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Nonparametric tests for differential gene expression and interaction effects in multi-factorial microarray experiments.

BACKGROUND: Numerous nonparametric approaches have been proposed in literature to detect differential gene expression in the setting of two user-defined groups. However, there is a lack of nonparametric procedures to analyze microarray data with multiple factors attributing to the gene expression. Furthermore, incorporating interaction effects in the analysis of microarray data has long been of great interest to biological scientists, little of which has been investigated in the nonparametric framework. RESULTS: In this paper, we propose a set of nonparametric tests to detect treatment effects, clinical covariate effects, and interaction effects for multifactorial microarray data. When the distribution of expression data is skewed or heavy-tailed, the rank tests are substantially more powerful than the competing parametric F tests. On the other hand, in the case of light or medium-tailed distributions, the rank tests appear to be marginally less powerful than the parametric competitors. CONCLUSION: The proposed rank tests enable us to detect differential gene expression and establish interaction effects for microarray data with various non-normally distributed expression measurements across genome. In the presence of outliers, they are advantageous alternative approaches to the existing parametric F tests due to the robustness feature.

Animals↗

[Madagascar: from Isoavinandriana to Soavinandriana or the remarkable history of the Girard and Robic Hospital].

The history of the Soavinandriana Hospital is remarkable for several reasons. The oldest hospital on the island, this institution is the product of the combined efforts of English Christian missionaries, French colonists, and native Madagascans. Its history has always been closely linked to political events in Madagascar and the successive names often reflect Franco-Malagasy relations. The hospital which was long the crown jewel of the "colonial" health corps still provides a framework for harmonious cooperation between French and Malagasy military physicians. The institution has always been on the forefront of medicine in Madagascar and, despite current problems, is still the best-equipped health facility on the island. Thanks to the quality of care and the dedication and competence of its staff, the hospital has succeeded in maintaining patient attendance from all classes of society. The hospital which in its over 100-year history has witnessed two momentous occasions with the visits of the last Queen and the first President of the Republic now stands on the threshold of a renaissance and could become a model for successful Franco-Malagasy cooperation.

Christianity↗

The identification of best practices in teaching quality competencies for preparing future healthcare leaders.

The mandate for quality in all aspects of clinical practice, service delivery, and management practice has never been greater. The Institute of Medicine's (IOM) landmarkwork To Erris Human heightened the urgency of this serious issue. In a follow-up report, the IOM's Crossing the Quality Chasm called for radical change to achieve numerous quality objectives throughout the continuum of the healthcare system including the preparation of future healthcare leaders. This study was conducted to assess how effectively healthcare management education faculty are meeting the challenge of integrating quality improvement into their curricula and how faculty perceived their quality expertise. Another goal was to identify the student learning assessment strategies, teaching methods, content, and resources utilized by faculty to achieve this integration and to suggest a framework for "best practices" in teaching qualitycompetencies citing the literature. The study's findings raise a number of important issues with respect to the ways in which QI is conceptualized and integrated into curricula and concludes that there is substantial need for 'quality improvement' in healthcare management education faculty's approaches to the teaching of QI.

Benchmarking↗

Analysis of cognitive function in animals, the value of SDT.

The search for a better understanding of cognitive decline in man has lead to the use of increasingly complex procedures in animal research. The analysis of the data generated in such experiments has been greatly facilitated by the wider use of computer assisted techniques. These techniques can only be as good as the hypotheses they are used to test. Signal detection theory (SDT) provides a rational framework within which to work. The procedures are derived from human cognitive neuropsychology and are already used to some extent in primate but to a lesser degree in rodent research. The use of SDT offers two main advantages: first, a testable hypothesis as to the manner in which competing processes arrive at choice between various courses of action; second, the statistical procedures offer clear advantages over more traditional approaches by reducing the chances of misinterpretation. Though relatively easy to apply some care must be exercised in the protocol design and the choice of SDT indices if the full value of the approach is to be achieved. If experimental designs can be developed to include the appropriate use of SDT analysis; both the power of such protocols, and their value in the understanding of cognitive function, will provide a major step forward for animal-based research.

Animals↗

Motor and functional skills of children with developmental coordination disorder: a pilot investigation of measurement issues.

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Peabody Developmental Motor Scales (fine motor total score) (M=85.65, SD=12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M=96.15, SD=10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M=49.98, SD=16.62) and mobility function (M=54.71, SD=3.99), however, self-care function was below the average range for age (M=38.01, SD=12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed.

