and the need for physicians (along with science and technology) to adhere to religious values. It discusses physicians' responsibilities, the issue of malpractice, and the difference between malpractice and complications. Recommendations are proposed to implement medical ethics in the curriculum of medical colleges around the Islamic world and to promote the role of medical religious committees in Islamic world as is being done in Saudi Arabia.

Codes of Ethics↗

PubMed2005

Family-centred service: moving ideas into practice.

BACKGROUND: With parents more involved in their child's day-to-day care, concepts of family-centred service (FCS) are increasingly adopted in children's health and rehabilitation service organizations. METHODS: In this paper, we report the results of a study to develop and evaluate educational materials for parents, service providers and health sciences students about FCS. The materials focus on the nature and philosophy of FCS, and the practical skills and systemic changes required for its implementation. RESULTS: Thirty-six participants (12 families, 12 service providers and 12 rehabilitation science students) were randomly assigned to receive one of the six FCS educational packages, each containing three FCS educational sheets. Participants' ratings of the format and content, and the impact of the FCS Sheets were very high, with overall means above 5.0 on a 7-point scale. Using a mixed model analysis, we found significant differences in participants' ratings of familiarity with the materials (students were less familiar than service providers). After statistical adjustment for familiarity, there were no significant differences between the groups or the packages on ratings of format and content or impact. CONCLUSIONS: There were no significant differences in the way in which the participant groups rated the impact of the FCS Sheets and the specific packages did not have an effect on the participants' ratings. The FCS educational materials, even those less familiar to participants, were rated highly on format and content, and impact. Results indicate that the material was perceived to be important to each group, and was formatted and written in a way that was easy to understand. This finding counters current recommendations in the knowledge transfer literature that suggest different versions should be written for different target groups.

Adolescent↗

PubMed2002

Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden.

Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Linköping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Linköping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.

Biological Science Disciplines↗

PubMed2002

Implementing a systematic course/clerkship peer review process.

OBJECTIVE: A systematic course/clerkship peer-review process was developed to meet several objectives: improvement of quality of course/clerkship, enhancement of understanding of individual course and overall curricular content, improvement of communication and collaboration between basic science and clinical disciplines across campuses, provision of forum to address curricular concerns of students and faculty, facilitation of data collection for LCME reviews and the AAMC CurrMIT project; and monitoring curricular equivalency at multiple clinical sites. DESCRIPTION: Previously each course had carried out an internal review process. These reviews varied considerably in terms of the data collected and how those data were used for quality improvement. Data and outcomes of the internal reviews were seldom shared with colleagues, students, or administrators. This limited communication discouraged collaboration and led to disparity in curricular content between campuses. A collaborative effort between the medical school's Office of Medical Education (OME) and the Education Council, the faculty governance committee composed of faculty from each basic science and clinical department on each campus, has led to the development and implementation of a systematic course/clerkship peer-review process. Two standing committees of the Education Council oversee the systematic review process. One committee is charged with oversight of the first two years of the curriculum and a second committee with oversight of the third and fourth years. A two-tiered course/clerkship review process was designed with all courses undergoing a limited annual review. A comprehensive, "nuts and bolts" review for required courses was to occur every three years. The limited annual review was based on course evaluations completed by students, collected and summarized by the OME, and presented to the Education Council. The comprehensive review of a required course/clerkship occurred over a six-to-eight-month period. Course directors on each campus completed a questionnaire and submitted materials. To facilitate cross-discipline communication and synergy, a subcommittee composed of both basic science and clinical faculty, principally course directors, and at least one medical student who had completed the course at each campus reviewed submitted materials and had a series of meetings with the course directors, support personnel, and department chairs. Final review reports presented to the Education Council identify issues, concerns, and recommendations for action. To date 11 required courses have completed the comprehensive review process. Simple oversights, significant curricular disparity between campuses, and opportunities for multidisciplinary collaboration have been identified and addressed. Student-rated satisfaction has improved for those courses that have been reviewed. DISCUSSION: The systematic course/clerkship peer-review process has been a success, although there was initial resistance to "outside review." We have not yet completed one cycle of comprehensive course reviews but already faculty and administration have a better understanding of individual course and overall curriculum content. Faculty have developed working relationships and are sharing educational strategies across disciplines and campuses, and identifying innovative collaborations. The annual review process is now perceived to lack depth and is under reconsideration.

