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Predictive validity of Marlatt's relapse taxonomy versus a more general relapse code.

Marlatt's system for classifying relapses involves integrating information about the context of a relapse into a judgment about the most critical aspects of the situation. Constraints in this taxonomy, however, may limit its validity. On a sample of 300 subjects drawn from six treatment facilities, we compared the predictive validity of Marlatt's taxonomy with that of a coding scheme with fewer constraints. Marlatt's taxonomy does not significantly predict drinking outcome, nor does it predict time to relapse. There is weak evidence, however, that under some circumstances Marlatt's taxonomy can predict the type of relapse subsequently observed. The alternative coding system also does not seem useful for predicting drinking outcome, although a possible association was found between internal attribution and time to return to heavy drinking. The alternative system does seem to be able to detect repetitive aspects of subsequent relapse situations; lack of social interactions, family setting, anxiety and depression were most likely to repeat. It may be useful to consider these relapse attributes in treatment planning. The minimal predictive validity for both the Marlatt and the alternative relapse code may be due to weaknesses in the relatively unstructured interview used to gather the data, or to failure to assess the most critical dimensions relating to subsequent relapse.

Adult↗

A taxonomy of model structures for economic evaluation of health technologies.

Models for the economic evaluation of health technologies provide valuable information to decision makers. The choice of model structure is rarely discussed in published studies and can affect the results produced. Many papers describe good modelling practice, but few describe how to choose from the many types of available models. This paper develops a new taxonomy of model structures. The horizontal axis of the taxonomy describes assumptions about the role of expected values, randomness, the heterogeneity of entities, and the degree of non-Markovian structure. Commonly used aggregate models, including decision trees and Markov models require large population numbers, homogeneous sub-groups and linear interactions. Individual models are more flexible, but may require replications with different random numbers to estimate expected values. The vertical axis of the taxonomy describes potential interactions between the individual actors, as well as how the interactions occur through time. Models using interactions, such as system dynamics, some Markov models, and discrete event simulation are fairly uncommon in the health economics but are necessary for modelling infectious diseases and systems with constrained resources. The paper provides guidance for choosing a model, based on key requirements, including output requirements, the population size, and system complexity.

Cost-Benefit Analysis↗

Issues in the taxonomy of psychopathology in mental retardation.

Several factors appear to impede the development of a valid taxonomy of psychopathology in children and adolescents with mental retardation. These include (a) the lack of a widely accepted definition of psychopathology in mental retardation, (b) disagreement on the nature of the relationship between mental retardation and psychopathology, and (c) insufficient evidence for the reliability and validity of current DSM or ICD systems in this population. In this article, we offer a definition of psychopathology in children with mental retardation; review concepts of the relationship between psychopathology and mental retardation; argue that in moving toward a valid taxonomy factors to be considered should include data from multivariate studies, findings related to behavior phenotypes, and diagnostic considerations with stereotypic behavior and self-injury, organic brain syndromes and pervasive developmental disorders. Finally, we outline a research strategy that may serve as a useful framework for developing a valid taxonomy of psychopathology in this population.

Adolescent↗

Etiology in a taxonomy of illnesses.

According to what Robert Koch termed the etiological standpoint, illnesses are best understood and controlled by focusing on their causes, including in their definitions and, thus, in the construction of their taxonomies. In some ways flawed, this standpoint has been misunderstood and misapplied. A taxonomy based solely on etiology was an unrealistic dream in the context of 'the bacteriological revolution', and it also is unrealistic in the present context of 'the genetic revolution.' We argue that the illnesses in a taxonomy of them are in some cases best defined directly in terms of their respective somatic anomalies, in some others indirectly by the unique and universal etiology of that anomaly (left unspecified) in a 'deeper' somatic anomaly, and in yet others as a combination of these; and when the somatic anomaly for direct definition remains unknown, it is to be defined indirectly by the clinical syndrome that is its patient-relevant manifestation, possibly in conjunction with a somatic cause. We note, also, that these taxonomic issues have no material bearing on epidemiologists' etiologic research for the knowledge base of community-level preventive medicine.

Disease↗

Child pedestrian injury taxonomy based on visibility and action.

With data from multidisciplinary investigations of child pedestrian injuries in Chicago, a new and simpler four-category taxonomy is presented based on the process that led to the collision. Two dimensions are recognized: the visibility of the child and/or the vehicle immediately prior to the event and the rapidity of action, either movement or change in direction, of the victim or the vehicle. The taxonomy is neutral with respect to responsibility for the collision and accommodates the findings of other researchers. This classification scheme is tested empirically using objective data elements such as child gender and age and event location. It is further tested using the results of a multidisciplinary causal sequence reconstruction of each injury event, based on such factors as child's psychological character, traffic risks, driver behavior, visibility obstructions, whether the child negotiated part of the street before being struck, and child's activities immediately prior to the injury. The results show that events in the categories in this new taxonomy are distinctly different from each other, and that the structure is useful for identifying and organizing interventions.

