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Partial compliance and patient consequences in schizophrenia: our patients can do better.

OBJECTIVE: The primary objective of this review is to evaluate the strategies used to improve patient compliance with antipsychotic medication in the treatment of schizophrenia. DATA SOURCES: An electronic literature search of relevant studies using MEDLINE and the Cochrane Library (January 1974-December 2002) was performed using the search terms adherence, antipsychotic, atypical, compliance, conventional, and schizophrenia. STUDY SELECTION: English-language and non-English-language articles, references from bibliographies of reviews, original research articles, and other articles of interest were reviewed. DATA EXTRACTION: Data quality was determined by publication in the peer-reviewed literature and the most important information was identified. DATA SYNTHESIS: Atypical antipsychotics are associated with an improved side-effect profile and reduced risk of relapse compared with the older agents. Additional benefit may be provided by long-acting injectable formulations as they provide the confidence of continuous medication coverage. CONCLUSIONS: Successful treatment of patients with schizophrenia requires acknowledgment that partial compliance will present a major barrier to achieving maximum outcomes. Ideally, all patients suspected of partial compliance should be considered suitable for treatment with a long-acting injectable atypical antipsychotic.

Antipsychotic Agents↗

Flip the tip: an automated, high quality, cost-effective patch clamp screen.

The race for creating an automated patch clamp has begun. Here, we present a novel technology to produce true gigaseals and whole cell preparations at a high rate. Suspended cells are flushed toward the tip of glass micropipettes. Seal, whole-cell break-in, and pipette/liquid handling are fully automated. Extremely stable seals and access resistance guarantee high recording quality. Data obtained from different cell types sealed inside pipettes show long-term stability, voltage clamp and seal quality, as well as block by compounds in the pM range. A flexible array of independent electrode positions minimizes consumables consumption at maximal throughput. Pulled micropipettes guarantee a proven gigaseal substrate with ultra clean and smooth surface at low cost.

Animals↗

A nationwide adaptive prediction tool for coronary heart disease prevention.

Standardised electronic recording of cardiovascular risk factor data collected during primary care delivery could be used to create a new strategy, using an adaptive prediction model, for targeting primary prevention interventions at high-risk individuals. In the short term, this should progressively improve data quality and allow risk modification to be monitored at the population level. In the long term, feedback of data on cardiovascular disease development might enable the model to tailor the recommended interventions more appropriately to the needs of the individual and to adapt to future changes in risk patterns. Ultimately, the inclusion of additional cardiovascular risk factors might enable a richer, more realistic picture of cardiovascular risk profiles to be uncovered. This model may have wider uses in both research and practice, and provides a further incentive for the standardisation of record keeping in primary care.

Adult↗

Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study.

BACKGROUND: Numerous studies examining the prevalence and natural history of dyspepsia in the general population have been conducted. However, few have reported the effect of quality of life on the development of dyspepsia. A 10-year longitudinal follow-up study examining the effect of quality of life on subsequent dyspepsia was performed. METHODS: Individuals originally enrolled in a population-screening programme for Helicobacter pylori were contacted through a validated postal dyspepsia questionnaire. Baseline demographic data, quality of life at original study entry, and dyspepsia and irritable bowel syndrome (IBS) symptom data were already on file. Consent to examine primary-care records was sought, and data regarding non-steroidal anti-inflammatory drugs (NSAID) and aspirin use were obtained from these. RESULTS: Of 8407 individuals originally involved, 3912 (46.5%) provided symptom data at baseline and 10-year follow-up. Of 2550 (65%) individuals asymptomatic at study entry, 717 (28%) developed new-onset dyspepsia at 10 years, an incidence of 2.8% per year. After multivariate logistic regression, lower quality of life at study entry (OR 2.63; 99% CI 1.86 to 3.71), higher body mass index (OR per unit 1.05; 99% CI 1.02 to 1.08), presence of IBS at study entry (OR 3.1; 99% CI 1.51 to 6.37) and use of NSAIDs and/or aspirin (OR 1.32; 99% CI 0.99 to 1.75) were significant risk factors for new-onset dyspepsia. CONCLUSIONS: The incidence of new-onset dyspepsia was almost 3% per year. Low quality of life at baseline exerted a strong effect on the likelihood of developing dyspepsia at 10 years.

