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Abstract: Laughter is employed in social interaction to construct meaning, identities, and relationships. Although studies have begun to examine humour within the medical workplace, none have employed observational methods to study laughables/laughter within the learning triad of the bedside teaching encounter (BTE). This paper focuses on this gap by exploring the novel question: How do students, patients, and doctors construct and co-construct power, identity and gender through laughter within BTEs? In this paper, we focus on the disaffiliative function of laughables/laughter across BTEs. Most of the laughables presented can be construed as teases: fallibility, frustration, cynicism and/or sexual teasing; and this teasing was accompanied by a competitive rather than collaborative play frame. Teasing and laughter was employed by participants to maintain or subvert existing power asymmetries, to construct identities, for example, as individuals who are intelligent, witty and powerful, and to construct gender by performing masculinity or femininity. Further research with a larger and more diverse sample of participants (including more female doctors, male students and female patients) is now essential to explore more fully the co-construction of power, identities and gender through laughter within medical workplace learning encounters. [ABSTRACT FROM AUTHOR]

This paper studies the attitude of the society towards the medical profession, which was torn between high social expectations and ideals and medical practice confronted with real-life obstacles. In the 19th century, the physician's position was still precarious and called for a renegotiation in the community. Physician's work was faced with people's distrust and resistance, superstitions and prejudices, folk medicine and religion. Even such ideal qualities as dignity, conscientiousness, and courage, would quickly be called into question by events such as epidemics. Particularly in 19th century rural areas, the physician's position was far from acknowledged and official medicine had yet to win people's trust. This paper explores the polyvalent attitude of people towards medicine and health. It investigates the discourse used to describe health and medicine in daily press, professional and popular literature, as well as in official medical documents of the time. It shows a long struggle of public health care to gain people's approval. During cholera epidemics, which apart from presenting serious threat to human life were an opportunity for medicine to win people's trust and obedience, the attitude towards health gradually began to change. To some extent this was a result of medical advances, new scientific discoveries, and increasing success in abating the epidemics. At the same time, as the society became more secular, medicine slowly gained people's trust and gradually replaced the healing methods of folk medicine. Health was less and less understood as a result of God's will and mercy, and the attitude towards disease began to evolve from passive resignation to an active battle for health. [ABSTRACT FROM AUTHOR]

This paper examines the rise of an epistemic genre, the Observationes, a new form of medical writing that emerged in Renaissance humanistic medicine. The Observationes (collections of case-histories) originated in the second half of the sixteenth century, grew rapidly over the course of the seventeenth, and had become a primary form of medical writing by the eighteenth century. The genre developed initially as a form of self-advertisement by court and town physicians, who stressed success in practice, over and above academic learning, as a core element of their professional identity. This unprecedented emphasis on practice as a source of knowledge remained a key feature of the Observationes in its subsequent development. As the genre evolved, the original emphasis on therapeutic success gave way to a new focus on the descriptive knowledge of disease through detailed observation. The authorial identity projected by the writers of Observationes was increasingly that of the learned and experienced observer, bent on comparing notes and sharing his cases with the fellow members of the res publica medica. This paper charts the development of the genre, examining how its growth contributed to the new epistemological value of observation in the age of the Scientific Revolution. [ABSTRACT FROM AUTHOR]

In this paper, we investigate recent changes in the definition and approach to Alzheimer's disease brought about by growing clinical, therapeutic and regulatory interest in the prodromal or preclinical aspects of this condition. In the last decade, there has been an increased interest in the biomolecular and epidemiological characterization of pre-clinical dementia. It is argued that early diagnosis of dementia, and particularly of Alzheimer's disease, will facilitate the prevention of dementing processes and lower the prevalence of the condition in the general population. The search for a diagnostic category or biomarker that would serve this purpose is an ongoing but problematic endeavour for research and clinical communities in this area. In this paper, we explore how clinical and research actors, in collaboration with regulatory institutions and pharmaceutical companies, come to frame these domains as uncertainties and how they re-deploy uncertainty in the 'collective production' of new diagnostic conventions and bioclinical standards. While drawing as background on ethnographic, documentary and interview data, the paper proposes an in-depth, contextual analysis of the proceedings of an international meeting organized by the Peripheral and Central Nervous System Drug Advisory Committee of the US Food and Drug Administration to discuss whether or not a particular diagnostic convention — mild cognitive impairment — exists and how best it ought to be studied. Based on this analysis we argue that the deployment of uncertainty is reflexively implicated in bioclinical collectives' search for rules and conventions, and furthermore that the collective production of uncertainty is central to the 'knowledge machinery' of regulatory objectivity. [ABSTRACT FROM AUTHOR]