Child↗

Cognitive fatigue of executive processes: interaction between interference resolution tasks.

A resource depletion framework motivated a novel strategy for investigating whether the central executive is unitary or separable into relatively independent subprocesses. The idea that tasks with overlapping neural representations may involve similar executive components was also critical to our approach. Of particular interest were tasks requiring resolution of interference among competing representations. Within a single experimental session intensive training reduced the ability to resolve interference on a transfer task if the training task placed high demands on interference resolution. Negative transfer was absent when interference resolution was minimally required by the task, or when the training and transfer tasks did not rely on overlapping neural representations. These results suggest a nonunitary central executive composed of separable subcomponents, at least one of which mediates interference resolution. Our results are consistent with an executive control process specialized for the selection of task-relevant representations from competitors. The results also agree with the view that higher cognitive processes are resource limited and can be temporarily depleted.

Adolescent↗

Validation of surrogate endpoint biomarkers in prostate cancer chemoprevention trials.

Phase 2 cancer chemoprevention trials are designed to provide estimates of the efficacy of an agent at a specified dose, and the expected size of the risk reduction that may be achieved in a subsequent phase 3 randomized trial. To allow these trials to be rapid and efficient, the study outcome is modulation of a surrogate endpoint biomarker (SEB), that is, a molecular event assumed to be on the causal pathway between the chemopreventive agent and the desired reduction in cancer incidence. However, SEBs commonly used in prostate cancer chemoprevention studies, such as prostate-specific antigen, high grade prostatic intraepithelial neoplasia, proliferation, and apoptosis, have not been validated by documenting that changes in the SEBs ultimately translate to decreased prostate cancer risk. Because of uncertainty in the pathway from SEBs to cancer, additional considerations are necessary to permit valid inferences from phase 2 trial data. This article considers the framework underlying validation and use of SEBs in specific chemoprevention models and methodologic issues in quantifying the effect of an agent. In particular, inferences depend on whether a single pathway involving the SEBs is assumed to mediate the effect of the agent on cancer incidence. If there are competing pathways of equal or greater importance than the one involving the candidate SEB, then the estimate of chemopreventive efficacy will be biased and may greatly underestimate the magnitude of the achievable risk reduction. Strategies for validating biomarkers and minimizing the degree of bias in the risk reduction estimate are discussed. Finally, problems associated with phase 2 study designs commonly used for prostate cancer chemoprevention are discussed, along with possible solutions.

Apoptosis↗

The SEGUE Framework for teaching and assessing communication skills.

This article examines uses and characteristics of the SEGUE Framework, a research-based checklist of medical communication tasks. A recent survey of US and Canadian medical schools indicates that the SEGUE Framework is the most widely used structure for communication skills teaching and assessment in North America. Student and faculty response to the SEGUE Framework as a teaching tool has been positive. Data drawn from clinical skills assessments with standardized patients provide evidence of concurrent and construct validity. Analysis of visits between general internists and their patients reinforces validity of the SEGUE Framework in an actual practice setting. Interrater reliability is high when standardized patients are recording student performance immediately after a live encounter, and when coders are evaluating videotaped or audiotaped encounters; intrarater reliability is strong as well. The SEGUE Framework has a high degree of acceptability, can be used reliably, has evidence of validity, and is applicable to a variety of contexts. Studies of predictive validity are needed.

Clinical Competence↗

Immersive virtual reality-assisted anatomy training improves endotracheal intubation performance in simulation: a randomized controlled trial among Chinese non-anesthesiology residents.

INTRODUCTION: This study aimed to compare immersive virtual reality (IVR)-assisted versus conventional anatomy training for teaching endotracheal intubation (ETI) to novice non-anesthesiology residents enrolled in China's Standardized Residency Training program. METHODS: A total of 90 non-anesthesiology residents without prior ETI experience were randomly assigned to either an IVR group receiving IVR-assisted anatomy training (n&#x2009;=&#x2009;45) or a control group receiving conventional anatomy training (n&#x2009;=&#x2009;45). All participants underwent a standardized teaching protocol. The primary endpoint was residents' ETI performance on a simulator, assessed using both the Global Rating Scale (GRS) and a task-specific checklist. The secondary endpoints included changes in written multiple-choice question (MCQ) scores and residents' evaluations of the course. RESULTS: In practical ETI assessments on a manikin, the IVR group achieved significantly higher scores on the task-specific checklist than the control group (90.34&#x2009;&#xb1;&#x2009;2.89 vs. 87.20&#x2009;&#xb1;&#x2009;3.29; p&#x2009;<&#x2009;0.001), whereas GRS scores were comparable between groups. Both groups showed significant post-training improvement in knowledge scores (p&#x2009;<&#x2009;0.001), with the IVR group showing a greater gain in theoretical knowledge (54.0% vs. 36.3%; p&#x2009;<&#x2009;0.001). Participants in the IVR group also expressed a stronger preference for their training method (80.8%) and reported higher levels of motivation, confidence, and enjoyment (all p&#x2009;<&#x2009;0.05). CONCLUSION: IVR-assisted anatomy training enhances the effectiveness of ETI training for novice non-anesthesiology residents, offering an interactive, engaging, and reproducible approach within China's Standardized Residency Training framework.

