bluuebunny/crossref_metadata_2025 huggingface dataset:
Participation in Medical Decision Making: The Patients' Perspective
Authors: Fraenkel Liana , McGraw Sarah
Published: September 2007

Purpose. Variability in reports of patients' preferences to participate in decision making may be due in part to a lack of understanding about how patients conceptualize their participation. The authors sought to learn more about how patients view their involvement in decisions related to their health care. Methods. The authors conducted individual interviews to allow patients to frame the decision-making process from their own perspective. The constant comparative-method approach to analysis was employed to ensure that the analysts defined the codes in a consistent manner. Results. Twenty-six persons were interviewed. The main themes discussed by the participants reflecting how they viewed their involvement in medical decision making are the following: 1) decision making is often an ongoing process in which patient participation may change over time, 2) decision making is performed within an extended social context, 3) the decisions patients report being involved in are often distinct from those traditionally studied (choice of treatment or screening strategies), 4) patient involvement in decision making occurs in response to physicians' recommendations, and 5) patients make choices in the context of their specific illness perceptions. Conclusions. Participants in this study view their participation in decision making as including ideas distinct from those traditionally discussed by researchers. These findings suggest that the variability in patient participation noted in previous studies may be due in part to limitations in study design.
The Drug Facts Box: Providing Consumers with Simple Tabular Data on Drug Benefit and Harm
Authors: Schwartz Lisa M. , Woloshin Steven , Welch H. Gilbert
Published: September 2007

Context. Direct-to-consumer drug ads have been criticized for providing inadequate and misleading information. Requiring ads to include a table with data on drug benefits and side effects (derived from clinical trials) could help, provided that consumers understand such tabular information. Objective. To determine if people could understand and use a 9-row × 2-column ``study findings table'' presenting expected outcomes (both beneficial and harmful) with and without a drug. Subjects.A convenience sample of 274 participants: 186 recruited from alumni of Dartmouth's ``Community Medical School'' public lecture series and Dartmouth Hitchcock's Center for Shared Decision Making and 88 veterans and their families recruited from waiting rooms in the Veterans Affairs outpatient clinic, White River Junction, Vermont. Design. Cross-sectional survey. Participants were tested on their comprehension of the study findings table about the drug tamoxifen used for the primary prevention of breast cancer—with no instructions on how to use the table. Main outcome measure. Five comprehension questions testing how well participants could read and use the table with drug benefits and side effects data. Results. On average, participants correctly answered 4 of the 5 table comprehension questions: 89% correctly used the table to determine the percentage of womengiventamoxifenwhogotabloodclotintheirlegsor lungs, and 71% were able to use data in the table to calculate the absolute difference in the proportion of women who got breast cancer in the tamoxifen v. the placebo group. Most participants were also able to use the table to make comparisons. Conclusion. Most participants—even those with lower formal educational attainment—were able to understand and use the tabular data.
Patient Decision Aids to Support Clinical Decision Making: Evaluating the Decision or the Outcomes of the Decision
Authors: McCaffery Kirsten , Irwig Les , Bossuyt Patrick
Published: September 2007

Decision aids (DAs) are tools to support patients make informed health decisions with their practitioner. They aim to improve patient knowledge of options, incorporate patient preferences and values, and increase patient involvement in health decision making. Increasingly, the debate about DAs concerns how they should be implemented in practice, with the view that DAs are superior to usual clinical care in facilitating health decisions. The authors challenge this view and suggest that DA research has focused on measures of decision process, leaving the effects on the outcome of the decision relatively unknown. It is still unclear in which conditions DAs are better for patient health and well-being than clinician-led decisions. The authors present a new randomized design to examine the effects of DA-supported patient choice on patient-centered outcomes to identify where DAs are best implemented in clinical practice. In this design, patients are randomized to 1 of 4 arms: intervention A, intervention B, choice of either intervention supported by a clinician, or choice of either intervention supported by a decision aid. Health and quality of life measured over the long term are presented as the primary outcomes. The authors propose that this design will allow the proper assessment of different modes of decision making.
Communication and Decision Making in Cancer Care: Setting Research Priorities for Decision Support/Patients' Decision Aids
Authors: Barnato Amber E. , Llewellyn-Thomas Hilary A. , Peters Ellen M. , Siminoff Laura , Collins E. Dale , Barry Michael J.
Published: September 2007

The following is a summary report from a special symposium titled, `Translating Research into Practice: Setting a Research Agenda for Clinical Decision Tools in Cancer Prevention, Early Detection, and Treatment,` that was held on 23 October 2005 in San Francisco at the Annual Meeting of the Society for Medical Decision Making (SMDM). The symposium was designed to answer the question: `What are the top 2 research priorities in the field of patients' cancer-related decision aids?` After introductory remarks by Dr. Barry, each of four panelists-Drs. Hilary Llewellyn-Thomas, Ellen Peters, Laura Siminoff, and Dale Collins-addressed the question and provided their rationale during prepared remarks. The moderator, Dr. Michael Barry, then facilitated a discussion between the panelists, with input from the audience, to further explore and add to the various proposed research questions. Finally, Dr. Amber Barnato conducted a simple vote count (see Table 1) to prioritize the panelists' and the audience's recommendations.
Communicating the Uncertainty of Harms and Benefits of Medical Interventions
Authors: Politi Mary C. , Han Paul K. J. , Col Nananda F.
Published: September 2007