Accidents, Traffic↗

IASP taxonomy of chronic pain syndromes: preliminary assessment of reliability.

Communication and consequently advancement of knowledge in understanding and treatment of chronic pain has been hindered by the absence of a taxonomy of chronic pain syndromes. Recently the IASP Subcommittee on Taxonomy proposed a classification method based on a multiaxial system. In the present study the interjudge reliability of 2 of the 5 axes, body location and presumed etiology are evaluated. Overall, axis I demonstrated good reliability, however, the reliability of several categories contained within this axis were low enough to suggest minor changes to this axis may increase its clinical utility. Axis V was found to have only fair reliability and many of the categories comprising this axis were demonstrated to have reliabilities that are not clinically acceptable. The implications of these results for future development and refinement of the IASP taxonomy are discussed.

Chronic Disease↗

The taxonomy of pain.

An ideal taxonomy should be comprehensive and its categories should be mutually exclusive. Every item should have a particular place either on its own or with other items that resemble it. This is rarely, if ever, achievable in practice in medicine. The reasons for this are explained. The taxonomy developed by the Task Force on Taxonomy of the International Association for the Study of Pain is described as well as the basis for it.

Humans↗

Supervision in childhood injury cases: a reliable taxonomy.

This paper describes the development of the "Chicago Children's Supervision Taxonomy" which operationally defines supervision based on the age of an injured child and the ages, familiarity, and proximity of that child's companions. The reliability, coverage, and utility of this taxonomy are illustrated by its application to 142 cases of urban childhood pedestrian injury. All cases were unambiguously classified with good interrater reliability. Most injured children were in unsupervised groups (42%) but 36% had supervisors nearby, thus, supervisor presence does not guarantee protection. Supervising more than one child (especially likely when the supervisor was a teenager) may increase injury risk compared with one-to-one supervision. The taxonomy provides a needed framework adaptable for describing direct supervision in most child injury situations and can facilitate studies of more complex aspects of supervision.

Accident Prevention↗

Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy.

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.'s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.

Cluster Analysis↗

An exercise in rational taxonomy.

The quest for a rational taxonomy of living forms began in the 17th century. Since the general acceptance of Darwin's theory of descent with modification, however, students of morphology became preoccupied with a systematics based on the genealogy of groups; and the rise of molecular phylogenies in recent years results in a further decline in the science of morphology. Reconstructing phylogenies by itself brings us no closer to the goal of rational taxonomy, which is to uncover the natural order inherent in the forms of living things. It is proposed that the rational taxonomy of forms should be derived from a study of development, much as von Baer had envisaged. To illustrate the method, a set of segmentation abnormalities in Drosophila larvae (previously exposed to either vapour) is considered, which can be individually classified as distinct disturbances in the process responsible for establishing normal segmental pattern. The process consists of a hierarchy of four successive bifurcations dividing the embryo's body first into two parts, then four, eight, and finally 16 subdivisions or segments. This gives rise to a taxonomic map of all possible transformations which contains the "phylogeny" of the actual forms and provides a natural system for classifying them. Attempts to recover the "true" phylogeny by various numerical methods are summarized and their implications for the validity of the basic assumptions of contemporary systematics discussed.

Animals↗

Taxonomy and physiology of probiotic lactic acid bacteria.

The current taxonomy of probiotic lactic acid bacteria is reviewed with special focus on the genera Lactobacillus, Bifidobacterium and Enterococcus. The physiology and taxonomic position of species and strains of these genera were investigated by phenotypic and genomic methods. In total, 176 strains, including the type strains, have been included. Phenotypic methods applied were based on biochemical, enzymatical and physiological characteristics, including growth temperatures, cell wall analysis and analysis of the total soluble cytoplasmatic proteins. Genomic methods used were pulsed field gel electrophoresis (PFGE), randomly amplified polymorphic DNA-PCR (RAPD-PCR) and DNA-DNA hybridization for bifidobacteria. In the genus Lactobacillus the following species of importance as probiotics were investigated: L. acidophilus group, L. casei group and L. reuteri/L. fermentum group. Most strains referred to as L. acidophilus in probiotic products could be identified either as L. gasseri or as L. johnsonii, both members of the L. acidophilus group. A similar situation could be shown in the L. casei group, where most of the strains named L. casei belonged to L. paracasei subspp. A recent proposal to reject the species L. paracasei and to include this species in the restored species L. casei with a neotype strain was supported by protein analysis. Bifidobacterium spp. strains have been reported to be used for production of fermented dairy and recently of probiotic products. According to phenotypic features and confirmed by DNA-DNA hybridization most of the bifidobacteria strains from dairy origin belonged to B. animalis, although they were often declared as B. longum by the manufacturer. From the genus Enterococcus, probiotic Ec. faecium strains were investigated with regard to the vanA-mediated resistance against glycopeptides. These unwanted resistances could be ruled out by analysis of the 39 kDa resistance protein. In conclusion, the taxonomy and physiology of probiotic lactic acid bacteria can only be understood by using polyphasic taxonomy combining morphological, biochemical and physiological characteristics with molecular-based phenotypic and genomic techniques.