Anti-Inflammatory Agents, Non-Steroidal↗

Accuracy of hospital discharge data for cancer registration and epidemiological research in Northern Ireland.

BACKGROUND: Cancer registries provide a basis for many epidemiological studies in cancer. Electronic data provide for prompt, economical data capture for disease registries; doubts, however, exist about their data quality. MATERIALS AND METHODS: We examined the accuracy for cancer registration of a subset of 7043 electronically captured hospital discharge data. RESULTS: Note availability was 82%. Of the notes available for examination demographic data accuracy was high; however, 7.4% of cases coded on discharge as cancer had no malignancy recorded in case notes while 4. 1% had in-situ or benign tumors. Almost a third had some inaccuracy in coding tumor site. Prevalent cases accounted for 17.2% of cases examined reflecting a new registry. Electronic data capture reduces time spent examining notes; only 40% of cases notified from PAS required a quick validation check. It enhances data completeness; without electronic discharge data 11.5% of the final database would have been missed. The validation check prevented overinflation of the cancer registration database by 7.5%. Measures of accuracy in the final database were high. CONCLUSION: This study shows that discharge data are a valuable data source for cancer registries but require a targeted note review aimed at cases without corroborating data.

Adult↗

Preparing the national healthcare disparities report: gaps in data for assessing racial, ethnic, and socioeconomic disparities in health care.

BACKGROUND: Efforts to quantify, monitor, understand, and reduce disparities in health care are critically dependent on the collection of high-quality data that support such analyses. In producing the first National Healthcare Disparities Report (NHDR), a number of gaps in data were encountered that limited the ability to assess racial, ethnic, and socioeconomic disparities in health care. OBJECTIVES: The objectives of this study were to identify and quantify gaps in data related to disparities in health care and discuss efforts to fill these gaps in future NHDRs. FINDINGS: : Data on specific racial, ethnic, and socioeconomic groups were often not collected or collected in formats that differed from federal standards. When collected, data were often insufficient to generate reliable estimates for specific racial, ethnic, and socioeconomic groups. These effects were magnified when attempting to assess disparities within many of the agency's priority populations such as women, children, the elderly, low-income populations, and rural residents. Future NHDRs begin to fill some of these gaps in data, but some gaps will likely persist and new gaps will likely arise as the availability of data for specific populations vary from year to year. CONCLUSIONS: Gaps in data limit the ability to address racial, ethnic, and socioeconomic disparities in health care. Although many federal efforts are underway to improve data collection, some groups and populations pose unique challenges for data collection that will be difficult to overcome.

Aged↗

Clinical epidemiology and research on HIV infection in Switzerland: the Swiss HIV Cohort Study 1988-2000.

BACKGROUND AND OBJECTIVES: The Swiss HIV Cohort Study (SHCS) was initiated in 1988 and represented the main scientific component of the comprehensive response to the AIDS epidemic in Switzerland. It brought together physicians and scientists from five university hospitals (Basel, Berne, Geneva, Lausanne and Zurich) and two Cantonal hospitals (Lugano and St. Gallen). The objective of SHCS was, and still is, to produce rapid, high quality patient-oriented medical research in the field of HIV infection. METHODS: SHCS is a prospective population-based cohort study. Any HIV-infected person aged > or = 16 years is eligible to participate. Data collection and study procedures are standardised. Data quality and protocol monitoring are conducted at the coordination and data centre in Lausanne. Detailed information on demographics, income, mode of HIV acquisition, risk behaviours, clinical events, laboratory results, treatment and treatment tolerance is collected at registration and at 6-monthly intervals. RESULTS: Since 1996, 10,600 persons have been enrolled and the SHCS study population is considered fairly representative of the HIV-infected population in Switzerland, at least in terms of gender and mode of HIV acquisition. In 1999, 4600 patients were actively followed up and more than 70% of patients were receiving highly active antiretroviral therapy (HAART). As a consequence, mortality and the incidence of HIV-related opportunistic infections have decreased significantly in the recent past. Between 1996 and 2000, 91 original manuscripts have been published by SHCS scientists and physicians, almost exclusively in peer-reviewed journals. A wide range of scientific questions have been addressed, including HIV primary infection, the natural history of HIV infection, the clinical and biological impact of HAART, drug resistance, risk factors for disease evolution including the timing of treatment initiation, the role of CD4 receptors, the validity of HIV surveillance reports, determinants of treatment access and tolerance, clinical trials of new drug combinations, the interruption of prophylaxis following a favourable response to HAART and issues relating to quality of life and interaction between income, social level and disease evolution. CONCLUSION: The SHCS has had, and continues to have, a significant impact on medical practice, public health and research in Switzerland and beyond. It represents a network of excellence which has brought together and fostered intensive collaboration between physicians and institutions throughout this country and beyond. This was possible thanks to the support of the Federal Office of Public Health and the commitment of primary care physicians, researchers and patients. This project may be model for focused and prioritised multicentre and transdisciplinary research programmes.