Background. There is growing interest in shared medical decision making among patients, physicians, and policy makers. This requires patients to interpret increasing amounts of medical information, much of which is uncertain. Little is known about the optimal approaches to or outcomes of communicating uncertainty about the risks and benefits of treatments. Methods. The authors reviewed the literature on various issues related to uncertainty in decision making: conceptualizing uncertainty, identifying its potential sources, assessing uncertainty, potential methods of communicating uncertainty, potential outcomes of communicating uncertainty, and current practices and recommendations by expert groups on communicating uncertainty. Results. There are multiple sources of uncertainty in most medical decisions. There are conceptual differences in how researchers define uncertainty and its sources, as well as in its measurement. The few studies that have assessed alternate means of communicating uncertainty dealt mostly with presenting uncertainty about probabilities. Both patients' and physicians' interpretation of and responses to uncertainty may depend on their personal characteristics and values and may be affected by the manner in which uncertainty is communicated. Conclusions. Research has not yet identified best practices for communicating uncertainty to patients about harms and benefits of treatment. More conceptual, qualitative, and quantitative studies are needed to explore fundamental questions about how people process, interpret, and respond to various types of uncertainty inherent in clinical decisions.
Numeric, Verbal, and Visual Formats of Conveying Health Risks: Suggested Best Practices and Future Recommendations
Authors: Lipkus Isaac M.
Published: September 2007

Perception of health risk can affect medical decisions and health behavior change. Yet the concept of risk is a difficult one for the public to grasp. Whether perceptions of risk affect decisions and behaviors often relies on how messages of risk magnitudes (i.e., likelihood) are conveyed. Based on expert opinion, this article offers, when possible, best practices for conveying magnitude of health risks using numeric, verbal, and visual formats. This expert opinion is based on existing empirical evidence, review of papers and books, and consultations with experts in risk communication. This article also discusses formats to use pertaining to unique risk communication challenges (e.g., conveying small-probability events, interactions). Several recommendations are suggested for enhancing precision in perception of risk by presenting risk magnitudes numerically and visually. Overall, there are little data to suggest best practices for verbal communication of risk magnitudes. Across the 3 formats, few overall recommendations could be suggested because of 1) lack of consistency in testing formats using the same outcomes in the domain of interest, 2) lack of critical tests using randomized controlled studies pitting formats against one another, and 3) lack of theoretical progress detailing and testing mechanisms why one format should be more efficacious in a specific context to affect risk magnitudes than others. Areas of future research are provided that it is hoped will help illuminate future best practices.
Are Patient Decision Aids the Best Way to Improve Clinical Decision Making? Report of the IPDAS Symposium
Authors: Holmes-Rovner Margaret , Nelson Wendy L. , Pignone Michael , Elwyn Glyn , Rovner David R. , O'Connor Annette M. , Coulter Angela , Correa-de-Araujo Rosaly
Published: September 2007

This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that ``decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.
Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis
Authors: O'Connor Annette M. , Stacey Dawn , Barry Michael J. , Col Nananda F. , Eden Karen B. , Entwistle Vikki , Fiset Valerie , Holmes-Rovner Margaret , Khangura Sara , Llewellyn-Thomas Hilary , Rovner David R.
Published: September 2007

Objective. To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS). Data sources. Five electronic databases (to July 2006) and personal contacts (to December 2006). Results. Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = —8.4, 95% CI = —11.9 to —4.8; unclear values WMD = —6.3, 95% CI = —10.0 to —2.7). There was no difference in process measures when detailed and simple PtDAs were compared. Conclusions. PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.
Comparison of the Split Stacked versus the Split Achilles Allograft for Dual Femoral Tunnel Posterior Cruciate Ligament Reconstruction
Authors: DeBerardino Thomas M. , Lonergan Keith T. , Brooks Daniel E.
Published: September 2007

Background

Cadaveric testing has shown that double-bundle reconstruction better replicates the native anatomy of the posterior cruciate ligament. With the current trend toward allograft Achilles posterior cruciate ligament reconstructions, the need to determine a graft configuration with the highest tensile and pull-out strength has become paramount.

Hypothesis

The split stacked Achilles allograft construct provides greater graft material to traverse the notch and provides increased load to failure at the tibial point of fixation compared with a standard monoblock Achilles allograft construct.

Study Design

Controlled laboratory study.

