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Hypermedia and randomized algorithms for medical expert systems.

KNET is an environment for constructing probabilistic, knowledge-intensive systems within the axiomatic framework of decision theory. The KNET architecture defines a complete separation between the hypermedia user interface on the one hand, and the representation and management of expert opinion on the other. KNET offers a choice of algorithms for probabilistic inference. We and our coworkers have used KNET to build consultation systems for lymph-node pathology, bone-marrow transplantation therapy, clinical epidemiology, and alarm management in the intensive-care unit. Most important, KNET contains a randomized approximation scheme (RAS) for the difficult and almost certainly intractable problem of Bayesian inference. Our algorithm can, in many circumstances, perform efficient approximate inference in large and richly interconnected models of medical diagnosis. In this article, we describe the architecture of KNET, construct a randomized algorithm for probabilistic inference, and analyze the algorithm's performance. Finally, we characterize our algorithms' empiric behavior and explore its potential for parallel speedups. From design to implementation, then, KNET demonstrates the crucial interaction between theoretical computer science and medical informatics.

Algorithms↗

Lee-Goldburg solid-state imaging.

A new approach to solid-state imaging (SSI) is presented. The method relies on narrowing the resonance line using the Lee-Goldburg sequence. The technique is easy to implement in practice and may find widespread applications in materials science.

Magnetic Resonance Spectroscopy↗

[Evidence-based nursing--the missing link between research and practice].

UNLABELLED: Evidence-based nursing (EBN) is being introduced promising to professionalize and emancipate nursing. Three questions are discussed as to whether this can be accomplished. The analysis comes to the following conclusions: Evidence-based nursing (EBN) as a problem solving process will become part of the German health care service by means of social legislation. The concept joins clinical experience and best evidence under the principle of patient adapted intervention. This complies with the demand for rationally justified, transparent, and economically comparable performance. One specific trait of research in nursing is the importance of qualitative methods that make the dimension of subjective meaning comprehensible. Only under a normative paradigm can the concept of evidence-based intervention be applied immediately. This leads to problems of adaptation that have to be solved when introducing EBN. Evidence-based nursing practice fits into modern concepts of professional nursing as well as into current visions regarding the reform of German nursing education. However, some peculiarities that characterize German nursing practice in particular must be taken into consideration. This includes the professional ideology of nursing staff as well as applied nursing science, which is still in its beginnings. CONCLUSION: With careful implementation the concept of evidence-based intervention can develop its potential to improve nursing practice. Further, EBN offers Germany an opportunity to catch up with international standards.

Clinical Nursing Research↗

Translational research: how social psychology can improve psychotherapy.

In an effort to generate innovative treatments, the National Institute of Mental Health has made translational research for alleviating mental illness a major funding priority. Although translational research is a powerful approach for moving basic science findings into novel treatments, it remains ambiguous and rarely implemented in psychology. The current article describes conceptual and methodological issues involved with translational research, including considerations about time frame, scope of hypothesis tested, dose of treatment, contraindication, and sampling. Translational concepts and methods are illustrated with areas of social psychology that are promising for translation into solutions for pressing questions in psychotherapy research.

Humans↗

A formative and summative evaluation model for special educational programs.

During the past two decades the problems of recruiting minority students into careers in the health fields have been addressed by many educators and various special study groups. Recent efforts by schools of medicine and allied health sciences to find viable solutions to the problem have facilitated implementation of career exploration and study-skills programs. Although the focus and sophistication of evaluation designs vary substantially among educational programs of this type, all share some common problems. The positions taken by the authors is that evaluation, both during and at the end of a program, is an essential aspect of the program and that the use of a systematic evaluation model is central to this effort. Data are presented which illustrate the utility of a systematic evaluation model when applied in a realistic test situation (an operational program for minority students). Several advantages of using this model are discussed.

Career Choice↗

Health, Society and Alcohol.