Clinical Clerkship↗

PubMedDate not supplied

Direct entry midwifery education. Evaluation of program innovations.

During the 1996-1997 academic year, the State University of New York Health Science Center at Brooklyn, in partnership with North Central Bronx Hospital, implemented the first direct entry (DE) midwifery education program to be preaccredited by the American College of Nurse-Midwives. Five DE midwifery students were admitted and graduated. During their one-year course of studies, these students were provided supplementary didactic and clinical instruction in the medical sciences and basic health skills in addition to the identical course of midwifery studies offered to their registered nurse-student peers. The experience of students and faculty during this first year was that there was no significant difference in academic performance between the DE and nurse-midwifery students. Moreover, once oriented to the clinical environment, DE students progressed through the clinical practicums, and acquired entry-level midwifery skills, at a pace equivalent to that of their nurse peers and consonant with all expectations of safe practice. In addition, the Basic Health Skills and Integrated Medical Science course offerings served as effective instructional supplements to the curriculum by providing DE students with an opportunity to equalize their knowledge base with that previously acquired by registered nurse-prepared students; an unanticipated discovery was that some nurse-midwifery students could equally benefit from enrollment in these courses.

Clinical Competence↗

PubMed2003

Issues in environmental water allocation--an Australian perspective.

Environmental water allocation is a critical issue in Australia and internationally. It has been prominent in Australia for a little over ten years during which time major policy and scientific advances have been made, but little implementation. This paper examines current understanding of environmental water allocation across a broad range of disciplines including the biophysical sciences, social sciences, economics, law, and policy. Development of practical methods for assessing environmental water requirements and experience with implementation in Australia are discussed. The paper concludes with thoughts on future needs.

Australia↗

PubMedDate not supplied

Knowledge transfer and utilization: implications for home healthcare pain management.

Implementation of research evidence into clinical practice is a complex and dynamic process that has become the subject of investigation in the field of "translation science" or "knowledge utilization." Research shows how individuals, units, and organizations all influence the rate and extent of adoption of research evidence. Environmental factors also play an important role in this process. This article summarizes key lessons from translation science and examines the implications for the organization and delivery of home healthcare. The implementation of pain management guidelines is used as an example.

Health Knowledge, Attitudes, Practice↗

PubMed1999

Institutional, Legal, and Economic Instruments in Ghana's Environmental Policy.

/ This paper reviews the state of the environment in Ghana and explores the potential for the use of institutional, legal, and economic instruments in environmental management in the specific context of this developing country.The environmental situation in Ghana is characterized by desertification, land degradation, deforestation, soil erosion, and inadequate water supply in the northern regions of the country. The population as a whole is growing at a rate of 3% per annum, with even greater urban growth rates, due to rural out-migration. Large parts of the coastal zone in the south are rapidly developing to become one large suburbanized area. Water quality is particularly threatened in the urban and industrialized areas, which are mainly located in the southern part of the country. The coastal lagoons and coastal waters are moderately to heavily polluted. Erosion extends along the whole Ghanaian coast with excesses, for example, in the Keta area, where during the last century over 90% of the original buildings have been washed awayby the sea. The obvious environmental consequences of the mining sector are illustrative of the environmental threats caused by a fast growing industry and industrializing agriculture, in a country where environmental policy is only in its formative years. Desertification, food insecurity and coastal erosion all contribute to an increasing number of environmental refugees.Environmental policy in Ghana is a post-Rio phenomenon. Environmental laws, a Ministry of Environment, Science and Technology, an advisory National Committee for the Implementation of Agenda 21, and a fully mandated environmental administration have been established. This administration advocates a progressive attitude towards environmental legislation and points out the specific utility of economic and legal instruments in environmental management in this relatively fast developing country.The choice of instruments for environmental management is increasingly influenced by the specific state of African environmental and technological capacity and by a call for the recognition of the role of traditional customs in nature conservation. This African perspective on environmental management is further intensified by an unmet need for regional, transboundary cooperation in the West African subcontinent. This specific West African context calls for an elaboration of an effective capacity-building program for environmental management in the area.KEY WORDS: Environmental profile; Environmental policy; Legal instruments; Economic instruments; African perspective; State of the environmenthttp://link.springer-ny.com/link/service/journals/00267/bibs/24n3p337.html

Journal Article↗

PubMed2006

The Strengthening Washington D.C. Families project: a randomized effectiveness trial of family-based prevention.

