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Empirical potentials and functions for protein folding and binding.

Simplified models and empirical potentials are being increasingly used for the analysis of proteins, frequently augmenting or replacing molecular mechanics approaches. Recent folding simulations have employed potentials that, in addition to terms assuring proper polypeptide geometry, include only two noncovalent effects-hydrogen bonding and hydrophobicity, with extremely simple approximations to the latter. The potentials that have been used in the free-energy ranking of protein-ligand complexes have generally been more involved. These potentials have more detailed solvation models and account for both local (hydrophobic and polar) solute-solvent phenomena and long range electrostatic solvation effects. The models of solvation that have been used most frequently are surface area related atomic parameters, knowledge-based models extracted from protein-structure data, and continum electrostatics with an additional area-related parameter. The knowledge-based approaches to solvation, although convenient and accurate enough, are suspect of double counting certain free-energy terms.

Databases, Factual↗

Australian nurses' personal constructs about effective nurses--a repertory grid approach.

Repertory grids were completed by nurses (N = 56) enrolled in university courses to elicit the personal constructs they used to characterize nurses as effective and to elicit the extent to which participants believed themselves to be effective nurses. The personal constructs of "good knowledge base," "good interpersonal and communication skills," were ranked, respectively, as the four most frequently elicited constructs associated with nurses. "Good knowledge base," "caring, compassionate," "good clinical skills," and "good decision-making and problem-solving skills" were ranked, respectively, as the four most frequently elicited constructs associated with "effective" nurses. Cluster analysis of individual repertory grids showed that there was a significant difference between self-perceptions of participants as effective nurses and the nurses they would like to become.

Adult↗

Urinary tract infection in diabetes.

PURPOSE OF REVIEW: The aim of this article is to review recent publications relevant to understanding the interaction of urinary tract infection and diabetes mellitus, including epidemiology, pathogenesis, microbiology, and treatment. RECENT FINDINGS: The largest number of identified reports described aspects of epidemiology, including defining the incidence and outcomes of urinary infection in patients with diabetes. In several reports, mortality and risk of hospitalization for urinary infection were not increased with diabetes, although length of hospitalization may be prolonged. Other reports quantify the increased incidence of cystitis or pyelonephritis in persons with diabetes, but remain subject to potential biases which could overestimate the occurrence in diabetic relative to non-diabetic populations. Several reports suggest that resistant bacteria are more frequently isolated from diabetic outpatients with urinary infection, but it is not clear how this is directly attributable to diabetes. There are no recent clinical trials which enhance our understanding of optimal treatment of symptomatic urinary infection, although several review articles acknowledge the appropriateness of the non-treatment of asymptomatic bacteriuria in diabetic women. SUMMARY: Recent reports exploring diabetes and urinary tract infection provide some insights, particularly for risks of infection and outcomes, but there are no recent large advances in the knowledge base. Questions related to incidence, optimal treatment, and role of metabolic control still need to be addressed to expand the knowledge base and enhance management of this common problem.

Anti-Bacterial Agents↗

Medical diagnostic system using Fuzzy Coloured Petri Nets under uncertainty.

We propose a medical diagnostic system using Fuzzy Coloured Petri Nets (FCPN) in this paper. For complex real-world knowledge Fuzzy Petri Net (FPN) models have been proposed to perform fuzzy reasoning automatically. However, in the Petri Net we have to represent all kinds of processes by separate subnets even though the process has the same behavior of other one. Real-world knowledge often contains many parts which are similar, but not identical. This means that the total PTN becomes very large. The kind of problems may be annoying for a small system, and it may be catastrophic for the description of large-scale system. To avoid this kind of problems we propose a learning and reasoning method using FCPNs under uncertainty. On the other hand to correct the rules of knowledge-based system hand-built classifier and empirical learning method both based on domain theory have been proposed as machine learning methods, where there is a significant gap between the knowledge-intensive approach in the former and the virtually knowledge-free approach in the later. To resolve such problems simultaneously we propose a hybrid learning method which is built on the top of knowledge-based FCPN and Genetic Algorithms (GA). To verify the validity and the effectiveness of the proposed system, we have successfully applied it to the diagnosis of intervertebral diseases.

Algorithms↗

A new philosophy of medical imaging.