The European Conference, Health, Society and Alcohol held in Paris, 12-14 December 1995, was a meeting point between science and policy. Science informed the policy process. As a tool for policy implementation, the Conference adopted the European Charter on Alcohol, a set of ethical principles and strategies for action. Of a number of important issues that frame policy, three deserve mention. First, market forces, as opposed to health and social policy decisions are increasingly influencing the policy debate. Second, existing policy options to reduce alcohol-related harm are unlikely to lead to an increased risk of coronary heart disease among older age groups. And third, policy developments and changes in drinking patterns in countries of southern Europe are an important driving force in European policy on alcohol.

Alcohol Drinking↗

Subjects' rights, freedom of inquiry, and the future of research in the addictions.

Since the recent passage of regulations concerning subjects' rights and freedom on inquiry, opposition by the public and others to some areas of research in the addictions has prevented its implementation or continuation. Research investigators in the biomedical and behavioral sciences have been placed in the position of defending their work in an adversary climate. The author points out the importance of transmitting to the public, the scientific community, and legislators the investigators' concern that "subjects' rights" not be viewed only in a legalistic context, but also in the context of not harming the patient.

Advisory Committees↗

Ethical problems in research on risky behaviors and risky populations.

The articles by Brooks-Gunn, Fisher, Hoagwood, Liss and Scott-Jones (all in this issue) present a panoply of real-world ethical issues in conducting scientific research on risky behaviors of children, adolescents, and their parents, particularly those from vulnerable populations. The universal, ethical principles of beneficence, justice, and respect for others are always applicable, but they do not resolve issues of child assent, parental consent, legal reporting requirements for illegal behaviors, and the special problems of studying risky behaviors in risky populations. Taken as a group, the articles raise some of the most interesting ethical problems that arise in developmental research. My discussion elaborates some issues and fails to resolve others. I hold the view that both science and ethics can be served by thoughtfully designed and implemented research on important social issues, but that the studies themselves cannot simultaneously solve the many societal problems of participants and be scientifically credible.

Adolescent↗

[Nursing: the integrated curriculum in the evaluation and perception of the nursing faculty].

The following study aims at determining the perspectives and difficulties experienced by the teaching staff of the Nursing Department at the Health Sciences Center in Londrina State University during the development and implementation of Module I of their integrated curriculum. The research was constituted by a case study and data were obtained from a set of questions posed to 13 (thirteen) teachers who designed and implemented the Module I of the integrated curriculum at the nursing school in Londrina State University, during the year of 2000. The analysis of the data allowed the authors to determine those factors which either made it difficult or facilitated the process implementation, as well as to raise teachers' perception about the process of curricular change. The study, by supplying indicatives of change, contributes to the improvement of the quality of nursing education as the new curriculum is implemented at Londrina State University.

Brazil↗

Adaptive radiofrequency hyperthermia-phased array system for improved cancer therapy: phantom target measurements.

A computer-controlled adaptive radio-frequency hyperthermia system for improved therapeutic tumour heating is experimentally investigated. Adaptive array feedback techniques are used to modify the electric-field and temperature distribution in hyperthermia experiments with homogeneous and heterogeneous phantom targets. A commercial hyperthermia phased-array antenna system at the SUNY Health Science Center in Syracuse, New York, has been modified to implement adaptive nulling and adaptive focusing algorithms. The hyperthermia system is the BSD Medical Corporation Model BSD-2000 with Sigma-60 annular phased-array antenna applicator. The transmit phased array system is made adaptive by software modifications which invoke a gradient-search feedback algorithm. The gradient-search algorithm implements the method of steepest descent for adaptive nulling (power minimization) and the method of steepest ascent for adaptive focusing (power maximization). The feedback signals are provided by electric-field short-dipole probe antennas. With an adaptive hyperthermia array using real-time measured data, it may be possible to maximize the applied electric field at a tumour position in a complex scattering target body and simultaneously minimize or reduce the electric field at target positions where undesired high-temperature regions (hot spots) occur. The measured phantom-target data indicate that adaptive nulling can reduce the electric field at one or more target positions while simultaneously focusing the electric field at a deep-seated position within the target.

