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PubMed2004

Using XML technology for the ontology-based semantic integration of life science databases.

Several hundred internet accessible life science databases with constantly growing contents and varying areas of specialization are publicly available via the internet. Database integration, consequently, is a fundamental prerequisite to be able to answer complex biological questions. Due to the presence of syntactic, schematic, and semantic heterogeneities, large scale database integration at present takes considerable efforts. As there is a growing apprehension of extensible markup language (XML) as a means for data exchange in the life sciences, this article focuses on the impact of XML technology on database integration in this area. In detail, a general architecture for ontology-driven data integration based on XML technology is introduced, which overcomes some of the traditional problems in this area. As a proof of concept, a prototypical implementation of this architecture based on a native XML database and an expert system shell is described for the realization of a real world integration scenario.

Algorithms↗

PubMedDate not supplied

The need for policy and risk analysis--the Department of Energy experience.

Reduction of major risks to the public and workers is a top priority of all federal agencies. Given current and future budget realities, agencies cannot attempt to address all risks simultaneously nor to address certain relatively lower risk activities as rapidly as some would like. The assumptions and judgments inherent in using risk analysis in the absence of data, however, have to be clearly stated. What is needed is an integrated risk assessment and management process that meets the current and future needs of the government, as well as of stakeholders. Yet there have been many questions raised regarding risk assessment: our ability to define the risks on a specific substance or site basis and in a systematic way; methodology questions about identifying and assessing diverse hazards and risks as well as uncertainties in the estimates, data gaps, and concern over the quality of information; and the fact that "who" performs the risk assessment matters. Knowing these controversies surrounding risk and the use of risk-based approach, the Department of Energy (DOE) requested the National Academy of Sciences-National Research Council to determine whether and how risk and risk-based decisions could be incorporated into a major federal program, the DOE's Office of Environmental Management. The report identified the major obstacles, issues, and barriers to implementing a risk-based management approach. The report concluded that the use of risk-based approach could help compare outcomes, build consensus, and gain early public involvement to include cultural, socioeconomic, historical, and religious values, if its purposes and limitations are well defined. A status of the DOE's ability to implement the recommendations presented in the report on the use of risk assessment in a major federal program and the adoption of principles for using risk analysis will be given.

Government Agencies↗

PubMed2001

Implementing a virtual reality paradigm in human anatomy/physiology college curricula.

Modes of instruction in the college course called Human Anatomy/Physiology are changing. Due to ethical concerns and the ever-increasing source of new physiological data, there is a need for enhancements to assist the instructor and student. The computer science of virtual reality (VR) provides a method to electronically educate, train, prototype, test and evaluate new enhancements to the college curricula. This study detailed the modeling and simulation of a skeletal human hand with degrees of freedom of movement, which provided the students with a physiological representation of some of the movements of the hand. The primary objectives of the study were to assess the use of the VR simulation by college students and to assess the potential learning outcomes of students in their use of the VR simulation. The simulation was implemented into classes of Human Anatomy/Physiology as an adjunct enhancement for the students' use. The expectation centered on the constructivist theory that students develop an analytic outlook to the various articulations of the human skeleton. Positive results were shown based on the answers to the questionnaire, summary and post-test taken by the students, after their use of the VR simulation. The results supported the constructivist theory that critical thinking took place. The results showed that the virtual reality simulation enhanced the learning ability of the students. The recommendations of the study include future experimentation to be done on increasing the number of VR simulations, incorporating the VR simulations into undergraduate courses, testing the outcomes, and following the progression of students into graduate programs that are using VR simulations. Faculty and administration are advised to consider implementing the paradigm of VR simulations in undergraduate courses of Human Anatomy/Physiology.

Anatomy↗

PubMed2004

The science of politics/the politics of science: examining the snowmobile controversy in Yellowstone National Park.

The snowmobile controversy in Yellowstone National Park not only pits snowmobilers against environmentalists, but it also pits the Bush Administration against the Clinton Administration. Caught in the middle are the National Park Service, scores of natural and social scientists, and Yellowstone's permanent residents-the flora and fauna. The controversy's political aspects are the focus of this paper; specifically, the tenuous relationship among research scientists, whose job it is to inform management and policy decisions; politicians, whose job it is to formulate those same decisions in the public arena; and public land management agencies, whose job it is to implement the decisions. The crux of the paper concerns the politicization of natural resource policy and ways in which research scientists tend to get caught up in it. Lessons learned from this Yellowstone episode regarding the role of science in policy-making processes are also considered. Two recent federal court rulings shed additional light on the politics surrounding Yellowstone's snowmobile controversy, as does the importance of governmental checks and balances in resolving natural resource management disputes.

Conservation of Natural Resources↗

PubMed2003

Literature & medicine: humanities at the heart of health care: a hospital-based reading and discussion program developed by the maine humanities council.