Methods

Eight matched pairs of Achilles allograft tendons were secured to 8 matched pairs of fresh-frozen human cadaveric tibiae. Group 1 consisted of single-block grafts (n = 8), and group 2 included the split stacked grafts (n = 8). The cross-sectional area of each graft's 2 collagenous bundles was measured with a micrometer. The graft constructs were pulled to ultimate failure at a rate of 50 mm/min on a materials testing machine.

Results

The mean cross-sectional area of the group 2 split stacked grafts (76.6 ± 3.1 mm2) was significantly greater than that of the group 1 single-block grafts (48.2 ± 3.0 mm2; P = .00006). The maximum load to failure of the group 2 construct was significantly greater (1383 ± 102 N) than that of the group 1 single-block configuration (1020 ± 136 N; P = .01).

Conclusion

These results indicate that the novel split stacked configuration of an Achilles tendon allograft provides a greater cross-sectional area of graft material across the joint as well as a significant increase in the overall load to failure strength compared with a standard monoblock Achilles allograft construct.

Clinical Relevance

The split stacked Achilles graft is an efficient method for using the entire allograft. With maintenance and use of all collagen fibers, the split stacked Achilles construct provides essentially 2 grafts in 1 while only using a single tibial tunnel.
The International Knee Documentation Committee Subjective Evaluation Form in a Preadolescent Population
Authors: Slobogean Gerard P. , Mulpuri Kishore , Reilly Christopher W.
Published: September 2007

Background

The International Knee Documentation Committee Subjective Knee Evaluation Form is a knee-specific instrument composed of 18 questions. It is commonly used in adult and pediatric studies as a surgical outcome measure. Normative data exist for an adult population, but there have been no published normative results for younger subjects.

Purpose

To compile and report pilot normative International Knee Documentation Committee Subjective Knee Evaluation Form scores in a preadolescent population.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

The International Knee Documentation Committee Subjective Knee Evaluation Form was administered to 146 seventh-grade students (aged 12–14 years) at 2 local schools. The form was administered in its original format. Demographic and descriptive results were compiled.

Results

One hundred twenty-five completed responses were eligible for analysis. The mean age was 13.2 years (SD, 0.5; range, 12.2–14.2 years); 15% of participants had a history of knee injury or pain. The mean International Knee Documentation Committee score for all respondents was 89.4 (SD, 10.5; 95% confidence interval, 87.6–91.3; range, 52–100).

Conclusion

This study provides pilot normative data for mean International Knee Documentation Committee scores in a preadolescent population. The mean score in this younger cohort is consistent with normative data of adults age 35 years or younger. Although the International Knee Documentation Committee Subjective Knee Evaluation Form is often used in adolescent surgical studies, its validity in these populations remains to be established. Further work to establish the psychometric properties of the current form in younger age groups would be of significant benefit to clinicians.
Lymphadenopathy—An Important Guiding Tool for Detecting Hidden HIV-Positive Cases: A 6-Year Study
Authors: Gill P.S. , Arora D.R. , Arora B. , Gill Meenu , Gautam Vikas , Karan Jai , Chaudhary Uma , Garg Nidhi
Published: September 2007

Lymphadenopathy is one of the leading and persistent signs during the progression of human immunodeficiency virus (HIV) infection. Lymphadenopathy, as a clinical sign, can become one of the important guiding tools for detecting hidden HIV-positive cases. The present study was conducted to assess the incidence of HIV positivity in previously undiagnosed patients of HIV presenting with lymphadenopathy, comparing it with the current trends of HIV infection in the community, and to ascertain the etiology of lymphadenopathy in HIV-positive and HIV-negative cases. Over a period of 6 years, a total of 1082 cases of extra-inguinal lymphadenopathy were screened for HIV infection. Simultaneously, fine needle aspiration cytology of the enlarged lymph nodes was performed to know the etiology. The incidence of HIV positivity was found to be 2.3% among the patients presenting with lymphadenopathy. Among the HIV-positive cases, tuberculous lymphadenopathy was found in 60% of cases as compared to 28% of cases in HIV-negative cases. Alarmingly high incidence of HIV infection among the lymphadenopathy cases has been observed. This necessitates the importance of exercising vigilance, caution, and a high degree of suspicion while dealing with patients of lymphadenopathy, to protect ourselves as well as a much larger population at risk from this scourge.
A Prospective Study of Adherence and Virologic Failure in HIV-Infected Patients: Role of a Single Determination of Plasma Levels of Antiretroviral Medications
Authors: Cuevas González María J. , Valín Luis Ortega , Pérez-Simón María del Rosario , Mostaza Fernández José Luis , Alcoba Leza Manuel , Sánchez Vicente Martin ,   the HAART Adherence Working Group of the Province of Léon, Spain
Published: September 2007