Can low-temperature plasma technology play a role in medicine? This is a question that many investigators today are trying hard to give a positive answer to. It did not quite start out this way. Almost two decades ago, few "curious" electrical engineers and physicists with the help of few "brave" biologists! microbiologists asked themselves more basic questions: What happens to biological cells if they were exposed to low-temperature plasma? Will they die? Will they survive? If they survive, will they come out the same or somehow "injured"? If injured, will they be able to repair the damage and recover? What kind of damage? Which plasma agent causes the damage? etc. As will be shown in this paper, some of these fundamental questions have been partially or fully answered, but until today, a complete picture has yet to emerge. This is good and not so good. It is good because if we already knew all the answers, we would not be looking forward to a more exciting research. It is not so good because after all these years, we are still quite a ways from an implementable medical application. In this review paper, the present state of knowledge regarding the effects of cold plasma on bacteria cells (prokaryotes) and on eukaryotic cells (such as mammalian cells) will be presented. As medical applications where low-temperature plasma is showing signs of success, blood coagulation and wound healing will be described. [ABSTRACT FROM AUTHOR]

This paper proposes a system, a meta-reasoner, to diagnose other systems. This system, called DSKE, performs its diagnosis based upon the knowledge of the structure of the system under diagnosis and based upon previous diagnostic experiences with that system. Since DSKE is based upon first order logic, it has strong deductive powers. Given adequate information, it can diagnose problems quite impressively. Contrary to probabilistic and fuzzy logic approaches, our system is not based upon data which may or may not be available, and which may or may not be reliable. Further, our system makes use of available knowledge. Contrary to model based diagnosis systems, our system can handle uncertainty and incomplete knowledge. The algorithm we provide yields a minimal diagnosis which covers all the abnormal behaviors detected. This paper provides a detailed description of DSKE. The inner workings of the system are carefully and comprehensively analyzed. Examples illustrate the advantages of our system, and demonstrate its use. [ABSTRACT FROM AUTHOR]

This purpose of this paper is to review the literature on racial/ethnic disparities in the utilization and quality of care and the proposed explanations for these differences. First, the literature on racial/ethnic disparities in medical treatment is reviewed briefly with the goal of providing a sense of the range of procedures and conditions on which these disparities occur. Then, the possible role of physician/provider, patient, and health care system factors in contributing to these disparities is reviewed. Finally, suggestions for new or expanded directions for research in each of these three areas are given. The goal of the paper is to identify factors that might be particularly amenable to the type of research done by health psychologists. [ABSTRACT FROM AUTHOR]

Background: This paper provides a summary of a Keynote lecture delivered at the 2009 Australasian Podiatry Conference. The aim of the paper is to review recent research that has adopted dynamic cadaver and invasive kinematics research approaches to better understand foot and ankle kinematics during gait. It is not intended to systematically cover all literature related to foot and ankle kinematics (such as research using surface mounted markers). Since the paper is based on a keynote presentation its focuses on the authors own experiences and work in the main, drawing on the work of others where appropriate Methods: Two approaches to the problem of accessing and measuring the kinematics of individual anatomical structures in the foot have been taken, (i) static and dynamic cadaver models, and (ii) invasive in-vivo research. Cadaver models offer the advantage that there is complete access to all the tissues of the foot, but the cadaver must be manipulated and loaded in a manner which replicates how the foot would have performed when in-vivo. The key value of invasive in-vivo foot kinematics research is the validity of the description of foot kinematics, but the key difficulty is how generalisable this data is to the wider population. Results: Through these techniques a great deal has been learnt. We better understand the valuable contribution mid and forefoot joints make to foot biomechanics, and how the ankle and subtalar joints can have almost comparable roles. Variation between people in foot kinematics is high and normal. This includes variation in how specific joints move and how combinations of joints move. The foot continues to demonstrate its flexibility in enabling us to get from A to B via a large number of different kinematic solutions. Conclusion: Rather than continue to apply a poorly founded model of foot type whose basis is to make all feet meet criteria for the mechanical 'ideal' or 'normal' foot, we should embrace variation between feet and identify it as an opportunity to develop patient-specific clinical models of foot function. [ABSTRACT FROM AUTHOR]