In general, the traditional approach to medical imaging is based on the solution of the inverse problem of deducing the characteristics of tissues within the body from the received field resulting from probing radiation. Ambiguities and lack of complete data, and physical limitations such as diffraction, field non-uniformity and so on, prevent the image from being an exact representation of what would be seen if the imaged part of the patient were to be exposed to direct vision or drawn by an artist. Much more exact representation could be produced, however, if the philosophy of imaging were to be changed to involve the solution of the forward problem in which the received field is iteratively compared with that calculated to be produced by a computer-simulated model of the object from a knowledge base of anatomy, pathology, histology, physical properties of tissues etc. As a result of this converging process of comparison and iterative minimisation of the difference signal, a model of the object would be simulated consistent with the received field resulting from probing radiation as well as with all the relevant information form a knowledge base containing general knowledge and also including the personal records of the particular patient. Using such a model, any required cross-section or three-dimensional pictorial representation of the region of interest in the investigated object could be displayed in the form of a pictorial image. Thus the proposed philosophy would make medical imaging much less subjective and increase its information value, because inherently it includes all relevant biomedical data in the displayed image.

Diagnostic Imaging↗

Therapeutic strategies for treatment of CF based on knowledge of CFTR.

CF is one of the first diseases where it is now possible to take an entirely "bottom-up" approach and attempt to develop molecular therapeutics based on fundamental properties of the gene and gene product which cause the disease. As I have tried to illustrate this is a task of enormous magnitude and although significant progress is being made, it is reasonable to expect that considerable time may be required for a satisfactory outcome to be achieved.

Child↗

Characteristics of information resources preferred by primary care physicians.

Primary care physicians use patient data, medical knowledge, logistic information, and population statistics. They rely on their personal knowledge to care for their patients, their top priority. When they seek information beyond this personal knowledge base, they frequently want information in the context of the care of a specific patient. They also continually add to their personal knowledge base. Less frequently, they seek logistic information and population statistics. For patient-specific questions, physicians most often seek medical facts or medical opinions. A physician may be persistent in seeking information if the patient's problem is perceived to be urgent and the doctor believes a definitive answer exists. Information resources for answering clinical questions should be readily available, familiar, and quick to use. Lifelong learning activities should also be readily available, and they should require a minimum of time, effort, and expense. Minimal cost in time and effort is particularly important when knowledge is sought as a part of ongoing medical learning, since there is less immediate benefit to balance the time and effort invested in information seeking.

Humans↗

Integrated access to metabolic and genomic data.

The EcoCyc system consists of a knowledge base (KB) that describes the genes and intermediary metabolism of Escherichia coli, and a graphical user interface (GUI) for accessing that knowledge. This paper addresses two problems: How can we create a GUI that provides integrated access to metabolic and genomic data? We describe the design and implementation of visual presentations that closely mimic those found in the biology literature, and that offer hypertext navigation among related entities, and multiple views of the same entity. We employ a frame knowledge representation system (FRS) called HyperTHEO to manage the EcoCyc knowledge base. Among the advantages of FRSs are an expressive data model for capturing the complexities of biological information, and schema-evolution capabilities that facilitate the constant schema changes that biological databases tend to undergo. HyperTHEO also includes rule-based inference facilities that are the foundation of expert systems, a constraint language for maintaining data integrity, and a declarative query language. A graphic KB editor and browser allow the EcoCyc developers to interactively inspect and modify this evolving KB.

Artificial Intelligence↗

TAMBIS--Transparent Access to Multiple Bioinformatics Information Sources.

The TAMBIS project aims to provide transparent access to disparate biological databases and analysis tools, enabling users to utilize a wide range of resources with the minimum of effort. A prototype system has been developed that includes a knowledge base of biological terminology (the biological Concept Model), a model of the underlying data sources (the Source Model) and a 'knowledge-driven' user interface. Biological concepts are captured in the knowledge base using a description logic called GRAIL. The Concept Model provides the user with the concepts necessary to construct a wide range of multiple-source queries, and the user interface provides a flexible means of constructing and manipulating those queries. The Source Model provides a description of the underlying sources and mappings between terms used in the sources and terms in the biological Concept Model. The Concept Model and Source Model provide a level of indirection that shields the user from source details, providing a high level of source transparency. Source independent, declarative queries formed from terms in the Concept Model are transformed into a set of source dependent, executable procedures. Query formulation, translation and execution is demonstrated using a working example.

Artificial Intelligence↗

A statistical analytical approach to decipher information from biological sequences: application to murine splice-site analysis and prediction.