This study explores the contribution of a single determination of plasma levels for measuring adherence by means of forecasting virologic failure. Adherence was measured by questionnaires, punctuality at appointments to withdraw drugs, and plasma levels. Virologic failure was considered when 2 detectable consecutive viral loads were observed in 2 consecutive determinations with at least 1 month between them. Univariant analysis, logistic regression, and receiver operating characteristic curves were carried out. In 29 cases, virologic failure was observed. The lowest incidence was found in patients considered adherent by plasma levels and highest in those who declared nonfulfillment. The combination of methods increased the association of the incidence of virologic failure with nonadherence. The use of questionnaires plus pharmacy information implies a gain in sensitivity and a slight loss of specificity. There is a high incidence of virologic failure in these patients and a strong link with their classification as nonadherent with methods such as questionnaires and pharmacy collection information. Plasma levels do not contribute much to the prediction of virologic failure.
Men Who Have Sex With Men and Recruit Bareback Sex Partners on the Internet: Implications for STI and HIV Prevention and Client Education
Authors: Blackwell Christopher W.
Published: September 2007

Men who have sex with men (MSM) frequently use Internet-based Web sites to recruit sex partners. Although many MSM users of such sites advocate for safe sex practices in their personal profiles, some users actively recruit sexual partners who wish to participate in anal sexual intercourse without the use of condoms, also known as “bareback” sex. Participating in this sexual practice places both sexual partners at higher risk of HIV transmission. In addition, data indicate this behavior is associated with other high-risk activities such as drug use and communication of other sexually transmitted infections. This article summarizes the literature assessing this phenomenon on the Internet. Specific recommendations are provided for clinicians, health educators, and researchers.
Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences
Authors: Sorror Mohamed L. , Giralt Sergio , Sandmaier Brenda M. , De Lima Marcos , Shahjahan Munir , Maloney David G. , Deeg H. Joachim , Appelbaum Frederick R. , Storer Barry , Storb Rainer
Published: September 2007

A new hematopoietic cell transplantation–specific comorbidity index (HCT-CI) was effective in predicting outcomes among patients with hematologic malignancies who underwent HCT at Fred Hutchinson Cancer Research Center (FHCRC). Here, we compared the performance of the HCT-CI to 2 other indices and then tested its capacity to predict outcomes among 2 cohorts of patients diagnosed with a single disease entity, acute myeloid leukemia in first complete remission, who underwent transplantation at either FHCRC or M. D. Anderson Cancer Center (MDACC). FHCRC patients less frequently had unfavorable cytogenetics (15% versus 36%) and HCT-CI scores of 3 or more (21% versus 58%) compared with MDACC patients. We found that the HCT-CI had higher sensitivity and outcome predictability compared with the other indices among both cohorts. HCT-CI scores of 0, 1 to 2, and 3 or more predicted comparable nonrelapse mortality (NRM) among FHCRC and MDACC patients. In multivariate models, HCT-CI scores were associated with the highest hazard ratios (HRS) for NRM and survival among each cohort. The 2-year survival rates among FHCRC and MDACC patients were 71% versus 56%, respectively. After adjustment for risk factors, including HCT-CI scores, no difference in survival was detected (HR: 0.98, P = .94). The HCT-CI is a sensitive and informative tool for comparing trial results at different institutions. Inclusion of comorbidity data in HCT trials provides valuable, independent information.
ChIP on SNP-chip for genome-wide analysis of human histone H4 hyperacetylation
Authors: McCann Jennifer A , Muro Enrique M , Palmer Claire , Palidwor Gareth , Porter Christopher J , Andrade-Navarro Miguel A , Rudnicki Michael A
Published: September 2007

Background

SNP microarrays are designed to genotype Single Nucleotide Polymorphisms (SNPs). These microarrays report hybridization of DNA fragments and therefore can be used for the purpose of detecting genomic fragments.

Results

Here, we demonstrate that a SNP microarray can be effectively used in this way to perform chromatin immunoprecipitation (ChIP) on chip as an alternative to tiling microarrays. We illustrate this novel application by mapping whole genome histone H4 hyperacetylation in human myoblasts and myotubes. We detect clusters of hyperacetylated histone H4, often spanning across up to 300 kilobases of genomic sequence. Using complementary genome-wide analyses of gene expression by DNA microarray we demonstrate that these clusters of hyperacetylated histone H4 tend to be associated with expressed genes.

Conclusion

The use of a SNP array for a ChIP-on-chip application (ChIP on SNP-chip) will be of great value to laboratories whose interest is the determination of general rules regarding the relationship of specific chromatin modifications to transcriptional status throughout the genome and to examine the asymmetric modification of chromatin at heterozygous loci.
Adaptive expression responses in the Pol-γ null strain of S. pombe depleted of mitochondrial genome
Authors: Chu Zhaoqing , Li Juntao , Eshaghi Majid , Karuturi R Krishna Murthy , Lin Kui , Liu Jianhua
Published: September 2007

Background

DNA polymerase γ(Pol-γ) has been shown to be essential for maintenance of the mitochondrial genome (mtDNA) in the petite-positive budding yeast Saccharomyces cerevisiae. Budding yeast cells lacking mitochondria exhibit a slow-growing or petite-colony phenotype. Petite strains fail to grow on non-fermentable carbon sources. However, it is not clear whether the Pol-γ is required for mtDNA maintenance in the petite-negative fission yeast Schizosaccharomyces pombe.

