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Determination of threshold conditions for a non-linear stochastic partnership model for heterosexually transmitted diseases with stages.

When comparing the performance of a stochastic model of an epidemic at two points in a parameter space, a threshold is said to have been crossed when at one point an epidemic develops with positive probability; while at the other there is a tendency for an epidemic to become extinct. The approach used to find thresholds in this paper was to embed a system of ordinary non-linear differential equations in a stochastic process, accommodating the formation and dissolution of marital partnerships in a heterosexual population, extra-marital sexual contacts, and diseases such as HIV/AIDS with stages. A symbolic representation of the Jacobian matrix of this system was derived. To determine whether this matrix was stable or non-stable at a particular parameter point, the Jacobian was evaluated at a disease-free equilibrium and its eigenvalues were computed. The stability or non-stability of the matrix was then determined by checking if all real parts of the eigenvalues were negative. By writing software to repeat this process for a selected set of points in the parameter space, it was possible to develop search engines for finding points in the parameter space where thresholds were crossed. The results of a set of Monte Carlo simulation experiments were reported which suggest that, by combining the stochastic and deterministic paradigms within a single formulation, it was possible to obtain more informative interpretations of simulation experiments than if attention were confined solely to either paradigm.

Acquired Immunodeficiency Syndrome↗

Internet availability of contraceptives.

OBJECTIVE: To measure the accessibility of contraceptive supplies over the Internet. METHODS: We performed an Internet search with the use of search engines and key words. We posed as consumers purchasing both prescription and over-the-counter contraceptive supplies. The number of clicks or web pages accessed, costs, shipping time, barriers to access, and prescription requirements were compared for selected birth control supplies. RESULTS: More than 200 web sites were visited to locate at least one site where we could purchase each selected product. Contraceptive supplies, including male and female condoms, spermicides, vaginal sponges, intrauterine devices (IUDs), diaphragms, and cervical caps, were easily obtained without a prescription from foreign web sites. Oral contraceptive pills (OCs) were readily available online in November 1999; some sites had discontinued sales by February 2000, but OCs could still be purchased with no prescription in August 2000. None of the four prescription sites supplied physician or prescriber credentials. The contraceptive costs varied by vendor and product. A type of copper IUD could be purchased for less than $50.00, whereas a single package of emergency contraceptive pills cost $141.00 from one vendor because of prescription and shipping fees. Some emergency contraceptive pills ordered arrived after 72 hours or did not arrive and the purchase was not refunded. A levonorgestrel IUD was shipped without difficulty in December 1999, but a second device, ordered in February 2000, was temporarily impounded by United States Customs. CONCLUSION: This method of contraceptive purchase is accessible, expensive, erratically regulated, and rapidly changing.

Contraceptive Agents↗

Isolation and characterization of a potent curarizing polypeptide from Tityus discrepans scorpion venom.

The pure TdI-1 polypeptide that blocks miniature endplate potentials (MEPPs) and abolishes or reduces endplate potentials (EPPs) below the action potential threshold was identified from the crude fraction of Tityus discrepans venom. The toxin is a potent reversible non-depolarizing muscle relaxant that blocks more than 95% of the EPP at a 2 microM (0.1 mg/ml) concentration. On a molar basis, TdI-1 is as potent as or more potent than many muscle relaxants since, at the concentration used, the toxin suppressed more than 95% of the EPP. Using matrix-assisted laser desorption time of flight (MALD-TOF) ionization mass spectrometry, TdI-1 was found to have an unusally large mol. wt for a scorpion toxin, close to 48,000. The N-terminal sequence of the first 23 residues of TdI-1 was also determined. The fragment differs from the N-terminal sequences of all 140 peptidic scorpion toxins found in the SWISSPROT and PIR databases using the search engine of the felix.EMBL-Heidelberg.de computer (European Molecular Biology Laboratory, Heidelberg, Germany.