Created by the Maine Humanities Council in 1997, Literature & Medicine: Humanities at the Heart of Health Care is a hospital-based humanities reading and discussion program for practicing health care professionals. To date, a total of 25 (65%) of Maine's hospitals have implemented the six-month program at least once, reaching over 900 participants. At the monthly meetings, participants discuss assigned readings-works of fiction, poetry, drama, and nonfiction that illuminate issues central to caring for people. Scholars selected to facilitate the discussion foster nonhierarchical, wide-ranging discussions of the texts. Participants connect the world of science with the world of lived experience and engage with humanistic perspectives and insights that help them do their work better. Literature & Medicine is unique in promoting statewide programs that involve a heterogeneous mix of veteran health care professionals. The program has been or will be implemented in seven other states, and organizers are exploring further expansion of the program through a national institute.

Allied Health Personnel↗

PubMed1999

Shared governance: a literature review.

This paper sets out to establish what is meant by shared governance, analyses the literature on shared governance implementation, and discusses emergent issues. The paper is based on research funded by the Department of Health (England) and by North Staffordshire NHS Trust. A literature search was undertaken using the terms 'shared governance' and 'empowerment', restricted to English language. The databases used were CINAHL, British Nursing Index, Medline, Social Sciences Citation Index and FirstSearch, and the search period was January 1988-May 1998. Initially, nearly 500 articles were identified. This search also highlighted articles describing participative management, professional practice models, and self-managed work teams. For the purposes of this review, only published articles which either described and/or evaluated the implementation of shared governance were analysed. According to these criteria, 48 studies, which were obtained by the cut-off date, were included for detailed assessment.

Decision Making, Organizational↗

PubMed2005

Lessons learned: one experience with focus groups in a school setting.

Focus group research is an effective way for school nurses to gain knowledge about a diverse range of issues that children in schools may face. It is a means to gather information about perceptions, feelings, points of view, and manners of thinking from a group of individuals about a specific topic. This article overviews focus groups as a research methodology and describes an experience of using them to gain information about low-income caretakers' knowledge of childhood nutrition. Several important lessons were learned from this study. These included the need to be flexible during the research process, to be creative in recruitment strategies, to maintain open communication with all the involved parties, and to share enthusiasm for the study. Learning more about children and their families can assist school nurses in planning and implementing interventions that enhance health and school achievement.

Child↗

PubMed2006

Dietitians' opinions and experiences of client-centred nutrition counselling.

PURPOSE: The concept of "client-centredness" was explored within a nutrition counselling relationship. METHODS: A two-round reactive Delphi survey was used. The first survey was sent to 65 Dietitians of Canada members who indicated in the member database that they had advanced counselling skills. Following analysis of the data, the second-round questionnaire was developed and sent to participants with a report of the first-round results. Analysis of the second-round survey indicated that participants' responses had remained stable, and the Delphi survey was terminated. RESULTS: Participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice; however, when participants were asked about their experience in these areas, median responses and/ or the interquartile ranges changed, indicating some difficulty in implementing the client-centred approach. Comments also indicated that the reality of their workplaces did not allow participants to be as client-centred as they thought they should be, and suggested that the concept of "client-centredness" is not universally understood by dietitians. CONCLUSION: If a client-centred approach to practice is truly important, we need to start a dialogue within the profession to gain a deeper understanding of what this means and how it can be implemented.

Adult↗

PubMed1980

Myocardial perfusion imaging in ischemic heart disease.

The ultimate clinical value of thallium-201 imaging depends, to a large extent, on the technical quality of the test and on an understanding of the fundamental clinical and physiologic principles of this imaging mode. This article offers an in-depth discussion of the underlying biokinetic concepts of thallium-201 imaging as well as the practical and technical considerations involved in its successful implementation.

Animals↗

PubMed1996

Building an infrastructure for data-based cancer control planning and intervention implementation.

Health agencies have traditionally played a central role in the characterization of health problems and disease. Data-based planning is considered the cornerstone of effective public health action, enabling state health agencies to use limited resources most effectively to achieve maximum reductions in disease morbidity and mortality. Over the past decade, state health agencies have made important strides in enhancing their capacity for data-based planning for cancer control and in establishing models to facilitate similar planning efforts in other states. Federal programs have served an important catalyst role in establishing states' data-based planning capacity and in facilitating the resulting increase in the application of cancer control science across the United States. This article provides an overview of the infrastructure for data-based cancer control planning and highlights the critical role of federal programs in enhancing the capacity of states to effectively plan and implement cancer control initiatives as well as some of the gaps that remain in states' capacity for data-based planning.

Databases, Factual↗

PubMedDate not supplied

Fast exact string pattern-matching algorithms adapted to the characteristics of the medical language.