Results

We show that disruption of the nuclear gene pog1
+ that encodes Pol-γ is sufficient to deplete mtDNA in S. pombe. Cells bearing pog1Δ allele require substantial growth periods to form petite colonies. Mitotracker assays indicate that pog1Δ cells are defective in mitochondrial function and EM analyses suggest that pog1Δ cells lack normal mitochondrial structures. Depletion of mtDNA in pog1Δ cells is evident from quantitative real-time PCR assays. Genome-wide expression profiles of pog1Δ and other mtDNA-less cells reveal that many genes involved in response to stimulus, energy derivation by oxidation of organic compounds, cellular carbohydrate metabolism, and energy reserve metabolism are induced. Conversely, many genes encoding proteins involved in amino acid metabolism and oxidative phosphorylation are repressed.

Conclusion

By showing that Pol-γ is essential for mtDNA maintenance and disruption of pog1
+ alters the genome-wide expression profiles, we demonstrated that cells lacking mtDNA exhibit adaptive nuclear gene expression responses in the petite-negative S. pombe.
The nicotinic acetylcholine receptor gene family of the silkworm, Bombyx mori
Authors: Shao Ya-Ming , Dong Ke , Zhang Chuan-Xi
Published: September 2007

Background

Nicotinic acetylcholine receptors (nAChRs) mediate fast synaptic cholinergic transmission in the insect central nervous system. The insect nAChR is the molecular target of a class of insecticides, neonicotinoids. Like mammalian nAChRs, insect nAChRs are considered to be made up of five subunits, coded by homologous genes belonging to the same family. The nAChR subunit genes of Drosophila melanogaster, Apis mellifera and Anopheles gambiae have been cloned previously based on their genome sequences. The silkworm Bombyx mori is a model insect of Lepidoptera, among which are many agricultural pests. Identification and characterization of B. mori nAChR genes could provide valuable basic information for this important family of receptor genes and for the study of the molecular mechanisms of neonicotinoid action and resistance.

Results

We searched the genome sequence database of B. mori with the fruit fly and honeybee nAChRs by tBlastn and cloned all putative silkworm nAChR cDNAs by reverse transcriptase-polymerase chain reaction (RT-PCR) and rapid amplification of cDNA ends (RACE) methods. B. mori appears to have the largest known insect nAChR gene family to date, including nine α-type subunits and three β-type subunits. The silkworm possesses three genes having low identity with others, including one α and two β subunits, α9, β2 and β3. Like the fruit fly and honeybee counterparts, silkworm nAChR gene α6 has RNA-editing sites, and α4, α6 and α8 undergo alternative splicing. In particular, alternative exon 7 of Bmα8 may have arisen from a recent duplication event. Truncated transcripts were found for Bmα4 and Bmα5.

Conclusion

B. mori possesses a largest known insect nAChR gene family characterized to date, including nine α-type subunits and three β-type subunits. RNA-editing, alternative splicing and truncated transcripts were found in several subunit genes, which might enhance the diversity of the gene family.
Measurement error adjustment in essential fatty acid intake from a food frequency questionnaire: alternative approaches and methods
Authors: Beydoun May A , Kaufman Jay S , Ibrahim Joseph , Satia Jessie A , Heiss Gerardo
Published: September 2007

Background

We aimed at assessing the degree of measurement error in essential fatty acid intakes from a food frequency questionnaire and the impact of correcting for such an error on precision and bias of odds ratios in logistic models. To assess these impacts, and for illustrative purposes, alternative approaches and methods were used with the binary outcome of cognitive decline in verbal fluency.

Methods

Using the Atherosclerosis Risk in Communities (ARIC) study, we conducted a sensitivity analysis. The error-prone exposure – visit 1 fatty acid intake (1987–89) – was available for 7,814 subjects 50 years or older at baseline with complete data on cognitive decline between visits 2 (1990–92) and 4 (1996–98). Our binary outcome of interest was clinically significant decline in verbal fluency. Point estimates and 95% confidence intervals were compared between naïve and measurement-error adjusted odds ratios of decline with every SD increase in fatty acid intake as % of energy. Two approaches were explored for adjustment: (A) External validation against biomarkers (plasma fatty acids in cholesteryl esters and phospholipids) and (B) Internal repeat measurements at visits 2 and 3. The main difference between the two is that Approach B makes a stronger assumption regarding lack of error correlations in the structural model. Additionally, we compared results from regression calibration (RCAL) to those from simulation extrapolation (SIMEX). Finally, using structural equations modeling, we estimated attenuation factors associated with each dietary exposure to assess degree of measurement error in a bivariate scenario for regression calibration of logistic regression model.