Humans↗

Diagnostic practise in nursing: a critical review of the literature.

The purpose of this article is to critically review and synthesize the literature related to the general concepts and the process of diagnosing the client's condition, and the possible variables which influence diagnostic practise in nursing. It is suggested that statistical theories are capable of capturing the diagnostic process and offer an effective means to predict diagnostic decisions. Studies underpinned by information-processing theory argue that diagnosing a patient's condition follows a hypothetico-deductive model that consists of specific stages. Those who hold a phenomenological perspective remark that there is yet another form of diagnostic practise: intuitive reasoning, which plays an important role in diagnosing the patient's clinical condition. Other related studies suggest that diagnostic practise is contingent on some personal, psychosocial, and structural variables. Regrettably, these studies offer no conclusive explanation to delineate diagnostic practise in nursing. Based on the literature reviewed, a conceptual framework is suggested to help articulate the underlying structures and processes of diagnostic practise in nursing.

Acute Disease↗

Improving rural cancer patients' outcomes: a group-randomized trial.

CONTEXT: Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. PURPOSE: To test the effects of a strategy targeting rural providers and their practice environment on patient travel for care, satisfaction, economic barriers, and health-related quality of life. METHODS: A group-randomized trial was conducted with 18 rural communities in the north-central United States. Twelve of these communities were included and defined as the unit of analysis for the patient outcomes portion of the study. The intervention targeted rural providers and their practice environment. The subjects were patients with breast, colorectal, lung, and prostate cancers from the rural communities. The main outcomes were patients' travel to obtain health care, satisfaction with care, perceptions of economic barriers to care, and health-related quality of life. In total, 881 patients were included. RESULTS: Group randomization was balanced. Travel for health care was significantly reduced in the community group exposed to the intervention during months 13 to 24 following cancer diagnosis. The mean miles traveled per patient were 1,326 (SE = 306) for the experimental group and 2,186 (SE = 347) for the control group (P = 0.03). No significant differences in satisfaction with care, economic barriers to care, or health-related quality of life were found. CONCLUSIONS: The intervention significantly reduced cancer patient travel for health care, which suggests that access to care improved in the experimental group. The results of this study do not allow conclusion that there was no effect on other patient outcomes. The results supported the study's conceptual framework and many of its hypotheses.

Aged↗

Mentoring: a framework for developing health disparities researchers.

Health disparities have been conceptualized as being the result of a confluence of factors: environmental, social, biological, economic, and cultural to name a few. Given the increasingly deleterious impact of health disparities on the lives of all Americans, new research methodological research approaches are needed to adequately understand and address the component parts of health disparities. To effectively address health disparities, an increased focus is needed on implementing transdisciplinary approaches to health disparities research. One approach is to focus on mentoring young investigators and students. This article discusses the centrality of mentoring in developing young health disparities researchers. An overview of health disparities research and researchers, and a summary of the different aspects of mentoring are provided. In addition, a case study of the implementation of a transdisciplinary mentoring framework at a higher education institution is presented.

Career Mobility↗

[Links between non-professional agents and the official Veterinary Services in sub-Saharan Africa].

Para-professional agents known as auxiliaries, or community animal health workers, provide low-cost basic veterinary services to communities of livestock producers. A 2003 survey of 16 Sub-Saharan African countries, carried out as part of the Pan-African Programme for the Control of Epizootics, showed that in the majority of cases, the official Veterinary Services have no (or very few) links with the auxiliaries, although they are well aware of their existence and in some cases the auxiliaries have been trained by officials of the Veterinary Services. However, there are isolated cases of countries establishing more formal links, for example, recognising the status of an auxiliary, recognising auxiliaries with no definition of a status, attaching auxiliaries to Veterinary Service staff, establishing agreements for the provision of auxiliary services through livestock producer associations, harmonising auxiliary training programmes, issuing professional auxiliary cards, and setting up a consultation framework on the issue of auxiliaries. Unlike private veterinarians, agents of the official services do not generally perceive auxiliaries as competitors, and sometimes collaboration develops at this level. The authors propose several measures to improve links between the official Veterinary Services and auxiliaries, as follows: the fields of competence of auxiliaries should be defined and their curriculum harmonised, the status of auxiliaries should be recognised, a monitoring and assessment mechanism should be established at senior level in the Veterinary Services, training for livestock producers should be improved.