The Strengthening Washington DC Families Project (SWFP) examined implementation fidelity and effectiveness when a selective, evidence-based prevention program was implemented with a sample of 715 predominantly African American families across multiple settings in an urban area. Using a true experimental design, this study reports on the differential effectiveness of four conditions (child skills training only, parent skills training only, parent and child skills training plus family skills training, and minimal treatment controls) in reducing child antisocial behavior and its precursors. Major challenges with recruitment and retention of participants and uneven program coverage were documented. No statistically significant positive effects for any of the program conditions were observed, and a statistically significant negative effect on child reports of Negative Peer Associations was observed for children of families assigned to the family skills training condition. Two marginally significant findings were observed: Child's positive adjustment favored families assigned to family skills training condition relative to minimal treatment and child training only, and family supervision and bonding was lower for children in family skills training than in the other three conditions. Hypotheses about potential explanations for the weaker than expected effects of this program are offered, as are thoughts about the infrastructure necessary to successfully implement family strengthening programs and the future of prevention science.

Adult↗

PubMed1996

On the Circuit Complexity of Sigmoid Feedforward Neural Networks.

This paper aims to examine the circuit complexity of sigmoid activation feedforward artificial neural networks by placing them amongst several classic Boolean and threshold gate circuit complexity classes. The starting point is the class NN(k) defined by [Shawe-Taylor et al. (1992)] Classes of feedforward neural nets and their circuit complexity. Neural Networks 5(6), 971-977. For a better characterisation, we introduce two additional classes NN(k)(Delta) and NN(k)(Delta,epsilon) having less restrictive conditions than NN(k) concerning fan-in and accuracy, and proceed to prove relations amongst these three classes and well established circuit complexity classes. For doing that, a particular class of Boolean functions F(Delta) is first introduced and we show how a threshold gate circuit can be recursively built for any f(Delta) belonging to F(Delta). As the G-functions (computing the carries) are f(Delta) functions, a class of solutions is obtained for threshold gate adders. We then constructively prove the inclusions amongst circuit complexity classes. This is done by converting the sigmoid feedforward artificial neural network into an equivalent threshold gate circuit [Shawe-Taylor et al. (1992)]. Each threshold gate is then replaced by a multiple input adder having a binary tree structure, relaxing the logarithmic fan-in condition from ([Shawe-Taylor et al. 1992]) to (almost) polynomial. This means that larger classes of sigmoid activation feedforward neural networks can be implemented in polynomial size Boolean circuits with a small constant fan-in at the expense of a logarithmic factor increase in the number of layers. Similar results are obtained for threshold circuits, and are liked with the previous ones. The main conclusion is that there are interesting fan-in dependent depth-size tradeoffs when trying to digitally implement sigmoid activation feedforward neural networks. Copyright 1996 Elsevier Science Ltd

Journal Article↗

PubMed2005

Lower frequency variability in the alpha activity in EEG among patients with epilepsy.