Algorithms↗

Strengthening HIV prevention: application of a research-to-practice framework.

As the HIV epidemic continues to affect at-risk and vulnerable populations, providers strive to improve prevention programs, in part by seeking new interventions with greater effects. Although interventions with scientific evidence of effectiveness are vital to this effort, many challenges limit access to research products. We examine key challenges and offer a framework for moving research to practice, one in which research steps are linked to practice steps and all these activities take place in a complex and dynamic environment. The Replicating Effective Programs (REP) project of the Centers for Disease Control and Prevention and other technology transfer activities illustrate the operation of this framework for HIV prevention. Further actions to improve technology transfer are called for. These include reducing time from study design to practice; learning from field-based implementations; providing guidance about fidelity to, and tailoring of, science-based interventions; improving linkages among consumers, providers, and researchers; and seeking additional resources.

Centers for Disease Control and Prevention, U.S.↗

Trajectory of cognitive science and psychological assessment: current status and expectations.

Salient commonalities and distinctions of the set of contributions to this special section are synthesized and discussed. The examination provides a springboard for observations on future developments in cognitive-science applications. Issues considered include imminence and nature of clinical implementation, prediction of selected client transactions outside the assessment context, integration with complementing modes of clinical assessment, and reciprocal information sharing by clinical and nonclinical cognitive scientists.

Cognition Disorders↗

High-throughput screening using genome-wide siRNA libraries.

Small-interfering RNA (siRNA) technology is a new approach for blocking the production of a protein by specific degradation of the messenger RNA that encodes the protein. The high potency of siRNA and the relative ease of application have led to broad implementation of the method in many aspects of the life science research. The combination of the developments in its application and in siRNA libraries to cover whole genomes has further enabled genome-wide high-throughput functional screening.

Combinatorial Chemistry Techniques↗

Drugs and related topics.

Drugs is a topic that was certainly an issue of discussion at this year's annual meeting. This Committee had the responsibility of organizing a half day symposium on "Pharmaceutical Authenticity and Safety" that took place September 12, 2005. This symposium aims at improving the critical points in the analytical pharmaceutical field related to traceability assessment, use of certified reference materials (CRMs), and proficiency testing implementation to get the highest quality of the obtained results. Recognized experts presented these topics. Also, other complementary subjects, such as the application of advanced analytical technologies to reach the authenticity and safety of the pharmaceutical drugs and drug products, their microbiological quality assessment, without disregarding an important topic such as sampling, was presented and discussed. The talks that were presented are the following: "Proficiency Testing as a Need in the Pharmaceutical Field," Arlene Fox (AOAC INTERNATIONAL, Gaithersburg, MD); "Implementation of Traceability in the Pharmaceutical Laboratory," Thomas Layloff, (Management Sciences for Health, Arlington, VA); "Harmonized Characteristics of Certified Reference Materials According to ISO Guides-Attractive also for Pharmaceutical Analysis," Hendrik Emons (Reference Materials, Unit Institute for Reference Materials and Measurements (IRMM), Joint Research Centre European Commission, (Geel, Belgium); "Importance of LC/MS/MS for the Fingerprinting of Pharmaceutical Drugs," Paul A. Steinberg, (Thermo Electron Corp., Woodstock, GA); "Process Analytical Technology (PAT) as a Way for Better Manufacturing and Quality Assurance," John F. Kauffman (Division of Pharmaceutical Analysis, U.S. Food and Drug Administration (St. Louis, MO); "Stability Testing for the Safety Assessment of Pharmaceuticals," Marta Vidal (Boeringher Ingelheim Argentina, Buenos Aires, Argentina); "Validation of Microbiological Methods for Sterile and Nonsterile Pharmaceutical Products," Michael Brodsky (Brodsky Consultants, Thornhill, ON, Canada); "The Relationship Between Pharmacopoeial Reference Standards and ISO REMCO Initiatives and Guides," Ronald G. Manning (United States Pharmacopoeia, Rockville, MD).

Calibration↗

[Bologna process and higher health education in Europe].