Despite incredible technological advancements in diagnostics and treatment, medicine remains the last significant paper-based industry in the United States. In fits and starts, the American healthcare system is transitioning from paper charts to electronic records. The ultimate goal is a nationwide health information network that includes a comprehensive, interoperable electronic medical record for each patient. The effective use of health information technology (HIT) in physician offices, hospitals, and even patients' homes promises to hold down rising healthcare costs and improve Americans' health. Unfortunately, no overarching national strategy has emerged for designing and implementing such a system. Though federal officials increasingly promote the use of HIT, state efforts have driven most government progress. This dual-track regulatory strategy carries significant risks of interstate redundancy and incompatibility. This Note argues that a national policy of state experimentation would mitigate these risks and best exploit HIT's considerable potential. Building on the ideas of democratic experimentalism, such a framework would encourage state innovation but require interstate collaboration and adherence to emerging standards in return. This Note's proposal would establish a forum for interstate collaboration, require state participation through a designated HIT coordinator, mandate information sharing among state and federal officials, and create a mechanism to rein in potentially disruptive state policies. In addition to offering a roadmap for the nation's HIT transition, this Note also provides a lens through which to view-and an opportunity to address-several criticisms of democratic experimentalist theory. [ABSTRACT FROM AUTHOR]

A challenge has recently been levelled against the legal and/or moral legitimacy of some advance directives. It has been argued that in certain cases an advance directive carries no weight in a decision on whether to withhold treatment, since the individual in the debilitating state is not the same person as the person who created the advance directive. In the first section of this paper, I examine two formulations of the argument against the moral legitimacy of the advance directives under review. The second section reviews, and criticizes, an objection to such arguments. In the penultimate section, possible models supporting the viability of the advance directives are considered. The final section makes good on an obligation incurred by the title of the paper. [ABSTRACT FROM AUTHOR]

This paper explores events surrounding the US Food and Drug Administration's formal approval of the heart failure drug BiDil in 2005. BiDil is the first drug ever to be approved with a race-specific indication, in this case to treat heart failure in 'self-identified black patients'. BiDil has been cast by many as a step toward the promised land of individualized pharmacogenomic therapies. This paper argues, however, that when examined in context, the approval of BiDil emerges as a new model of how a pharmaceutical company may exploit race in the marketplace by literally capitalizing on the racial identity of minority populations and leveraging the disproportionate risk of adverse health outcomes they suffer into a cheaper, more efficient way to gain the US Food and Drug Administration's approval for drugs. Discussions of BiDil in both popular media and professional journals have repeatedly elided the difference between pharmacogenomic and race-based medicine. In fact, broad-based true pharmacogenomic therapies remain years—perhaps decades—in the future. The story of BiDil's development elucidates an alternative model to developing tailored therapies that promises to fill in the gap between the promise and reality of pharmacogenomic medicine. It is a model that exploits race to gain regulatory and commercial advantage, while ignoring its power to promote a regeneticization of racial categories in society at large. [ABSTRACT FROM AUTHOR]

Summary: Objective: Medical data is often very high dimensional. Depending upon the use, some data dimensions might be more relevant than others. In processing medical data, choosing the optimal subset of features is such important, not only to reduce the processing cost but also to improve the usefulness of the model built from the selected data. This paper presents a data mining study of medical data with fuzzy modeling methods that use feature subsets selected by some indices/methods. Methods: Specifically, three fuzzy modeling methods including the fuzzy k-nearest neighbor algorithm, a fuzzy clustering-based modeling, and the adaptive network-based fuzzy inference system are employed. For feature selection, a total of 11 indices/methods are used. Medical data mined include the Wisconsin breast cancer dataset and the Pima Indians diabetes dataset. The classification accuracy and computational time are reported. To show how good the best performer is, the globally optimal was also found by carrying out an exhaustive testing of all possible combinations of feature subsets with three features. Results: For the Wisconsin breast cancer dataset, the best accuracy of 97.17% was obtained, which is only 0.25% lower than that was obtained by exhaustive testing. For the Pima Indians diabetes dataset, the best accuracy of 77.65% was obtained, which is only 0.13% lower than that obtained by exhaustive testing. Conclusion: This paper has shown that feature selection is important to mining medical data for reducing processing time and for increasing classification accuracy. However, not all combinations of feature selection and modeling methods are equally effective and the best combination is often data-dependent, as supported by the breast cancer and diabetes data analyzed in this paper. [Copyright &y& Elsevier]