OBJECTIVE: The authors consider the problem of exact string pattern matching using algorithms that do not require any preprocessing. To choose the most appropriate algorithm, distinctive features of the medical language must be taken into account. The characteristics of medical language are emphasized in this regard, the best algorithm of those reviewed is proposed, and detailed evaluations of time complexity for processing medical texts are provided. DESIGN: The authors first illustrate and discuss the techniques of various string pattern-matching algorithms. Next, the source code and the behavior of representative exact string pattern-matching algorithms are presented in a comprehensive manner to promote their implementation. Detailed explanations of the use of various techniques to improve performance are given. MEASUREMENTS: Real-time measures of time complexity with English medical texts are presented. They lead to results distinct from those found in the computer science literature, which are typically computed with normally distributed texts. RESULTS: The Boyer-Moore-Horspool algorithm achieves the best overall results when used with medical texts. This algorithm usually performs at least twice as fast as the other algorithms tested. CONCLUSION: The time performance of exact string pattern matching can be greatly improved if an efficient algorithm is used. Considering the growing amount of text handled in the electronic patient record, it is worth implementing this efficient algorithm.

Algorithms↗

PubMed1995

Universal precautions for the prevention of HIV and HBV infection in health care settings. Committee for Science and Education, Medical Association of South Africa.

OBJECTIVE: To outline the principles guiding the deliberate actions that should be taken in health care settings to prevent the spread of pathogens, especially HIV and hepatitis B virus (HBV), to patients and health care workers (HCWs). OUTCOMES: Universal precautions should be implemented in all health care settings. EVIDENCE: Based on similar international recommendations. VALUES: An adaptation of an existing guideline, it was sent to 87 organisations for comment. The comments received were included where possible in this guideline. It is the right of HCWs and patients to be protected from nosocomial HIV and HBV infection. BENEFITS, HARMS AND COSTS: The prevention of costly HIV and HBV infection by simple, rational precautions in the health care setting. The cost to the health care system has not been measured. The cost to individual patients or HCWs who acquire either infection is inestimable. RECOMMENDATIONS: The guideline recommends that the four basic elements of universal precautions be implemented appropriately in all health care settings: (i) body fluids should be handled with the same precautions as blood; (ii) avoidance of sharps (sharp objects); (iii) avoidance of skin or mucous membrane contamination; (iv) cleaning/disinfecting/sterilising. VALIDATION: The draft guideline was subjected to extensive external review by specialist, generalist and health professional groups. These included HIV activist groups. There were no major disputes about the content. The most important amendment to the draft guideline is the inclusion of HBV and other related pathogens together with the HIV. DEVELOPMENT AND FUNDING: The Medical Association of South Africa Committee for Science and Education. ENDORSEMENTS: The MASA and twenty national health care organisations and three provincial health authorities (see list at end of document).

Body Fluids↗

PubMed2004

Science and the common good: indefinite, non-reviewable mandatory detention of asylum seekers and the research imperative.

Despite a strong historical record of resettling and providing care for refugee populations, the Australian Federal Government has increasingly implemented harsh and restrictive policies regarding the treatment and management of asylum seekers. Most controversial of these has been the mandatory detention of asylum seekers, a policy applied indiscriminately and without discretion where individual cases have not been subject to judicial review or time constraints. From the outset health professionals have raised concerns about the possible adverse mental health impacts of prolonged detention. In contrast, government representatives have characterized conditions in detention as benign and comfortable, and have consistently contested criticism of detention, often citing a lack of scientific evidence as tacit support for the continuation of the policy. Nevertheless, requests for access to the detention centres to undertake rigorous scientific investigations have gone unheeded. In this context we argue that the Australian Government has failed to uphold its commitment to good governance by allowing transparency, openness and a willingness to have the impact of its policies scrutinized by scientists. The manifest conflict of interest in the government position leads to a breach in the normal social contract between mental health researchers and those responsible for the policy of detention. There is, we argue, a legitimate moral imperative in such situations for clinical researchers to breach the walls of enforced silence and give a voice to those who are afflicted. This imperative, however, must be carefully balanced against the risks that may face detainees agreeing to participate in such research.

Australia↗

PubMed2026

Genomic Medicine Sweden: Advancing precision medicine at the national level.