AIDS-Related Opportunistic Infections↗

The use of noncancer endpoints as a basis for establishing a reference concentration for formaldehyde.

Published studies involving formaldehyde were selected for quality and relevance for determining whether noncancer endpoints could be used to derive a reference concentration for formaldehyde. Chamber studies provided the highest quality data for determining the presence of eye, nose, or throat irritation at a known level of formaldehyde. Some individuals begin to sense irritation at about 0.5 ppm, 5-20% report eye irritation at 0.5 to 1 ppm, and greater certainty for sensory irritation appears at 1 ppm or greater. These levels of formaldehyde do not appear to impact asthmatics even though these individuals are thought to be more sensitive to irritants. Mild, reversible changes in pulmonary function (forced expiratory volume at 1 s and midexpiratory flow) can occur in sensitized individuals at levels approaching 2 ppm. Studies in the manufacturing setting, while confounded by multiple exposures, provide useful information for setting boundaries for sensory irritation or changes in pulmonary function. Community surveys do not provide the specificity nor sensitivity needed to establish a reference concentration. Histological studies of the nasal mucosa suffer significant methodological and technological shortcomings in addition to issues commonly associated with the design of residential and workplace studies. Based on the review of chamber, community, and workplace studies of human exposures to formaldehyde, it is not possible to identify a specific no observed adverse effect level or lowest observed adverse effect level for formaldehyde. Ranges of exposures associated with acute sensory irritation can be derived and do include sensitive subpopulations. However, given the quality and variability of the data, human studies alone, especially those involving sensory irritation, are not adequate to serve as a reference concentration for estimating risk, or lack thereof, for a lifetime of exposure to formaldehyde. Alternative approaches, such as modeling cellular changes observed in animal studies, may be more useful for quantitative risk assessment of noncancer endpoints and should be used as an adjunct to interpreting human sensory studies.

Air Pollutants, Occupational↗

ARAMIS today: moving toward internationally distributed databank systems for follow-up studies.

The American Rheumatism Association Medical Information System (ARAMIS) is a consortium of North American rheumatic disease data banks. Founded in 1974, it has grown to include more than 16 centers, 22,000 patients, 140,000 patient encounters, and 80,000,000 observations. Traditionally, data storage and computer programs have resided on the IBM "2"-370 system at Stanford University. Distant peripheral centers have entered and retrieved data and performed analyses using proprietary long distance telephone networks. With growth, ARAMIS has placed strong emphasis on data quality and epidemiological soundness. "Core" groups at Stanford specifically address issues of quality control, biostatistics, health care economics, outcome assessment, study design, and administration. Advances in microcomputers and software has led ARAMIS to begin a migration from mainframe computing to distributed systems using IBM PC/XT/AT type computers and the Medlog software system. Substantial cost savings have been noted with distributed processing. The ability to easily transfer data and software forms a groundwork for international data banks and data exchange, but common vocabulary and common quality control procedures are essential for effective international cooperation and exchange.

Arthritis, Rheumatoid↗

Statistical process control for large scale microarray experiments.

MOTIVATION: Maintaining and controlling data quality is a key problem in large scale microarray studies. In particular systematic changes in experimental conditions across multiple chips can seriously affect quality and even lead to false biological conclusions. Traditionally the influence of these effects can be minimized only by expensive repeated measurements, because a detailed understanding of all process relevant parameters seems impossible. RESULTS: We introduce a novel method for microarray process control that estimates quality based solely on the distribution of the actual measurements without requiring repeated experiments. A robust version of principle component analysis detects single outlier microarrays and thereby enables the use of techniques from multivariate statistical process control. In particular, the T(2) control chart reliably tracks undesired changes in process relevant parameters. This can be used to improve the microarray process itself, limits necessary repetitions to only affected samples and therefore maintains quality in a cost effective way. We prove the power of the approach on 3 large sets of DNA methylation microarray data.