A simple statistical approach for the analysis of biological sequences, such as splice-sites, promoter regions, helices and extended structure forming regions or any other sequence dependent functional entities in proteins, is presented. The approach has been proved useful to develop a method for prediction of such entities in newly available sequences. We first search for invariant sequence features of each functional entity from the experimentally available sequences and identify a set of 'like' sequences with similar sequence features. In the next step, concrete features of sequence entities in terms of occurrences of smaller subsequences are identified at various positions which are used as a knowledge base to select potential functional entities from the identified 'like' sequences. The third step consists of refinement of this pattern learning, statistical improvements of the knowledge base weight matrices, and finally its application to predict functional entities in newly available sequences. Such an analysis is operationally described for murine splice-site predictions. Regions comprising -30 to +30 nucleotides from the splice-junction at the murine splice-sites (donors and acceptors), reported earlier, were analyzed. Invariant sequence-specific features in terms of monomer frequency average were used to identify splice-site-like sequences in the EMBL murine DNA sequence data base. The frequencies of occurrence of mono-, di-, tri- and tetranucleotides in the known splice-sites were studied in comparison with the splice-site-like sequences; the significant differences in their occurrences were extracted as statistical knowledge coded in weight matrices for computer to identify potential splice-sites. The algorithm was refined and a method was developed to predict potential splice-sites in a given murine DNA; the analysis was also extended to human DNA. The success rate of the method to predict correct splice-sites in these species is found to be 80% and 85%, respectively. The major strength of this method lies in reducing significantly the number of false positives which are normally picked up in such analysis.

Algorithms↗

Efficient web-based navigation of the Foundational Model of Anatomy.

The University of Washington's Foundational Model of Anatomy (FMA)1 is a complex, frame-based model composed of over 170,000 frames collectively specified by more than 1.4 million slot values. The Foundational Model Explorer (FME) was designed to provide simple and intuitive web access to this complex knowledge base. The Foundational Model Explorer (FME) (Figure 1) is built upon the Protégé 2000 knowledge base access library [http://protege.stanford.edu/]. The FME application, associated libraries, and the FMA database all reside on remote servers. Users of the FME are not required to download, install, or set-up any of these components. The FME application, in response to a query, retrieves the appropriate information from the FMA, formats these data into html documents, and transmits them, via the Internet, back to the client where they can be viewed from any standard web browser

Anatomy↗

Reconstructing medical problem solving competence: MACCORD.

The building of medical knowledge-based systems involves the reconstruction of methodological principles and structures within the various subdomains of medicine. ACCORD is a general methodology of knowledge-based systems, and MACCORD its application to medicine. MACCORD represents the problem solving behavior of the medical expert in terms of various types of medical reasoning and at various levels of abstraction. With MACCORD the epistemic and cognitive processes in clinical medicine can be described in formal terminology, covering the entire diversity of medical reasoning. MACCORD is close enough to formalization to make a significant contribution to the fields of medical knowledge acquisition, medical didactics and the analysis and application of medical problem solving methods.

Artificial Intelligence↗

Predicting modes of toxic action from chemical structure: an overview.

In the field of environmental toxicology, and especially aquatic toxicology, quantitative structure activity relationships (QSARs) have developed as scientifically-credible tools for predicting the toxicity of chemicals when little or no empirical data are available. A basic and fundamental understanding of toxicological principles has been considered crucial to the continued acceptance and application of these techniques as biologically relevant. As a consequence, there has been an evolution of QSAR development and application from that of a chemical-class perspective to one that is more consistent with assumptions regarding modes of toxic action. The assessment of a compound's likely mode of toxic action is critical for a correct QSAR selection; incorrect mode of action-based QSAR selections can result in 10- to 1000-fold errors in toxicity predictions. The establishment of toxicologically-credible techniques to assess mode of toxic action from chemical structure requires toxicodynamic knowledge bases that are clearly defined with regard to exposure regimes and biological models/endpoints and based on compounds that adequately span the diversity of chemicals anticipated for future applications. With such knowledge bases classification systems, including rule-based experts systems, have been established for use in predictive aquatic toxicology applications.

Animals↗

Pediatric and Adolescent Gynecology experience in academic and community OB/GYN residency programs in Michigan.