Abstract: In these two companion papers, we provide an overview and a brief history of the multiple roots, current developments and recent advances of integrative systems biology and identify multiscale integration as its grand challenge. Then we introduce the fundamental principles and the successive steps that have been followed in the construction of the scale relativity theory, which aims at describing the effects of a non-differentiable and fractal (i.e., explicitly scale dependent) geometry of space–time. The first paper of this series was devoted, in this new framework, to the construction from first principles of scale laws of increasing complexity, and to the discussion of some tentative applications of these laws to biological systems. In this second review and perspective paper, we describe the effects induced by the internal fractal structures of trajectories on motion in standard space. Their main consequence is the transformation of classical dynamics into a generalized, quantum-like self-organized dynamics. A Schrödinger-type equation is derived as an integral of the geodesic equation in a fractal space. We then indicate how gauge fields can be constructed from a geometric re-interpretation of gauge transformations as scale transformations in fractal space–time. Finally, we introduce a new tentative development of the theory, in which quantum laws would hold also in scale space, introducing complexergy as a measure of organizational complexity. Initial possible applications of this extended framework to the processes of morphogenesis and the emergence of prokaryotic and eukaryotic cellular structures are discussed. Having founded elements of the evolutionary, developmental, biochemical and cellular theories on the first principles of scale relativity theory, we introduce proposals for the construction of an integrative theory of life and for the design and implementation of novel macroscopic quantum-type experiments and devices, and discuss their potential applications for the analysis, engineering and management of physical and biological systems and properties, and the consequences for the organization of transdisciplinary research and the scientific curriculum in the context of the SYSTEMOSCOPE Consortium research and development agenda. [Copyright &y& Elsevier]

We consider a generalized joint optimization policy of block replacement & periodic review spare inventory with random lead time. According to the relationship between geometric area in the graph of inventory level over time, and holding or shortage costs, a model analyzing four mutually exclusive & exhaustive possibilities is developed for the expected average cost per unit time, and is based on the stochastic behavior of the assumed system. The model reflects the cost of inventory holding, spare shortage, replacement, and ordering. And for the first time known to the authors, we deliver the sufficient and necessary conditions of the existence and uniqueness of the minimum in the joint models of this type. Because the model and its analysis are general, one existing result is shown to be subsumed by this model with some modifications. Some numerical cases verify the deduction, and give a general searching solution procedure. Finally, we introduce some discussions related to the models. The models mentioned in the paper can be readily applied in many fields such as economical fields, financial engineering, armament administration, and even medical fields, with some modifications. And the mathematical deduction in the paper will be a guideline for analyzing related stochastic models. [ABSTRACT FROM AUTHOR]

This paper re-examines missionary medicine in Tanganyika, considering its relationship with the colonial state, the impulses that led it to evolve in the way that it did, and the nature of the medical services it offered. The paper suggests that, contrary to traditional depictions, missionary medicine was not entirely curative in focus, small in scale, nor inappropriate to the health needs of the communities in which it was based. Rather, missionary medicine should be considered as a vital aspect of early colonial health services, serving those excluded by the colonial state. Missionary medicine before 1945 was fragmented, small-scale, lacking in resources and overstretched. Its services could not necessarily compete in quality with the best of the state hospitals. But it succeeded, within the local context, in providing a network of health services that stretched into the rural society, and ensured that, where there was a mission hospital, there was an option for the local people to make western biomedicine a choice for healing. [ABSTRACT FROM AUTHOR]

Background: PubMed is designed to provide rapid, comprehensive retrieval of papers that discuss a given topic. However, because PubMed does not organize the search output further, it is difficult for users to grasp an overview of the retrieved literature according to non-topical dimensions, to drill-down to find individual articles relevant to a particular individual's need, or to browse the collection. Results: In this paper, we present Anne O'Tate, a web-based tool that processes articles retrieved from PubMed and displays multiple aspects of the articles to the user, according to pre-defined categories such as the "most important" words found in titles or abstracts; topics; journals; authors; publication years; and affiliations. Clicking on a given item opens a new window that displays all papers that contain that item. One can navigate by drilling down through the categories progressively, e.g., one can first restrict the articles according to author name and then restrict that subset by affiliation. Alternatively, one can expand small sets of articles to display the most closely related articles. We also implemented a novel cluster-by-topic method that generates a concise set of topics covering most of the retrieved articles. Conclusion: Anne O'Tate is an integrated, generic tool for summarization, drill-down and browsing of PubMed search results that accommodates a wide range of biomedical users and needs. It can be accessed at [4]. Peer review and editorial matters for this article were handled by Aaron Cohen. [ABSTRACT FROM AUTHOR]