Algorithms↗

Anaesthesia for treating distal radial fracture in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. Anaesthesia is usually provided during manipulation of displaced fractures or during surgical treatment. OBJECTIVES: To examine the evidence for the relative effectiveness of the main methods of anaesthesia (haematoma block, intravenous regional anaesthesia (IVRA), regional nerve blocks, sedation and general anaesthesia) as well as associated physical techniques and drug adjuncts used during the management of distal radial fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2001), MEDLINE (1966 to October 2001), EMBASE (1988 to 2001 Week 48), Current Controlled Trials (December 2001) and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating relevant interventions for these injuries (see Objectives). We excluded pharmacological trials comparing drug dosages and, with one exception, different drugs in the same class. Also excluded were trials reporting only pharmacokinetic and/or physiological outcomes. DATA COLLECTION AND ANALYSIS: All trials meeting the selection criteria were independently assessed by the three reviewers for methodological quality. Data were extracted independently by two reviewers. Quantitative data are presented using relative risks or mean differences together with 95 per cent confidence limits. Only very limited pooling of results from comparable trials was possible. MAIN RESULTS: The 18 included studies involved at least 1200, mainly female and older, patients with fractures of the distal radius. All studies had serious methodological limitations, notably in the frequent failure to assess clinically important and longer-term outcomes. Five trials provided evidence that, when compared with haematoma block, IVRA provided better analgesia during fracture manipulation and enabled better and easier reduction of the fracture, with some indication of a reduced risk of later redislocation or need for re-reduction. In contrast, haematoma block was quicker and easier to perform and less resource intensive. There was inadequate evidence of relative effectiveness of different methods of anaesthesia only examined within single trials: nerve block versus haematoma block; intravenous sedation versus haematoma block; general anaesthesia versus haematoma block; general anaesthesia versus sedation; and general anaesthesia versus haematoma block and sedation. None of the three trials evaluating three different physical aspects of anaesthesia (injection site of, or extra tourniquet, for IVRA; and technique for brachial plexus block) provided conclusive evidence for the effectiveness and safety of the novel technique. Six trials examined the use of drug adjuncts. The addition of two different muscle relaxants and one analgesic was tested for IVRA; one sedative and hyaluronidase for haematoma block; and clonidine for brachial plexus block. All trials evaluating adjuncts failed to provide evidence on eventual clinical outcome. A seriously flawed study comparing bupivacaine with prilocaine for IVRA gave some insight on the potential confounding effects of treatment by different doctors on patient outcome. REVIEWER'S CONCLUSIONS: There was insufficient robust evidence from randomised trials to establish the relative effectiveness of different methods of anaesthesia, different associated physical techniques or the use of drug adjuncts in the treatment of distal radial fractures. There is, however, some indication that haematoma block provides poorer analgesia than IVRA, and can compromise reduction. Given the many unresolved questions over the management of these fractures, we suggest an integrated programme of research, which includes consideration of anaesthesia options, is the way forward.

Aged↗

Rehabilitation for distal radial fractures in adults.

BACKGROUND: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. OBJECTIVES: To examine the evidence for effectiveness of rehabilitation intervention(s) for adults with conservatively or surgically treated distal radial fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), the Cochrane Rehabilitation and Related Therapies Field database, MEDLINE (1966 to January 2002), EMBASE (1988 to 2001 Week 50), CINAHL (1982 to December Week 2 2001), Current Controlled Trials (December 2001), AMED, PEDro, conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating rehabilitation as part of the management of fractures of the distal radius sustained by skeletally mature patients. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians. DATA COLLECTION AND ANALYSIS: All trials meeting the selection criteria were independently assessed by all three reviewers for methodological quality. Data were extracted independently by two reviewers. The trials were grouped into categories relating to the main comparisons, and to when the intervention(s) commenced (for example, during or after plaster cast immobilisation). Quantitative data are presented using relative risks or mean differences together with 95 per cent confidence limits. MAIN RESULTS: Twelve trials, involving 601 mainly female and older patients, were included. Initial treatment was conservative, involving plaster cast immobilisation, in all but 20 patients whose fractures were fixed surgically. Though some trials were well conducted, others were methodologically compromised. No trial provided definitive evidence. Only very limited pooling of results from comparable trials was possible. During immobilisation, there was weak evidence of improved hand function in the short term, but not in the longer term, for early occupational therapy (1 trial), and of a lack of differences in outcome between supervised and unsupervised exercises (1 trial). Post-immobilisation, there was weak evidence of a lack of clinically significant differences in outcome in patients receiving formal rehabilitation therapy (3 trials), passive mobilisation (2 trials) or whirlpool immersion (1 trial) compared with no intervention. There was weak evidence of a short-term benefit of continuous passive motion (post external fixation) (1 trial), intermittent pneumatic compression (1 trial) and ultrasound (1 trial). There was weak evidence of better short-term hand function in patients given physiotherapy than in those given instructions for home exercises by a surgeon (1 trial). REVIEWER'S CONCLUSIONS: The available evidence from randomised trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius.