AIM: Introduction of the two cycles (Bachelor/Master) system represents sensitive aspect of the implementation of the Bologna process into higher health education. The authors used the methods of evidence based medicine to analyse available documents on the implementation of the Bologna process into the education of health sciences. METHODS: Electronic search in the closed MEDLINE and open Internet databases. RESULTS: Electronic data collection resulted in so-called country reports (n=47) and in professional statements (n=7) of health education bodies. Majority of the country reports (n=26) did not mention at all the peculiar position of health education within the Bologna process. Many country reports stated with (n=8) or without (n=9) explanation that health sciences should be excluded from the introduction of the two educational cycles system. Only 4 country reports discussed future conditions and possibilities of introducing the two cycles system into higher health education; the German country report definitely declared that the two cycles educational system may be introduced also into health education. The seven statements of professional health educational bodies (including an ad hoc committee of the Hungarian medical faculties) did not support the introduction of the two cycles system into health education. The low demand for health professionals with Bachelor (i.e. unfinished) degree was repeatedly mentioned as strong argument for not introducing the two cycles system into health education. It should be noted, however, that the process of introducing the two cycles system has began: recent survey of EUA (European University Association) indicates that in three countries (Denmark, Flanders and Switzerland) the introduction in under current discussion. CONCLUSION: Among the principles of the Bologna process, the introduction of the two cycles system has not gain acceptance in the higher health education in Europe. However, most documents firmly support the introduction of other elements of the Bologna process (comparable degrees, system of credits, promotion of mobility of students and tutors, quality control, life long learning).

Education, Medical↗

HUBNET: Wide Area Network utilization of Local Area Network medical reference and communication resources.

The State University of New York at Buffalo School of Medicine and Biomedical Sciences and its associated teaching sites have developed and partially implemented a regional Wide Area Network (WAN) in Buffalo and Western New York. The school wishes to use this WAN to deliver reference and communication resources to students, residents and faculty. The richest pool of easy to use reference and communication resources are PC software programs that are intended for individual workstations or at best, client-server, Local Area Network (LAN) implementation. HUBNET (Hospitals and University at Buffalo Library Resource Network), a project of the School of Medicine and the Library Consortium of Health Institutions in Buffalo offers integrated presentation of many such LAN resources over this regional WAN. The system crosses many institutional boundaries and reaches physically remote sites in a complex mix of information systems environments with few issues related to performance. The system design provides a level of ease of use that has brought many new users into active computer use while addressing integration into diverse information systems settings and networking environments.

Computer Communication Networks↗

Personal metabolomics as a next generation nutritional assessment.

Nutrition research is in the process of addressing a series of questions related to the future of diet and health. Are all humans the same with respect to their response to diet? If not, humans must be fed differently according to the differences in their genetics and metabolic needs. Are those differences self-evident to the individual or their care-givers? If not, methods must be developed to measure the basis of differences between humans. Are the current sets of diagnostic biomarkers for disease appropriate and sufficient to distinguish the appropriate diets of humans for optimal metabolic health? If not, metabolites must be measured such that the differences in human metabolism are resolvable before they become diseased. Will a small subset of metabolic markers provide an indication of intended and unintended effects of diets that relate to overall metabolism? If not, comprehensive metabolic analyses (metabolomics) must be put in place to ensure that all aspects of health are accurately assessed. Inappropriate dietary choices are accelerating the development of chronic metabolic disease and threatening to overwhelm public health's ability to manage them. Nutrition and food sciences will need to collaborate with other scientific disciplines to develop and implement metabolic assessment technologies and to assemble annotated databases of metabolite profiles in humans, thus building the knowledge needed to link metabolism to diet and health. Biochemical and physiological research must be guided to define the mechanisms by which diet interacts with metabolism in different individuals. Integrating metabolism with the genetic and dietary variables that affect health is the role of nutrition sciences. Integrating personal nutritional value with food's other key values of safety, quality, comfort, delight, convenience and affordability is the role of food science. It is time for these two fields to address a common problem, metabolic health, with coordinated solutions.

Computational Biology↗