Amino Acid Sequence↗

Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses.

OBJECTIVES: To determine the clinical utility of urine-based bladder tumor markers (UBBTMs) and cytology in the treatment of patients with transitional cell carcinoma on the basis of their statistical performance. METHODS: A comprehensive literature review was performed using Medline (1966 to current) and other search engines. Data regarding the statistical performance of UBBTMs were double extracted and rectified. Studies addressing comparable patient populations were combined and hierarchical Bayesian meta-analyses performed to calculate the sensitivity and specificity of commonly used UBBTMs, as well as urinary cytology. Patient populations were stratified by tumor stage and grade when data were presented in an extractable fashion. RESULTS: The literature review yielded 54 publications, 338 distinct patient groups (controls, screening population, patients with cancer, strata based on grade and stage) and more than 10,000 patients. The number of groups varied from 1 to 18, and the number of patients ranged from less than 100 to more than 1500 for the various markers. All UBBTMs have better sensitivity compared with cytology, especially for low-grade/stage disease, but do not match cytology regarding specificity. In patients with grade 1 and 2 tumors, several UBBTMs are significantly superior statistically in terms of sensitivity compared with cytology. The sensitivity for transitional cell carcinoma in situ (Tis) is surprisingly poor for all UBBTMs. CONCLUSIONS: UBBTMs can be used for follow-up of low-grade/stage tumors but should not replace cystoscopy. All UBBTMs have better sensitivity than cytology and could potentially replace routine cytology during patient follow-up.

Bayes Theorem↗

Atomoxetine hydrochloride for the treatment of attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) occurs in approximately 3% to 10% of the pediatric population. Most of the drugs typically used to treat ADHD are stimulants, which, because of their addictive properties and potential for abuse, are controlled substances. Although these drugs are the mainstay of treatment for ADHD, nearly one third of patients may not respond to or be able to tolerate them. Atomoxetine hydrochloride, a nonstimulant approved by the US Food and Drug Administration for the treatment of ADHD, may provide an alternative to the use of stimulants. OBJECTIVE: The goal of this review was to describe the chemistry, mechanism of action, pharmacokinetics, drug interactions, and efficacy and safety profiles of atomoxetine in pediatric and adult patients with ADHD, as well as relevant pharmacoeconomic considerations. METHODS: Relevant publications were identified through a search of the English-language literature indexed on PreMEDLINE and MEDLINE (1966-May 2003) using the search terms atomoxetine, tomoxetine, and LY139603. These terms were also applied to the Google search engine. All articles were reviewed for suitability for inclusion. The manufacturer of atomoxetine provided both published and unpublished data. RESULTS: In the data reviewed, atomoxetine was more efficacious than placebo in patients with ADHD (P<0.05 to P<0.01). Therapeutic doses ranged from 45 mg or placebo (P<0.05). These results add support to the hypothesis that atomoxetine may not cause the increase in dopamine concentrations in the nucleus accumbens that is associated with pleasurable effects and abuse potential.

Adolescent↗

The antibody web

The internet has evolved to play a central role in the lives of immunologists. Powerful search engines facilitate the location of references or suppliers at the click of a mouse. Specialized websites provide reviews for many immunological topics and links for fast navigation to related information. This article highlights websites related to monoclonal and recombinant antibodies.

Journal Article↗

Psychopathology and delinquency in adolescents: a descriptive and developmental perspective.

The current article presents a review on psychiatric pathology in delinquent adolescents. The putative developmental significance of this co-occurrence is discussed within Moffitt's [Psychol. Rev. 100 (1993) 674] developmental framework on antisocial behavior. Articles on psychopathology in delinquent adolescents were retrieved through search engines (MEDLINE, Psychlit) and by exploration of references in those articles. Substantial evidence is at hand that delinquent adolescents have higher rates of externalizing and internalizing disorders when compared to adolescents in the general population. Although substantial limitations hamper interpretation of the findings, the marked similarities across a diversity of samples from different countries suggest that the findings are fairly generalizable. Evidence was found for differences in prevalence and developmental significance of psychiatric pathology between adolescent limited (AL) offenders and life-course persistent (LCP) offenders. Although psychopathology was more severe in LCP offenders, AL offenders still had significant and potential harmful levels of psychopathology. These findings emphasize the necessity of developing mental health services to delinquent adolescents and the necessity of adequate diagnostic and therapeutic interventions in these adolescents.