OBJECTIVES: The purpose of this study is to assess training in Pediatric and Adolescent Gynecology (PAG) at the Obstetrics and Gynecology (OB/GYN) resident level. SETTING: Two large Michigan programs were studied: a university-based, inner-city program, and a suburban, community-based program. Seventy-one questionnaires were distributed to the residents, and descriptive and inferential analysis of answers to demographic, training, attitude, and knowledge-based questions regarding PAG was performed. RESULTS: Sixty-one questionnaires were returned, a response rate of 86%. The majority of respondents reported no PAG rotations or clinics and recalled limited didactic sessions with only 0-2 lectures. Ninety-eight percent of university residents and 94% of community residents requested more PAG training. Comfort levels about PAG issues were assessed on a 5 point scale (1 = low, 5 = high comfort); university residents scored 3.7 with pediatric patients and 4.4 with adolescents, and community residents scored 4.0 with the pediatric age group and 4.3 with adolescents. However, both groups responded with familiarity to knowledge based questions only 61% of the time. CONCLUSIONS: OB/GYN residents in both academic and community programs report little experience and scant training in PAG but express interest in obtaining the skills and information needed. It is concerning that residents lack the basic knowledge that is required for the routine daily care of this patient population. More emphasis needs to be placed on these issues in OB/GYN residency training programs.

Adolescent↗

PC-based system for classifying dysmorphic syndromes in children.

A system is described running on any IBM-compatible personal computer operating under MS-DOS which permits an expert in pediatric dysmorphology to formulate dysmorphic features and syndromes in a knowledge base, and a user to enter, analyze, store and retrieve case data. For each case, the system calculates the Bayesian probability of the presence of each syndrome in the knowledge base and lists as the differential diagnosis those syndrome whose probability exceeds 90%. For explanatory purposes, the syndrome definitions can be displayed and compared to the case data. The system has been tested and used in the Department of Clinical Genetics at Uppsala University Hospital. The current scope of the system's knowledge was found to be of valuable assistance to the pediatric practitioner but it must be expanded and refined for use by a clinical geneticist. This study has shown the validity of the system's design and structure and further work is under way to extend its knowledge capability.

Abnormalities, Multiple↗

Clinical lactation practice: 20 years of evidence.

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.

Breast Feeding↗

The relative value of nursing work: a study in progress.

The nursing shortage is likely to continue and, without intervention, may worsen. While retention and recruitment are constantly discussed among nursing leaders, the shortages, particularly in specialty areas, continue. Nurses have frequently stated that they are not valued for their knowledge. Yet many nurses have university degrees, post graduate degrees, specialty certificates and specialty credentials. Nurses seek recognition for what they know and what they do. To date, however, there is no objective method that is used to assess the value of nurses and their work. The study of relative value may provide a method for recognizing nurses' work. The concept of relative value deals with logical operators and facilitates assigning value to a nurse's overall knowledge base and capacity to perform nursing work. Currently, nursing shortages are concentrated in specialty areas. Nurses who work in specialized areas need specialized knowledge in a narrow field of nursing. Specialty nurses are not interchangeable with specialists in other areas or with generalists. A study is in progress to calculate the relative value of nursing work in 15 specialties. The goal is to assess relative value from the point of view of the knowledge base in the specialties and between specialties. In this paper, the research team reports on the background of the study, the study's parameters and its progress to date. Outcomes will include devising a way to recognize nurses' work, developing policies related to retention and recruitment and finding a long-term solution for dealing with the nursing shortage in specialty areas.

British Columbia↗

Development of a computerized infectious disease monitor (CIDM).

At the LDS Hospital in Salt Lake City, an interface was developed between the microbiology laboratory computer system and the HELP integrated central hospital computer system. The HELP system includes medical information from most clinical care support areas. The microbiology data are translated from the laboratory computer file structure to a hierarchical data structure on the HELP system. A knowledge base was created with the help of infectious disease experts, and became part of a Computerized Infectious Disease Monitoring system (CIDM). The knowledge base is automatically activated when specific microbiology data are entered into a patient's computer file (data driven), thus decisions are made automatically with no additional effort required of medical personnel. The CIDM was designed to inform infectious disease personnel when a patient has one of the following conditions: a hospital-acquired infection, an infection at a normally sterile body site, an infection due to a bacteria with an unusual antibiotic sensitivity pattern, an infection for which the patient is not receiving an antibiotic to which the offending bacteria is sensitive, an infection that could be treated with a less expensive antibiotic, an infection which is required by law to be reported to state and national health authorities, and those patients receiving prophylactic antibiotics longer than is medically indicated. All of the microbiology data are now extensively reviewed by nurses and physicians from terminals at nursing stations or intensive care units. The CIDM is currently being used for hospital-acquired infection surveillance at LDS Hospital.

Anti-Bacterial Agents↗