Bifidobacterium↗

On molecular taxonomy: what is in a name?

Gene sequences of small portions of the genome are often used for premature detailed taxonomic changes, neglecting polyphasic taxonomy, which should also consider phenotypical characteristics. Three examples are given: (i) Recently, members of the genera Eperythrozoon and Haemobartonella have been moved, correctly so, from the Rickettsiales to the Mycoplasmatales, but were assigned to the genus Mycoplasma, mostly on the basis of 16S rRNA sequence analysis. Not only is the 16S rRNA sequence similarity between 'classical' Mycoplasma and these species of Eperythrozoon and Haemobartonella less than that between some other well-recognised bacterial genera, but their biological differences amply justify their classification in different genera of the Mycoplasmatales. Furthermore, the move creates considerable confusion, as it necessitates new names for some species, with more confusion likely to come when the 16S rRNA sequences of the type species of Eperythrozoon, a name which has priority over Mycoplasma, will be analysed. (ii) In the Rickettsiales, members of the genera Anaplasma, Ehrlichia, Cowdria, Neorickettsia and Wolhbachia are so closely related phylogenetically on the basis of 16S rRNA sequences, and for some also of groESL operon sequences, that they have recently been fused, correctly so, into one family, the Anaplasmataceae, while the tribes Ehrlichieae and Wolbachieae have been abolished. Sequence diversity within the 'classical' genus Ehrlichia has led to classifying E. phagocytophila (including E. equi and the agent of human granulocytic ehrlichiosis), E. platys and E. bovis in the genus Anaplasma, while others have been retained in Ehrlichia, which also includes Cowdria ruminantium. E. sennetsu and E. risticii have been transferred to the genus Neorickettsia. 16S rRNA and GroEL sequences of 'classical' Anaplasma and some members of 'classical' Ehrlichia do show a close relationship, but differences in citrate synthase gene sequences, the GC content of this gene, and sequences of the gene encoding the beta-subunit of RNA polymerase, not to speak of the phenotypical differences, do not justify the fusion into one genus. Because of the phylogenetical diversity in Ehrlichia it is recommended that a new genus name be created for the E. phagocytophila genogroup (and E. platys and E. bovis). (iii) One of the conclusions of studies on the phylogeny of ticks of the subfamilies Rhipicephalinae and Hyalomminae, based on nucleotide sequences from 12S rRNA, cytochrome c oxidase I, the internal transcribed spacer 2, 18S rRNA, as well as morphological characters, is that Boophilus should be considered as a subgenus of Rhipicephalus. While Boophilus and Rhipicephalus are undoubtedly close, the obviously important morphological and biological differences between the genera Rhipicephalus and Boophilus are thus overruled by similarities in the sequences of a number of genes and this leads to considerable confusion. Polyphasic taxonomy amply justifies maintaining Boophilus as a separate genus, phylogenetically near to Rhipicephalus. This note is a plea for a cautious and balanced approach to taxonomy, taking into account molecular genotypical information, as far as is possible from different genes, as well as phenotypical characteristics.

Anaplasmataceae↗

The development of an empirical psychosocial taxonomy for patients with diabetes.

The main purpose of this study was to develop and to cross-validate an empirically derived psychosocial taxonomy of patients with diabetes. In the first study, 101 patients with Type I or Type II diabetes completed the Multidimensional Diabetes Questionnaire. Cluster analysis identified three clusters, labeled adaptive copers, low support-low involvement, and spousal overinvolvement. In the second study, the taxonomy was cross-validated using an independent sample of 132 patients with long-standing Type II diabetes. The results confirmed that the multivariate classification system was unique and highly accurate. External validation, using general psychological as well as diabetes-specific measures, supported the validity and distinctiveness of the patients' profiles. These findings help establish a multiaxial psychosocial taxonomy of diabetes and may have significant implications for the management of patients with diabetes.

Adaptation, Psychological↗

Responses to racism: a taxonomy of coping styles used by Aboriginal Australians.

The author takes up the challenge from social psychologists to explore the coping responses of those who experience racism. Previous attempts to provide taxonomies of responses to racism-discrimination-oppression are reviewed. An analysis of data derived from semistructured interviews conducted with 34 Indigenous Australians that explored experiences of racism and emotional and behavioral responses is reported, and a taxonomy of coping made up of 3 broad categories is presented. The defining feature of these categories is the purpose of the responses contained therein: to defend the self, to control or contain the reaction, or to confront the racism. It is argued that this may be a more useful way to understand responses to racism than taxonomies previously proposed.