Adult↗

Gas chromatography/flame ionisation detection mass spectrometry for the detection of endogenous urine metabolites for metabonomic studies and its use as a complementary tool to nuclear magnetic resonance spectroscopy.

Metabonomics is a relatively new field of research in which the total pool of metabolites in body fluids or tissues from different patient groups is subjected to comparative analysis. Nuclear magnetic resonance (NMR) spectroscopy is the technology that is currently most widely used for the analysis of these highly complex metabolite mixtures, and hundreds of metabolites can be detected without any upfront separation. We have investigated in this study whether gas chromatography (GC) separation in combination with flame ionisation detection (FID) and mass spectrometry (MS) detection can be used for metabolite profiling from urine. We show that although GC sample preparation is much more involved than for NMR, hundreds of metabolites can reproducibly be detected and analysed by GC. We show that the data quality is sufficiently high--particularly if appropriate baseline correction and time-warping methods are applied--to allow for data comparison by chemometrics methods. A sample set of urines from eleven healthy human volunteers was analysed independently by GC and NMR, and subsequent chemometrics analysis of the two datasets showed some similar features. As judged by NIST database searches of the GC/MS data some of the major metabolites that are detected by NMR are also visible by GC/MS. Since in contrast to NMR every peak in GC corresponds to a single metabolite, the electron ionisation spectra can be used to quickly identify metabolites of interest if their reference spectra are present in a searchable database. In summary, we show that GC is a method that can be used as a complementary tool to NMR for metabolite profiling of urine samples.

Gas Chromatography-Mass Spectrometry↗

Community indicators of child health.

Indicators of health in child populations are critically reviewed and the potential for routinely collected morbidity and life quality data discussed. A short list of currently available, routinely collected child health data is proposed which, if available for all European countries, would form the basis of a useable and comparable European child health data base. A European consensus group on child health indicators is proposed and further research into morbidity and life quality measures relevant to children recommended.

Adolescent↗

Practice review of five bioreactor/recirculation landfills.

Five landfills were analyzed to provide a perspective of current practice and technical issues that differentiate bioreactor and recirculation landfills in North America from conventional landfills. The bioreactor and recirculation landfills were found to function in much the same manner as conventional landfills, with designs similar to established standards for waste containment facilities. Leachate generation rates, leachate depths and temperatures, and liner temperatures were similar for landfills operated in a bioreactor/recirculation or conventional mode. Gas production data indicate accelerated waste decomposition from leachate recirculation at one landfill. Ambiguities in gas production data precluded a definitive conclusion that leachate recirculation accelerated waste decomposition at the four other landfills. Analysis of leachate quality data showed that bioreactor and recirculation landfills generally produce stronger leachate than conventional landfills during the first two to three years of recirculation. Thereafter, leachate from conventional and bioreactor landfills is similar, at least in terms of conventional indicator variables (BOD, COD, pH). While the BOD and COD decreased, the pH remained around neutral and ammonia concentrations remained elevated. Settlement data collected from two of the landfills indicate that settlements are larger and occur much faster in landfills operated as bioreactors or with leachate recirculation. The analysis also indicated that more detailed data collection over longer time periods is needed to draw definitive conclusions regarding the effects of bioreactor and recirculation operations. For each of the sites in this study, some of the analyses were limited by sparseness or ambiguity in the data sets.

Bioreactors↗

How and why is aquatic quality changing at Nahanni National Park Reserve, NWT, Canada?