Results and conclusion

Attenuation factors for Approach A were smaller than B, suggesting a larger amount of measurement error in the dietary exposure. Replicate measures (Approach B) unlike concentration biomarkers (Approach A) may lead to imprecise odds ratios due to larger standard errors. Using SIMEX rather than RCAL models tends to preserve precision of odds ratios. We found in many cases that bias in naïve odds ratios was towards the null. RCAL tended to correct for a larger amount of effect bias than SIMEX, particularly for Approach A.
Brief Intervention in Type 1 diabetes – Education for Self-efficacy (BITES): Protocol for a randomised control trial to assess biophysical and psychological effectiveness
Authors: George Jyothis T , Valdovinos Abel Peña , Thow Jonathan C , Russell Ian , Dromgoole Paul , Lomax Sarah , Torgerson David J , Wells Tony
Published: September 2007

Background

Self management is the cornerstone of effective preventive care in diabetes. Educational interventions that provide self-management skills for people with diabetes have been shown to reduce blood glucose concentrations. This in turn has the potential to reduce rates of complications. However, evidence to support type, quantity, setting and mode of delivery of self-management education is sparse.

Objectives: To study the biophysical and psychological effectiveness of a brief psycho-educational intervention for type 1 diabetes in adults.

Methods/Design

Design: Randomised controlled clinical trial.

Setting: Multidisciplinary specialist diabetes centre.

Hypothesis: Our hypothesis was that the brief (2.5-day) intervention would be biophysically and psychologically effective for people with type 1 diabetes.

Intervention: A brief psycho-educational intervention for type 1 diabetes developed by a multi-professional team comprising of a consultant diabetologist, a diabetes specialist nurse, a specialist diabetes dietician and a clinical health psychologist and delivered in 20 hours over 2.5 days.

Primary outcomes: HbA1c and severe hypoglycaemia.

Secondary outcomes: Blood pressure, weight, height, lipid profile and composite psychometric scales.

Participants: We shall consent and recruit 120 subjects with postal invitations sent to eligible participants. Volunteers are to be seen at randomisation clinics where independent researcher verify eligibility and obtain consent. We shall randomise 60 to BITES and 60 to standard care.

Eligibility Criteria: Type 1 diabetes for longer than 12 months, multiple injection therapy for at least two months, minimum age of 18 and ability to read and write.

Randomisation: An independent evaluator to block randomise (block-size = 6), to intervention or control groups using sealed envelopes in strict ascendant order. Control group will receive standard care.

Assessment: Participants in both groups would attend unblinded assessments at baseline, 3, 6 and 12 months, in addition to their usual care. After the intervention, usual care would be provided.

Ethics approval: York Research Ethics Committee (Ref: 01/08/016) approved the study protocol.

Discussion

We hope the trial will demonstrate feasibility of a pragmatic randomised trial of BITES and help quantify therapeutic effect. A follow up multi-centre trial powered to detect this effect could provide further evidence.

Trial registration

Current Controlled Trials ISRCTN75807800
Comparison of three molecular methods for the detection and speciation of Plasmodium vivax and Plasmodium falciparum
Authors: Boonma Prapaporn , Christensen Peter R , Suwanarusk Rossarin , Price Ric N , Russell Bruce , Lek-Uthai Usa
Published: September 2007

Background

Accurate diagnosis ofPlasmodiumspp. is essential for the rational treatment of malaria. Despite its many disadvantages, microscopic examination of blood smears remains the current "gold standard" for malaria detection and speciation. PCR assays offer an alternative to microscopy which has been shown to have superior sensitivity and specificity. Unfortunately few comparative studies have been done on the various molecular based speciation methods.

Methods

The sensitivity, specificity and cost effectiveness of three molecular techniques were compared for the detection and speciation ofPlasmodium falciparumandPlasmodium vivaxfrom dried blood spots collected from 136 patients in western Thailand. The results from the three molecular speciation techniques (nested PCR, multiplex PCR, and real-time PCR) were used to develop a molecular consensus (two or more identical PCR results) as an alternative gold standard.

Results

According to the molecular consensus, 9.6% (13/136) of microscopic diagnoses yielded false negative results. Multiplex PCR failed to detectP. vivaxin three mixed isolates, and the nested PCR gave a false positiveP. falciparumresult in one case. Although the real-time PCR melting curve analysis was the most expensive method, it was 100% sensitive and specific and least time consuming of the three molecular techniques investigated.

Conclusion

Although microscopy remains the most appropriate method for clinical diagnosis in a field setting, its use as a gold standard may result in apparent false positive results by superior techniques. Future studies should consider using more than one established molecular methods as a new gold standard to assess novel malaria diagnostic kits and PCR assays.
Characterization of heterotypic interaction effects in vitro to deconvolute global gene expression profiles in cancer
Authors: Buess Martin , Nuyten Dimitry SA , Hastie Trevor , Nielsen Torsten , Pesich Robert , Brown Patrick O
Published: September 2007

Background

Perturbations in cell-cell interactions are a key feature of cancer. However, little is known about the systematic effects of cell-cell interaction on global gene expression in cancer.