Adolescent↗

[Do we need a chart of quality for websites related to cosmetic surgery?].

UNLABELLED: Convergence of medicine and Internet may be one of the most remarkable transformations in the health care business. Following the path led by the United States, the number of French websites related to cosmetic surgery is growing rapidly. In this study, we intend to assess the quality of French websites dedicated to cosmetic surgery regarding good quality criteria currently available and recommendations suggested by the French Medical Association. MATERIALS AND METHODS: We browsed the main French search engines on the Web that initially answering the following question: how many webpages are available regarding cosmetic surgery and what are the best referenced websites. For each website, we surveyed the following data: author's name and qualification, date of creation and last update, sources of information, level of interactivity, and adherence to a chart of quality such as HON. RESULTS: Eighty-five websites were surveyed and assessed. Forty-five French websites were active websites dedicated to cosmetic surgery. Websites are mainly hosted by private clinics (18 sites = 40%), with informative content. We found that no website adheres to any chart of quality, and the French Society for Plastic Surgery (SOF.C.P.R.E.) is never mentioned. Intrinsic quality criteria for websites (author's identification, last update, sources of information, confidentiality) are only partially present. DISCUSSION: We recall the key statistics regarding e-health business in the world, the various charts of quality available for medical websites, and recommendations provided by the French Medical Association. We suggest that websites should be available as a service (for information to the patient, for managing the office, for setting up medical records) rather than a poor personal webpage or a showcase. CONCLUSION: The quality of websites for cosmetic surgery is poor; however, as in the USA, the number of web surfers on medical sites is growing. Online presence of our speciality should evolve. To improve medical websites, collective awareness is required. We recommend using a specific chart of quality, with recommendations rather than constraints.

France↗

Online resources for news about toxicology and other environmental topics.

Technology has revolutionized researchers' ability to find and retrieve news stories and press releases. Thanks to electronic library systems and telecommunications--notably the Internet--computer users in seconds can sift through millions of articles to locate mainstream articles about toxicology and other environmental topics. But that does not mean it is easy to find what one is looking for. There is a confusing array of databases and services that archive news articles and press releases: (1) some are free; others cost thousands of dollars a year to access, (2) some include hundreds of newspaper and magazine titles; others cover only one publication, (3) some contain archives going back decades; others have just the latest news, (4) some offer only journalistically balanced reports from mainstream news sources; others mix news with opinions and advocacy and include reports from obscure or biased sources. This article explores ways to find news online - particularly news about toxicology, hazardous chemicals, environmental health and the environment in general. The article covers web sites devoted to environmental news; sites and search engines for general-interest news; newspaper archives; commercial information services; press release distribution services and archives; and other resources and strategies for finding articles in the popular press about toxicology and the environment.

Environmental Health↗

Internet resources for occupational and environmental health professionals.

The Internet = s global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines. Effective use of the Web requires discovery and familiarity with sites housing query engines for technical databases. Although the Web = s structure and capacity is so dynamic that any listing is incomplete, introductions to many resources are provided in this article. The Internet also offers professionals electronic access to one another, for collegial discourse. Electronic mailing lists provide assembly points for collaboration and guidance about technical issues. Several specialty forums for OEH professionals are also discussed.

Databases as Topic↗

Internet resources for occupational and environmental health professionals.