High-throughput sequencing has transformed clinical diagnostics of rare diseases (RD), cancer and infectious diseases by enabling the identification of disease-causing genetic alterations and facilitating individualised treatment and care. In response to these advances, Genomic Medicine Sweden (GMS) was established in 2017 as a national collaborative effort to accelerate implementation of genomics-based precision medicine within Sweden's regionally organized, publicly funded healthcare system. GMS brings together the seven university healthcare regions and their associated medical faculties, in collaboration with healthcare regions across Sweden, Science for Life Laboratory, patient organizations, industry and governmental agencies. Activities are coordinated through national disease-specific expert groups, supported by cross-cutting functions in bioinformatics, health economics, ethics, education and patient engagement. At the operational level, seven Genomic Medicine Centres, embedded at university hospitals, develop and deliver harmonised genomic diagnostics nationwide. The National Genomics Platform provides secure infrastructure for large-scale data storage, analysis, and national and international data sharing. Following initial project-based funding, GMS now receives long-term governmental support. This review describes the national implementation of genomic-based precision diagnostics, discusses challenges and lessons learnt, and highlights key milestones across disease areas, including whole-genome sequencing in RD and paediatric cancer, comprehensive genomic profiling of haematological malignancies and solid tumours, pathogen genomics in microbiology, pharmacogenomic testing and emerging applications of polygenic risk scores in complex diseases. Collectively, these efforts have contributed to more than 500,000 genomic tests being performed within Swedish healthcare between 2017 and 2025. Finally, we outline future diagnostic needs and priority areas to ensure sustainable, scalable and equitable access to precision medicine.

Precision Medicine↗

PubMed1999

US National Park Buffer Zones: Historical, Scientific, Social, and Legal Aspects.

/ This review will trace the evolution of beyond boundary/buffer zone thinking and policy responses in the US National Park Service (NPS); address buffer zone science, benefits, and limitations; examine pertinent legal and social concerns; highlight some agency attempts to create buffer zone-like areas; and propose highlights of a protected area strategy, with buffer zones and corridors as one component. Some findings follow. The need to expand national parks to accommodate large ungulate movement began in the late 1800s, but the recognition that such land was also needed to thwart human impacts such as poaching surfaced in the 1930s. External park buffer zone recommendations by 1930s park scientists were not implemented, and other related adopted policy forgotten, supporting the belief that great insight can be discovered in forgotten institutional history. Buffer zones can remedy some impacts but not others, but their benefits are multiple and underappreciated. The science of buffer zones is very immature and deserves more attention. A present primary obstacle to creating park buffer zones and connecting corridors is a social climate opposing federal initiatives that may intrude on the rights of private landowners. Some proactive NPS bufferlike activity examples are reviewed, but there were none where permanent, complete, effective nonlegislated park buffer zones, derived from nonfederal property, circumscribed large natural area parks. The need for buffer zones and corridors may be a symptom of inadequate regional planning. Options to create buffer zones from private and federal land are outlined. A comprehensive, overall protected area strategy must include more than just buffer zones, with highlights provided. Because optimal regional planning for US national parks is now thwarted by land-use politics, American society must soon decide what is most crucial to future well-being. KEY WORDS: Buffer zone; Reserve; Boundary; Policy; Planning

Journal Article↗

PubMed2005

Community-based organizations' perspective on health information outreach: a panel discussion.

OBJECTIVE: A panel was convened to elicit guidance for librarians in initiating and implementing community-based health information outreach. PARTICIPANTS: Participants included a panel of individuals from communities or community organizations who represented the types of groups with which librarians or information specialists need to interact and an audience who represented health sciences libraries, public libraries, academic institutions, government agencies, funding agencies, and community-based organizations and could contribute to a discussion on community-based health information outreach. PROGRAM: The panel was presented with a hypothetical community setting and asked to respond to a series of questions: What do librarians need to learn about the community before they make their visits? What methods of outreach have been successful in your work? How would you implement and sustain a health information program in your community? How would health information interventions reduce racial and ethnic disparities in health? MAIN RESULTS: The panel helped to frame many of the issues that may confront librarians as they initiate information-related programs in communities. CONCLUSION: There is clear consensus on the need for librarians to make the effort to reach out into the community, to make the contacts, to seek to understand the community, to talk with leaders, and to respect the community as they promote and teach the use of health information resources. It was confirmed that librarians and libraries have an important role in diminishing health disparities by improving access to health information.

Community-Institutional Relations↗

PubMed2005

Maternity referral systems in developing countries: current knowledge and future research needs.

A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

Developing Countries↗

PubMed2002

Assessment of key elements to determine causation and risk factors in dentistry.

The best research method for assessing therapeutic modalities is the RCT. The prospective nature and the randomization of the subjects in an RCT provide the greatest opportunity to control bias and offer the most valid answer to the clinical question. Observational studies generate hypotheses about causation and should be viewed as a first step in the continuum of health care delivery. The preponderance of evidence will mount as the hypotheses are tested by additional prospective, longitudinal, observational trials. The clinician's involvement is to design and implement therapeutic strategies to alter the causal exposure, intervene in the dose-response gradient, and block the pathophysiologic mechanisms. Dentistry is an art and a science. Moving through the continuum from causation hypothesis to therapeutic intervention is the science of dentistry. It is the science of dentistry that will change the scope of the profession in this millennium.

Bias↗