Results

We used an ex vivo model to simulate tumor-stroma interaction by systematically co-cultivating breast cancer cells with stromal fibroblasts and determined associated gene expression changes with cDNA microarrays. In the complex picture of epithelial-mesenchymal interaction effects, a prominent characteristic was an induction of interferon-response genes (IRGs) in a subset of cancer cells. In close proximity to these cancer cells, the fibroblasts secreted type I interferons, which, in turn, induced expression of the IRGs in the tumor cells. Paralleling this model, immunohistochemical analysis of human breast cancer tissues showed that STAT1, the key transcriptional activator of the IRGs, and itself an IRG, was expressed in a subset of the cancers, with a striking pattern of elevated expression in the cancer cells in close proximity to the stroma. In vivo, expression of the IRGs was remarkably coherent, providing a basis for segregation of 295 early-stage breast cancers into two groups. Tumors with high compared to low expression levels of IRGs were associated with significantly shorter overall survival; 59% versus 80% at 10 years (log-rank p = 0.001).

Conclusion

In an effort to deconvolute global gene expression profiles of breast cancer by systematic characterization of heterotypic interaction effects in vitro, we found that an interaction between some breast cancer cells and stromal fibroblasts can induce an interferon-response, and that this response may be associated with a greater propensity for tumor progression.
InSite: a computational method for identifying protein-protein interaction binding sites on a proteome-wide scale
Authors: Wang Haidong , Segal Eran , Ben-Hur Asa , Li Qian-Ru , Vidal Marc , Koller Daphne
Published: September 2007

We propose InSite, a computational method that integrates high-throughput protein and sequence data to infer the specific binding regions of interacting protein pairs. We compared our predictions with binding sites in Protein Data Bank and found significantly more binding events occur at sites we predicted. Several regions containing disease-causing mutations or cancer polymorphisms in human are predicted to be binding for protein pairs related to the disease, which suggests novel mechanistic hypotheses for several diseases.
Regio-controlled Oxidative Polymerization of 2,5-Dimethylphenol by Using CuCl–TMEDA Complex
Authors: Suzuki Yasuo , Shibasaki Yuji , Ueda Mitsuru
Published: September 2007

A regio-controlled poly(2,5-dimethyl-1,4-phenylene ether) was successfully prepared by the oxidative coupling polymerization of 2,5-dimethylphenol using di-μ-hydroxobis[(N,N,N′,N′-tetramethylethylenediamine) copper(II)] as a catalyst under oxygen. The catalyst effectively promoted the regio-controlled polymerization even at the concentration of 0.1 mol % to the monomer, and the resulting polymer showed a melting temperature at 280 °C.
"The English Disease" or "Asian Rickets"? Medical Responses to Postcolonial Immigration
Authors: Bivins Roberta E.
Published: September 2007

Do the former colonizing powers, like their former colonies, have "postcolonial medicine," and if so, where does it take place, who practices it, and upon whom? How has British medicine in particular responded to the huge cultural shifts represented by the rise of the New Commonwealth and associated postcolonial immigration? I address these questions through a case study of the medical and political responses to vitamin D deficiency among Britain's South Asian communities since the 1960s. My research suggests that in these contexts, diet frequently became a proxy or shorthand for culture (and religion, and race), while disease justified pressure to assimilate.
Teamwork, Clinical Research, and the Development of Scientific Medicines in Interwar Britain: The "Glasgow School" Revisited
Authors: Hull Andrew
Published: September 2007

This article argues that historians of medicine have, until very recently, misinterpreted the relationship of "science" and "the clinic" in the early twentieth century. It follows recent historiographic developments in focusing on the relationship in practice as exemplified by the development of a specific variety of collaborative clinical research using laboratory methods, ca. 1919–37, in a major British medical school. It suggests that it is such working hybrids that should be studied in order to understand fully the development of scientific medicines in the United Kingdom in this period. In Glasgow, it was the local medical culture's characteristic local subservience to clinical priorities that facilitated, in a particular kind of academic unit, a certain type of hierarchical teamwork between clinicians and laboratory workers; the paper reveals how and why this teamwork became, over time, more of an equal partnership.
Healthcare Reconsidered: Forging Community Wellness among African Americans in the South
Authors: Nelson Jennifer
Published: September 2007

This article details the history of Slossfield Hospital, an African American hospital and community center founded in Birmingham, Alabama, in 1937. During its New Deal–era existence it provided African American physicians institutional support for their medical practices. Additionally, as a community center, it addressed the socioeconomics of good health. This paper uses Slossfield as a case study to explore how some African Americans included the socioeconomic in their definition of public health during the New Deal, as well as to understand how these ideas were subsumed by more mainstream ideas about public health promulgated by black and white physicians and the local and federal governments.
Erwin H. Ackerknecht, Social Medicine, and the History of Medicine
Authors: Rosenberg Charles E
Published: September 2007