Adaptation, Psychological↗

Taxonomies in biology, phonetics, phonology, and speech motor control.

This article begins with a review explaining the different purposes of biological taxonomies. Taxonomic units are often dependent on the purpose for which the taxonomy has been constructed. Biological taxonomies provide an analogy that we use to emphasize some of the distinctions among the units of phonetic transcription systems, competence phonologies, and performance phonologies. The units of both phonology and phonetic transcription are considered as possible units of the speech motor system, and some of the difficulties of this assumption are explained. Although phonemic units, like units of phonetic transcription, are useful for many purposes, it is not theoretically necessary to use units derived as part of competence phonologies in systems attempting to explain phonological performance or speech motor performance. In this regard, we challenge the concept of coarticulation, because it is based on assumptions about the role of phonological or phonetic units in speech motor control. We offer an integrated perspective that has implications for research in speech motor control and deficits of the speech motor system. We see speech motor deficits as distinct from, yet possibly interacting with, phonological deficits.

Humans↗

The conceptual validity of a taxonomy of nursing interventions.

The purpose of this paper is to report validity evidence for the nursing intervention taxonomy developed as part of the Nursing Intervention Lexicon and Taxonomy (NILT) Study. Using eclectic classification methods of library science, cognitive science, nursing science and computational linguistics, a taxonomy of nursing interventions consisting of seven categories was developed. These categories which incorporate care as a central concept are described and defined, and prototypical examples of each category are presented. Brinberg & McGrath's validity schema provides the framework within which evidence for validity as value, validity as correspondence and validity as generalizability were examined. Comparison of the NILT categories with previously published categorizations of nursing functions and interventions provides strong support for the validity of this classification. Additionally, comparison of the NILT categories with two internationally derived categorizations of nursing functions supports the robustness or generalizability of the NILT classification.

Job Description↗

Biochemical identification and numerical taxonomy of Aeromonas spp. isolated from environmental and clinical samples in Spain.

AIMS: To study the phenotypic characteristics of Aeromonas spp. from environmental and clinical samples in Spain and to cluster these strains by numerical taxonomy. METHODS AND RESULTS: A collection of 202 Aeromonas strains isolated from bivalve molluscs, water and clinical samples was tested for 64 phenotypic properties; 91% of these isolates were identified at species level. Aeromonas caviae was predominant in bivalve molluscs and Aerom. bestiarum in freshwater samples. Cluster analyses revealed eight different phena: three containing more than one DNA-DNA hybridization group but including strains that belong to the same phenospecies complex (Aerom. hydrophila, Aerom. sobria and Aerom. caviae), Aerom. encheleia, Aerom. trota and three containing unidentified Aeromonas strains isolated from bivalve molluscs. CONCLUSIONS: Aeromonas spp. are widely distributed in environmental and clinical sources. A selection of 16 of the phenotypical tests chosen allowed the identification of most isolates (91%), although some strains remain unidentified, mainly isolates from bivalve molluscs, suggesting the presence of new Aeromonas species. Numerical taxonomy was not in total concordance with the identification of the studied strains. SIGNIFICANCE AND IMPACT OF THE STUDY: Numerical taxonomy of Aeromonas strains isolated from different sources revealed the presence of potentially pathogenic Aeromonas spp., especially in bivalve molluscs, and phena with unidentified strains that suggest new Aeromonas species.

Aeromonas↗

A taxonomy for goal setting in the care of persons with dementia.

OBJECTIVE: Develop a taxonomy for understanding and classifying goals in the care of persons with dementia. DESIGN: Qualitative study using open-ended interviews with key informants and the constant comparative method of qualitative data analysis. SETTING: The geriatric assessment center at a large academic medical center in Connecticut. PARTICIPANTS: Key informant interviews with 36 subjects: consecutive patients receiving geriatric assessment at the center and their primary family caregivers, case managers, and physicians of patients. MEASUREMENTS AND MAIN RESULTS: Goals, or desired outcomes, for the patient's care as described by patients, primary family caregivers, case managers, and physicians were the main measurements. Participant interviews were conducted until the point of theoretical saturation, i.e., until further interviews no longer provided new concepts. All participants articulated at least one goal. Specific goals were characterized by a limited number of goal attributes resulting in a taxonomy, or consistent classification system, for reported goals. These attributes include domain (or content), specificity, time frame, and level of challenge. CONCLUSIONS: The findings suggested that patients, primary family caregivers, and clinicians can articulate goals of care and may bring differing perspectives to the goal-setting process. The research identified a taxonomy that may facilitate negotiation of goals by revealing important, and perhaps overlooked, aspects of goals and the goal-setting process.

Activities of Daily Living↗