OBJECTIVE: Clinically, intra-subject variability of the alpha frequency is well known, but sparsely documented and practically not used in the evaluation of the electroencephalogram (EEG). In cognitive science, however, the peak alpha frequency (PAF) variations are implemented. The aim of the present study was to document the clinical notion of differences in alpha frequency variations in patients with epilepsy compared to a control group. METHODS: Standard EEG recordings from 28 patients, 18 with epilepsy and 10 patients having EEG for other reasons were included. Ten seconds of artifact free EEG were sampled from F3, F4, T5, T6, O1 and O2 at the beginning, after hyperventilation and at the end of a 20 m recording and Fast Fourier transforms was applied to these epochs of each recording. RESULTS: The study showed a lower frequency in the epilepsy group (frontal 9.22 vs. 10.24 Hz, temporal 9.18 vs. 9.88 Hz and occipital 9.42 vs. 10.30 Hz) and lower frequency variability, with lower values in the epilepsy group in occipital (0.8 vs. 1.44 Hz) and temporal leads (0.89 vs. 1.39 Hz). Frontally, the variability was not significant (0.71 vs. 1.18 Hz, P = 0.0824). Within the groups, there was no relation between frequency and variability. CONCLUSIONS: This study shows that there is PAF variability in the alpha activity. This variability is compromised in patients with epilepsy. Lower alpha frequency is observed in epilepsy group. It is to some extent due to antiepileptic drugs. The lower alpha frequency variability is probably due to a different mechanism as there is no relation between the frequency and its variability within the two groups. SIGNIFICANCE: The alpha activity shows physiological frequency variations that may be compromised by epilepsy.

Adult↗

PubMed2026

PanForest: predicting genes in genomes using random forests.

MOTIVATION: The presence or absence of some genes in a genome can influence whether other genes are likely to be present or absent. Understanding these gene co-occurrence and avoidance patterns reveals fundamental principles of genome organization, with applications ranging from evolutionary reconstruction to rational design of synthetic genomes. RESULTS: PanForest, presented here, uses random forest classifiers to predict the presence and absence of genes in genomes from the set of other genes present. Performance statistics output by PanForest reveal how predictable each gene's presence or absence is, based on the presence or absence of other genes in the genome. Further, PanForest produces statistics indicating the importance of each gene in predicting the presence or absence of each other gene. The PanForest software can run serially or in parallel, thereby facilitating the analysis of pangenomes at Network of Life scale.A pangenome of 12 741 accessory genes in 1000 Escherichia coli genomes was analysed in around 5 h using eight processors. To demonstrate PanForest's utility, we present a case study and show that certain genes associated with resistance to antimicrobial drugs reliably predict the presence or absence of other genes associated with resistance to the same drug. Further, we highlight several associations between those genes and others not known to be associated with antimicrobial resistance (AMR), or associated with resistance to other drugs. We envisage PanForest's use in studies from multiple disciplines concerning the dynamics of gene distributions in pangenomes ranging from biomedical science and synthetic biology to molecular ecology. AVAILABILITY AND IMPLEMENTATION: The software if freely available with a full manual and can be found with at www.github.com/alanbeavan/PanForest DOI: https://doi.org/10.5281/zenodo.17865482.

Software↗

PubMed2002

Creating a mission-based reporting system at an academic health center.

The authors developed a Web-based mission-based reporting (MBR) system for their university's (UC Davis's) health system to report faculty members' activities in research and creative work, clinical service, education, and community/university service. They developed the system over several years (1998-2001) in response to a perceived need to better define faculty members' productivity for faculty development, financial management, and program assessment. The goal was to create a measurement tool that could be used by department chairs to counsel faculty on their performances. The MBR system provides measures of effort for each of the university's four missions. Departments or the school can use the output to better define expenditures and allocations of resources. The system provides both a quantitative metric of times spent on various activities within each mission, and a qualitative metric for the effort expended. The authors report the process of developing the MBR system and making it applicable for both clinical and basic science departments, and the mixed success experienced in its implementation. The system appears to depict the activities of most faculty fairly accurately, and chairs of test departments have been generally enthusiastic. However, resistance to general implementation remains, chiefly due to concerns about reliability, validity, and time required for completing the report. The authors conclude that MBR can be useful but will require some streamlining and the elimination of other redundant reporting instruments. A well-defined purpose is required to motivate its use.

Academic Medical Centers↗

PubMed2006

Promoting academic excellence through leadership development at the University of Washington: the Teaching Scholars Program.