The Internet's global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines. Effective use of the Web requires discovery and familiarity with sites housing query engines for technical databases. Although the Web's structure and capacity is so dynamic that any listing is incomplete, introductions to many resources are provided in this article. The Internet also offers professionals electronic access to one another, for collegial discourse. Electronic mailing lists provide assembly points for collaboration and guidance about technical issues. Several specialty forums for OEH professionals are also discussed.

Databases as Topic↗

The nociceptive flexion reflex in humans -- review article.

The nociceptive flexion reflex (NFR) is a physiological, polysynaptic reflex allowing for painful stimuli to activate an appropriate withdrawal response. NFR is easily measurable in clinical setting, and is a reliable and objective tool for measurement of an individual's pain experience. An exhaustive review of the literature, covering multiple search engines, indicates that the NFR method is valuable in studying the impact of diverse pharmacological and non-pharmacological interventions on the flexion reflex, in conditions of acute pain and in healthy volunteers. More recently, the NFR method has gained particular attention as a research tool in studies of central sensitization and persistent or chronic pain.

Humans↗

Evaluation of patient information Internet web sites about menopause and hormone replacement therapy.

OBJECTIVES: To evaluate quality of web based information on the menopause and hormone replacement therapy, to identify whether site ownership is an indicator of both web site and content quality, and therefore to provide guidance for healthcare professionals over which sites are suitable for recommendation to patients. METHODS: A search of web sites was conducted using eight commonly used search engines and two key terms ('menopause' and 'hormone replacement therapy') limited to English language. Thus, a sample of 25 sites (of varied ownership) was generated. Using a specific scoring tool, each site was assessed on factual information provided and quality of site. For each criterion, a score of 1-5 was assigned, and two mean scores were generated. Each site was also assessed in a semi-structured qualitative manner. RESULTS: The mean informational value of the sites sampled was 3.129 (out of a maximum of 5) but with a range of 1.6-4.6. The mean value of the sample for the quality of web sites was higher (3.504) but again over a broad range (2.5-4.5). Certain types of ownership were associated with higher quality sites, including the pharmaceutical industry, community pharmacies, governments, and charities. CONCLUSIONS: The information about menopause and HRT on the web is often of dubious calibre, with incomplete information being commonly provided. Therefore it is recommended that healthcare professionals direct women to sites owned by the pharmaceutical industry, community pharmacies, governments, and charities. In doing so it would be prudent to advise women that commercial sites may be biased towards particular products.

Female↗

Web-based interventions for substance use disorders: a qualitative review.

Substance use disorder is one of the most common mental health problems in the Western world with a significant contribution to the global burden of disease and a high level of unmet treatment need. To assess the use and effectiveness of web-based interventions for substance use disorders. A qualitative review of the published literature across databases Medline, EMBASE, PsychINFO, GrayLIT Network, and Web of Science using relevant key terms. A search of the worldwide web was also conducted using search engines such as Google. There were a number of computerized and internet-based interventions for mental health disorders including substance use disorders located; however, they are largely descriptive with no large randomized controlled trials of internet-delivered interventions for substance use disorders reported. While the literature on internet-based substance use interventions is sparse and flawed, the potential impact of effective intervention is considerable. On the basis of the limited research available it is reasonable to suggest that a demand for such interventions exists and there is a likelihood that they would be as effective as those delivered by therapists for the majority of less severely dependent clients. Further clinical outcome research, particularly in the area of brief interventions for alcohol use disorders and extension to other drugs such as cannabis and club drugs, is certainly justified. (c) 2004 Elsevier Science Inc. All rights reserved.

Health Education↗

Pharmacy technology of the ICU. Today and tomorrow.