Nahanni National Park Reserve is located at southwestern NWT-Yukon border. One of the first UNESCO World Heritage sites, Nahanni lies within Taiga Cordillera and Taiga Shield Ecozones. Base and precious metal mining occurred upstream of Nahanni prior to park establishment. Nahanni waters, sediments, fish, and caribou have naturally elevated metals levels. Baseline water, sediment and fish tissue quality data were collected and analyzed throughout Nahanni during 1988-91 and 1992-97. These two programs characterized how aquatic quality variables are naturally varying in space and time, affected by geology, stream flow, seasonality, and extreme meteorological and geological events. Possible anthropogenic causes of aquatic quality change were examined. Measured values were compared to existing Guidelines and site-specific objectives were established.

Environmental Monitoring↗

Vitamin D, calcium, and bone status in children with developmental delay in relation to anticonvulsant use and ambulatory status.

Reports of abnormalities in vitamin D, calcium, and bone status associated with anticonvulsant use are inconsistent and difficult to interpret because of widely varying study designs, particularly for ambulatory status. We examined the relative effects of anticonvulsant use and ambulatory status on vitamin D, calcium, and bone status in a large group (n = 338) of children who had either normal motor function (ambulatory) or were nonambulatory and either receiving anticonvulsants or not; all had developmental delays. Data included diet records, serum analyses (calcium and calcidiol), and hand-wrist radiographs evaluated for bone maturation and quality. Data were analyzed by using a general linear models (GLM) procedure. Dietary and biochemical data were compared with those of a group of 34 normal children. There were no differences in calcium or vitamin D intakes among the four study groups; however, a high percentage of intakes was below the recommended dietary allowances for calcium (56%) and vitamin D (70%). Vitamin D intakes were positively associated with serum calcium (P < 0.005) and calcidiol (P < 0.01) concentrations. Analysis of covariance indicated that ambulatory status but neither anticonvulsant use nor their interaction contributed significantly to the prediction of serum calcium (P < 0.009) and calcidiol (P < 0.0001), the Z scores for number of ossified centers (P < 0.008), bone age (P < 0.0001), and bone area (P < 0.003). A strong interaction between anticonvulsant use and ambulatory status was seen for percentage cortical area (P < 0.0008), which was entirely due to anticonvulsant use in nonambulatory children (effect size = 0.98). Results suggest that ambulatory status is more important than was recognized previously in relation to abnormalities in vitamin D, calcium, and bone statuses; that all nonambulatory children may be at risk for low serum calcidiol and osteopenia; and that routine monitoring of risk and consideration of prophylactic vitamin D supplementation are warranted.

Anticonvulsants↗

CEBS object model for systems biology data, SysBio-OM.

MOTIVATION: To promote a systems biology approach to understanding the biological effects of environmental stressors, the Chemical Effects in Biological Systems (CEBS) knowledge base is being developed to house data from multiple complex data streams in a systems friendly manner that will accommodate extensive querying from users. Unified data representation via a single object model will greatly aid in integrating data storage and management, and facilitate reuse of software to analyze and display data resulting from diverse differential expression or differential profile technologies. Data streams include, but are not limited to, gene expression analysis (transcriptomics), protein expression and protein-protein interaction analysis (proteomics) and changes in low molecular weight metabolite levels (metabolomics). RESULTS: To enable the integration of microarray gene expression, proteomics and metabolomics data in the CEBS system, we designed an object model, Systems Biology Object Model (SysBio-OM). The model is comprehensive and leverages other open source efforts, namely the MicroArray Gene Expression Object Model (MAGE-OM) and the Proteomics Experiment Data Repository (PEDRo) object model. SysBio-OM is designed by extending MAGE-OM to represent protein expression data elements (including those from PEDRo), protein-protein interaction and metabolomics data. SysBio-OM promotes the standardization of data representation and data quality by facilitating the capture of the minimum annotation required for an experiment. Such standardization refines the accuracy of data mining and interpretation. The open source SysBio-OM model, which can be implemented on varied computing platforms is presented here. AVAILABILITY: A universal modeling language depiction of the entire SysBio-OM is available at http://cebs.niehs.nih.gov/SysBioOM/. The Rational Rose object model package is distributed under an open source license that permits unrestricted academic and commercial use and is available at http://cebs.niehs.nih.gov/cebsdownloads. The database and interface are being built to implement the model and will be available for public use at http://cebs.niehs.nih.gov.

Database Management Systems↗