The University of Washington Teaching Scholars Program (TSP) was established in 1995 to prepare faculty for local and national leadership and promote academic excellence by fostering a community of educational leaders to innovate, enliven, and enrich the environment for teaching and learning at the University of Washington (UW). Faculty in the Department of Medical Education and Biomedical Informatics designed and continue to implement the program. Qualified individuals from the UW Health Sciences Professional Schools and foreign scholars who are studying at the UW are eligible to apply for acceptance into the program. To date, 109 faculty and fellows have participated in the program, the majority of whom have been physicians. The program is committed to interprofessional education and seeks to diversify its participants. The curriculum is developed collaboratively with each cohort and comprises topics central to medical education and an emergent set of topics related to the specific interests and teaching responsibilities of the participating scholars. Core sessions cover the history of health professions education, learning theories, educational research methods, assessment, curriculum development, instructional methods, professionalism, and leadership. To graduate, scholars must complete a scholarly project in curriculum development, faculty development, or educational research; demonstrate progress towards construction of a teaching portfolio; and participate regularly and actively in program sessions. The TSP has developed and nurtured an active cadre of supportive colleagues who are transforming educational practice, elevating the status of teaching, and increasing the recognition of teachers. Graduates fill key teaching and leadership positions at the UW and in national and international professional organizations.

Adult↗

PubMed2006

From novice to informed educator: the teaching scholars program for educators in the health sciences.

The Teaching Scholars Program for Educators in the Health Sciences at McGill University, in Montreal, Quebec, was designed to promote the professional development of health science educators by increasing their expertise in developing and implementing educational programs and taking on leadership roles in education. This program, which was initiated in 1997 and is tailored to the individual needs of the participants, consists of participation in: two university courses; a monthly seminar; a research study or an educational project, consisting of curriculum design and evaluation; and faculty-wide faculty development activities. As of 2006, 34 scholars have completed this program. Outcome data indicate that the majority of teaching scholars have taken on new roles and responsibilities in medical education; maintained the changes implemented in their teaching practices; continued to participate in faculty development activities; and presented their work at educational meetings. A number of scholars have also applied successfully for educationally related grants and have published their educational projects. Five of the scholars have pursued advanced studies. This program, which aims to move beyond the improvement of teaching skills by providing a foundation for educational leadership and scholarship, resembles many others in its emphasis on independent study, peer support, and the maintenance of ongoing responsibilities. It is innovative in that scholars participate in university courses and are encouraged to attend an "outside" conference or course. The overall benefits of this program, as noted by the scholars, include increased knowledge and skills, introduction to a "community of practice," and new career paths and opportunities.

Adult↗

PubMed2004

Outcomes of adoption: measuring evidence uptake by individuals and organizations.

BACKGROUND: The translation and diffusion of findings into health care validate the potential of evidence-based innovation to improve clinical practice and affirm the benefits of society's investment in advancing science. AIMS: This article briefly reviews key concepts in the knowledge use process, considers theoretical implications for measuring outcomes and uptake of innovation, discusses issues to consider in planning for measurement of adoption, and provides an example of confronting those challenges from a project now in progress. THEORETICAL PERSPECTIVES AND TRANSLATION OUTCOMES: Four principal conceptual frameworks related to translational science, Lewin, Rogers, Havelock, and Promoting Action on Research Implementation in Health Services (PARIHS), explicate a process that catalyzes new knowledge adoption and use by individuals and systems to solve problems. Each conceptual perspective suggests that translation is not complete until the extent and impact of use is examined and understood. Most perspectives support evaluation of impact of evidence-based practice using process measures that integrate clinician knowledge, actual performance of the practice, and patient/clinician outcomes. Based on the Agency for Healthcare Research and Quality (AHRQ) framework, additional measures might include changes in patterns of care and changes in policies, procedures, or protocols. CASE EXAMPLE: A description of process and outcome measures used in an in-progress quality improvement demonstration project, California Nursing Outcomes Coalition (CalNOC) Partners in Quality Translating Research into Practice to Reduce Patient Falls Project, is presented. IMPLICATION(S) FOR PRACTICE, RESEARCH, AND POLICY: Since the adoption of evidence-based innovation is a process that is often described along a continuum, investigators seeking to measure the impact of an evidence-based innovation must gather evidence that uptake of the innovation has occurred. The theoretical perspective and practical measurement issues of a given project will drive selection of process and outcome measures. CONCLUSIONS: Efforts to change practice in order to enhance evidence-based patient care must integrate monitoring and evaluation of specific target outcomes of adoption as the basis for validating the impact of the change.

Accidental Falls↗