This article takes a broad sweep at some of the forces that will impact pharmacy in the intensive care units of tomorrow. Each of the topics covered has journals or societies devoted to these issues. The incredible change from 10 years ago is that one can easily put these topics into a search engine on the Internet and receive more information than it is possible to read in one setting. The challenge to us all is to find ways to maintain a degree of knowledge about these changes that is both timely and considered. The old axiom of not being the first or the last to change is still a safe approach, but the speed at which the decision must be made is ever increasing. We must all put pressure on our professional societies and our employers to assure that we have adequate access to the rapidly developing technology and a level of expert review prior to its adoption. Future technology is already in our intensive care units but what we do with the technology and the information will determine the future healthcare outcomes of our patients.

Drug Delivery Systems↗

Adherence of published diabetes mellitus practice guidelines to methodologic standards of guideline development.

There are multiple practice guidelines published pertaining to diabetes care. Experts have formulated methodologic standards of guideline formulation. To determine whether practice guidelines pertaining to diabetes and published in peer-reviewed publications and the Internet adhered to established methodologic standards of guideline development. We identified all guidelines pertaining to diabetes care published between 1980 and 2000 using a computerized search of Medline, the Practice Guidelines Clearinghouse, the Institute for Clinical Systems Improvement Web site, and a global internet search engine. We used a previously validated 25-item assessment tool to determine guideline adherence to methodologic standards in three categories: guideline development and format, identification and summary of evidence, and formulation of recommendations. We conducted a multivariable regression analysis to determine the influence of guideline author, publishing medium, year of publication, and guidelines length on adherence to methodologic standards of guideline development. We evaluated 43 guidelines: 33% published on the Internet, 66% in peer-reviewed journals; 51% published by organizations, and 49% by individual experts. Of a maximum of 25 methodologic standards, the number of standards adhered by a guideline was 9 (range, 2 to 19). Mean proportion (SD) of guidelines that adhered to methodologic standards on guideline development and format was 48% (28); on identification and summary of evidence, 21% (22); and on the formulation of recommendations, 36% (27). Longer guidelines had greater adherence to methodologic standards (P < 0.0001). Guidelines pertaining to diabetes care published on the internet and in peer-reviewed publications do not meet most methodologic standards of guideline development.

Diabetes Mellitus↗

Integrating content-based retrieval in a medical image reference database.

Image reference databases (IRDBs) are a recurrent research topic in medical imaging. Most IRDBs are designed to help experienced physicians in diagnostic tasks and require that users have prior extensive knowledge of the field for their use to be fruitful. Therefore, the educational potential of such image collections cannot be exploited thoroughly. In this paper we propose an image-indexing method to extend the functionalities of an existing medical IRDB and allow for its use in educational applications, as well as in computer-assisted diagnosis. Our method, based on the Kahrunen-Leève transform, has been used to develop a content-based search engine for tomographic image databases on which we are presently experimenting and which we aim to integrate into a working radiological IRDB installed at the University of Florence. Results achieved in our preliminary tests are also reported.

Brain↗

Caring for a febrile child: the quality of Internet information.

AIM: A small study was conducted to evaluate the quality of information on the Internet about caring for a child with fever in order to alert nurses to the variable nature of information on the Internet for their own professional use and to provide advice to their patients. METHODS: Three search engines were used to locate web sites with information about the management of fever. A total of 22 web sites were assessed after duplicate and irrelevant web sites were excluded from the analysis. Each site was evaluated against the criteria: accuracy; currency; source; original source; and disclosure. The web sites were also examined for warnings against potentially dangerous treatments. RESULTS: The quality of information on the Internet about the management of fever varied greatly, but was generally poor. Accuracy was assessed using five recommendations for managing fever and the proportion of web sites that included these recommendations ranged from 5% to 64%. Less than two-thirds of the sites recorded their creation or review dates. A third of the web sites did not carry warnings about potentially dangerous treatments. CONCLUSION: This study's findings highlight the poor quality of health information on the Internet and indicate factors to consider when using the Internet as an information source. Nurses' awareness of the variable quality of information on the Internet will assist them to identify quality information for their own professional practice and knowledge on which to base advice to patients.

Child↗