Africa South of the Sahara↗

Computer applications for staff development and patient education.

The changing and evolving profession of nursing necessitates extensive staff development activities on the part of nursing management. This ongoing responsibility is essential to maintaining the currency and competence of practicing nurses and facilitating their professional growth. Simultaneously there are economic constraints coinciding with increased consumer demands for patient education. The purpose of this paper is to explore an innovative teaching method, the use of instructional computing for staff development and patient education programs. The theoretical frameworks for this instructional modality are identified and general advantages and disadvantages of instructional computing applications are described. Specific examples of programs from the literature are briefly discussed.

Attitude to Computers↗

Introduction: evolutionary theory and the search for a unified theory of fertility.

Demography and evolutionary biology share common origins but have divergent emphasis on the role of theory in understanding population phenomena. A unified theory of fertility would be beneficial in explaining variation in demographic characteristics across geographic and temporal gulfs and in integrating disparate perspectives. The six papers in this thematic collection represent a nascent but vital field: human evolutionary demography. These papers examine the ways in which evolutionary theory can inform, strengthen, and focus research on topics of long-standing interest to demographers by explicitly modeling the relationship of socioecological variables to life history traits. The papers demonstrate that an understanding of human life history evolution and the use of evolutionary theory as an organizing framework can lead to a productive reassessment of five areas, which are of long-standing concern to demographers, and which conventional demographic approaches have had limited success in understanding. These are conflicts of interest between parents and children and between men and women, the allocation of resources to competing and/or alternative forms of investment in reproduction and parenting, resource flow within the household, demographic transitions and particularly the fertility transition associated with economic development, and variation in life history characteristics such as fertility and mortality across populations. Future research integrating models of trait-environment correlation with models of individual information processing and decision-making will help identify areas of focus, revitalize current models, and play a leading role in the development of a unified theory of fertility applicable across societies and times.

Birth Rate↗

The principles and practice of rinderpest eradication.

Rinderpest can be controlled by interrupting its transmission. This objective can be achieved by implementing zoo sanitary controls to eliminate or reduce the excretion of virus or by the use of vaccine to prevent the infection of fresh hosts. For success in the eradication of rinderpest these two techniques must be combined and used within time-bound campaign frameworks. The tools required for implementing rinderpest eradication are legal powers to declare farms to be infected premises and their surroundings to be infected areas, along with a cheap and efficacious vaccine. Finally, before embarking on rinderpest eradication an epidemiologically valid strategy must be adopted, financed and placed under competent management.

Animals↗

A systematic review of human avoidance learning: Cognition, computation, and methods.

Avoidance behaviour is fundamental for survival but can become maladaptive in clinical conditions. A large body of literature has accumulated on the dynamics of human avoidance learning. However, current theories and overviews do not provide an exhaustive account of this evidence. In this systematic review, we identify N = 116 studies on human avoidance learning. We analyse these studies with the goal of distilling robust empirical phenomena as a basis for theory-building, and examine their diagnostic value in differentiating between competing theories. We find that the evidence is difficult to reconcile with foundational two-factor and classical safety-signal accounts, and most strongly supports expectancy- and inference-based views, in which avoidance responses are selected with respect to represented consequences. At the same time, no current framework provides a complete account of the evidence: several findings point to an additional role for operant valuation, Pavlovian influences, and contextual or latent-state control over the expression of avoidance. Methodologically, we observe that the problem setting in the most common experimental paradigms is radically simpler than real-world avoidance and therefore unlikely to expose the limits of inferential or reflective mechanisms. Consequently, we argue that paradigms with greater computational demands and more realistic action affordances are required to identify the mechanisms underlying avoidance learning. Collectively, these insights provide a foundation for theoretical refinement, computational modelling, and methodological innovation, with implications for advancing interventions targeting maladaptive avoidance.

Humans↗

[Role of the implicit theories of intelligence in learning situations].