Erwin H. Ackerknecht was an influential member of that small group of largely émigré historians of medicine who professionalized their field in the United States. Ackerknecht was influenced by both contemporary social science and an implicitly political vision of social medicine. It was a vision reinforced by his work in social anthropology in Paris in the 1930s, and it is a tradition that has its own intellectual pedigree, one that can be traced back to the era of Rudolf Virchow. It was no accident that Ackerknecht wrote on the social and ecological dimensions of disease, and that he was a vigorous advocate of a powerfully felt but, in retrospect, inconsistent relativism. His emphases on everyday medical practice and on siting ideas in their social and institutional context seem prescient, a forerunner of contemporary trends in social and cultural history.
Is Classical Electrodynamics an Inconsistent Theory?
Authors: Belot Gordon
Published: September 2007

Classical Electrodynamics is a classical theory treating Systems comprising an electromagnetic field and electrically charged matter. In a recent book Mathias Frisch argues that this theory is inconsistent within its intended domain of application and that a number of interesting methodological morals follow from this conclusion (2005,33-5; all citations of Frisch refer to this work).
Material Points and Formal Concepts in the Early Wittgenstein
Authors: Blank Andreas
Published: September 2007

In an influential article, Gerd Grasshoff has argued for the identification of the objects in Wittgenstein's Tractatus with the ultimate constituents of reality in Heinrich Hertz's Principles of Mechanics. Grasshoff's interpretation is based on two interrelated claims: (1) The specific determination of the objects in the world and the relation among them is the primary theme in Wittgenstein's early philosophy, because it is the primary theme for Hertz. (2) Wittgenstein did not assume the existence of simple objects on purely logical grounds without having specific examples of simple objects in mind, because Hertz did not do this.
Forgery and the Corruption of Aesthetic Understanding
Authors: Irvin Sherri
Published: September 2007

In 1968, Nelson Goodman made an observation about artistic forgery that has never been fully appreciated, though his discussion of forgery has received plenty of philosophical attention. Goodman describes the case in which you, the viewer, are confronted with an original work and a forgery that is, for you, perceptually indistinguishable from it. On the basis of lab tests, you know which of the works is forged, but you can see no difference between them. Nonetheless, Goodman says, the knowledge that one of them is forged makes for an aesthetic difference between the works, for you, now. One reason is that this knowledge changes the way you look at the works, and the way you should look at them; it alters the sorts of scrutiny it is appropriate to apply. In fact, knowledge that one of the works is forged ‘assigns the present looking a role as training toward … perceptual discrimination’ (Goodman, 1976,105).
Equality and Proportionality
Authors: Knapp Christopher
Published: September 2007

The idea that all people are moral equals enjoys broad support. Practically speaking, there is no doubt that this is a great moral victory. Inegalitarian views are often morally arbitrary, and many have been used to support self-serving and deeply harmful actions and policies. Coming, as it does, on the heels of ideas of racial, ethnic, religious, and gender-based superiority, there is no question that the world is a far better place for our commitment to the idea that all (normal adult) humans deserve to be shown equal moral respect or concern.
More Bad Newsfor the Logical Autonomy of Ethics
Authors: Nelson Mark T.
Published: September 2007

Since the time of Hume, many philosophers have thought it impossible to deduce an ‘Ought’ from an ‘Is,’ or in general to deduce ‘ethical sentences’ from purely ‘factual sentences.’ Some of these philosophers claim that this is due, not to any Special feature of ethics, but to a general feature of logic, namely, its conservativeness:

A conclusion containing an ‘ought’ cannot (as a matter of logic) be derived from ‘ought’-free premises. (The same, of course, goes for the other moral words.) Logic is conservative; the conclusions of a valid inference are contained within the premises. You don't get out what you haven't put in. Hence if ‘ought’ appears in the conclusion of an argument but not in the premises, the inference is not logically valid.’
Determinables, Determinates, and Causal Relevance
Authors: Walter Sven
Published: September 2007

Mental causation, our mind's ability to causally affect the course of the world, is part and parcel of our ‘manifest image’ of the world. That there is mental causation is denied by virtually no one. How there can be such a thing as mental causation, however, is far from obvious. In recent years, discussions about the problem of mental causation have focused on Jaegwon Kim's so-called Causal Exclusion Argument, according to which mental events are ‘screened off’ or ‘preempted’ by physical events unless mental causation is a genuine case of overdetermination or mental properties are straightforwardly reducible to physical properties.
Commentary
Authors: Borza Eugene N
Published: September 2007

This paper not only provides a commentary on the papers of the other panelists but also raises questions about the appropriate pedagogy employed in teaching modern university students. Intensive source criticism is a means of training students to assess evidence on a microcosmic scale, thereby determining the validity of ancient evidence about what happened in antiquity. Countering that approach is the study of larger historical issues—such as the impact of Alexander's conquests on the history of Europe and Asia—or the development of analogies between ancient and modern warfare in the Middle East. These pedagogical techniques are not mutually exclusive.