Most studies have tried to explain the school difficulties by analysing the intellectual factors that lead to school failure. However in addition to the instrumental capacities, authors also recognize the role played by other factors such as motivation. More specifically, the theory of achievement motivation aims to determine motivational factors involved in achievement situations when the students have to demonstrate their competencies. This paradigm attributes a central place to beliefs in order to explain children's behavior in academic situations. According to Dweck, it seems that beliefs about the nature of intelligence have a very powerful impact on behavior. These implicit theories of intelligence create a meaning system or conceptual framework that influences the individual interpretation of school situations. Thus, an entity theory of intelligence is the belief that intelligence is a fixed trait, a personal quality that cannot be changed. Students who subscribe to this theory believe that although people can learn new things, their underlying intelligence remains the same. In contrast, an incremental theory of intelligence is the belief that intelligence is a malleable quality that can increase through efforts. The identification of these two theories allows us to understand the cognition and behavior of individuals in achievement situations. Many studies carried out in the academic area show that students who hold an entity theory of intelligence (ie they consider intelligence like a stable quality) have a strong tendency to attribute their failures to a fixed trait. They are more likely to blame their intelligence for ne-gative outcomes and to attribute failures to their bad intellectual ability. In contrast, students who hold an incremental theory of intelligence (ie they consider intelligence as a malleable quality) are more likely to understand the same ne-gative outcomes in terms of specific factors: they attribute them to a lack of effort. This differential emphasis on traits versus specific mediators in turn fosters different reactions to negative events. Several studies have shown that entity theorists of intelligence are more likely than incremental theorists to react helplessly in the face of failure. They are not only more likely to make negative judgments about their intelligence from the failures, but also more likely to show negative affect and behaviors. This helpless response pattern is cha-racterized by a lack of persistence, and performance decrements. In contrast, incremental theorists, who focus more on behavioral factors (eg effort, problem-solving strategies) as causes of negative achievement outcomes, tend to act on these mediators. They try harder and develop better strategies and continue to work. Some authors have tendency to consider implicit theories of intelligence as a disposition or a stable dimension. But in the last few years, several studies showed that people's theories are not fixed traits; they are beliefs that may be influenced. These studies also suggested that students use the two types of beliefs and that the context determines the choice between the two types of theories. According to these authors, the psychological state of the student depends on dispositional factors but also on situational factors. Thus, several studies have tried to demonstrate that it is possible to modify experimentally implicit theories of intelligence and subsequent cognitions and behaviors by modifying situational factors. Several studies have demonstrated that it was possible to induce students to adopt one of the two theories of intelligence by presenting them a scientific article that compelling argued for either an entity or an incremental view of intelligence. The results showed that participants who had received the entity theory induction exhibited more evidence of a helpless reaction to failure. These studies show that some of the judgments and reactions associated with implicit theories can be experimentally induced by manipulating participant theories. However in the context of school difficulties, only few works have been conducted. We think that the model of the motivation of achievement would allow us to better understand maladjusted behaviors that engender failure and scholastic exclusion. In one study, reseachers have demonstrated that children with mental disorders are less likely than other children to hold an incremental theory of their intellectual abilities. Other studies have demonstrated that entity theorists interpret their bad results according to their global intelligence level by negatively judging their global abilities ("I think I am stupid"). It is interesting to note that these students make the same attributions as depressive students. These results reveal the need to determine systems of beliefs within populations with anxiety or depressive symptoms in order to characterise their motivational profiles. Indeed, we think that these symptoms contribute to modify implicit theories of intelligence and the nature of the subsequent scholastic achievement. Finally, we think that it is inte-resting to demonstrate the positive motivational effects of the experimental induction of the incremental theory. A series of studies showed that children's theories of intelligence expe-rimentally induced will influence their tendency to persevere in the face of failure. Like normally developing children, children with mental disorders were more likely to prefer challenging activities and report high levels of interest-enjoyment when the task was presented as one which is improvable. It suggests that although children with difficulties are pessimistic about improving their intellectual capacities, if a new task is introduced in a way that highlights the possibility of self-improvement (incremental theory), then they will pursue the challenge in an adaptive manner (strong perseverance, enjoy, and important interest). These results are very inte-resting. Indeed, highlighting an incremental theory had a po-sitive motivational effect on behavior in achievement situations. In addition, all these results also may open up several interesting perspectives for the treatment of learning disabi-lities. The results should lead to plan programmes of cognitive therapy in order to modify beliefs that underlie maladjusted achievement behaviors of children and adolescents in scholastic failure.

Achievement↗