Background: Improved evaluation methodologies have been identified as a necessary prerequisite to the improvement of text mining theory and practice. This paper presents a publicly available framework that facilitates thorough, structured, and large-scale evaluations of text mining technologies. The extensibility of this framework and its ability to uncover system-wide characteristics by analyzing component parts as well as its usefulness for facilitating third-party application integration are demonstrated through examples in the biomedical domain. Results: Our evaluation framework was assembled using the Unstructured Information Management Architecture. It was used to analyze a set of gene mention identification systems involving 225 combinations of system, evaluation corpus, and correctness measure. Interactions between all three were found to affect the relative rankings of the systems. A second experiment evaluated gene normalization system performance using as input 4,097 combinations of gene mention systems and gene mention system-combining strategies. Gene mention system recall is shown to affect gene normalization system performance much more than does gene mention system precision, and high gene normalization performance is shown to be achievable with remarkably low levels of gene mention system precision. Conclusion: The software presented in this paper demonstrates the potential for novel discovery resulting from the structured evaluation of biomedical language processing systems, as well as the usefulness of such an evaluation framework for promoting collaboration between developers of biomedical language processing technologies. The code base is available as part of the BioNLP UIMA Component Repository on SourceForge.net. [ABSTRACT FROM AUTHOR]

We present a study of image features for cancer diagnosis and Gleason grading of the histological images of prostate. In diagnosis, the tissue image is classified into the tumor and nontumor classes. In Gleason grading, which characterizes tumor aggressiveness, the image is classified as containing a low- or high-grade tumor. The image sets used in this paper consisted of 367 and 268 color images for the diagnosis and Gleason grading problems, respectively, and were captured from representative areas of hematoxylin and eosin-stained tissue retrieved from tissue microarray cores or whole sections. The primary contribution of this paper is to aggregate color, texture, and morphometric cues at the global and histological object levels for classification. Features representing different visual cues were combined in a supervised learning framework. We compared the performance of Gaussian, k-nearest neighbor, and support vector machine classifiers together with the sequential forward feature selection algorithm. On diagnosis, using a five-fold cross-validation estimate, an accuracy of 96.7% was obtained. On Gleason grading, the achieved accuracy of classification into low- and high-grade classes was 81.0%. [ABSTRACT FROM AUTHOR]

Background: There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006. Methods: The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases. Results: This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system. Conclusion: The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis. [ABSTRACT FROM AUTHOR]

Background: Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney. Methods: We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns. Results and Discussion: First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement. Conclusion: In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies. [ABSTRACT FROM AUTHOR]

Two interpretations of the precautionary principle are considered. According to the normative (action-guiding) interpretation, the precautionary principle should be characterised in terms of what it urges doctors and other decision makers to do. According to the epistemic (belief-guiding) interpretation, the precautionary principle should be characterised in terms of what it urges us to believe. This paper recommends against the use of the precautionary principle as a decision rule in medical decision making, based on an impossibility theorem presented in Peterson (2005). However, the main point of the paper is an argument to the effect that decision theoretical problems associated with the precautionary principle can be overcome by paying greater attention to its epistemic dimension. Three epistemic principles inherent in a precautionary approach to medical risk analysis are characterised and defended. [ABSTRACT FROM AUTHOR]

Health-care costs are rising dramatically. Errors in medical delivery are associated with an alarming number of preventable, often fatal adverse events. A promising strategy for reversing these trends is to modernize and transform the health-care information exchange (HIE), that is, the mobilization of health-care information electronically across organizations within a region or community. The current HIE is inefficient and error-prone; it is largely paper-based, fragmented, and therefore overly complex, often relying on antiquated IT (information technology). To address these weaknesses, projects are underway to build regional and national HIEs which provide interoperable access to a variety of data sources, by a variety of stakeholders, for a variety of purposes. In this paper we present a technologist's guide to health-care interoperability. We define the stakeholders, roles, and activities that comprise an HIE solution; we describe a spectrum of interoperability approaches and point out their advantages and disadvantages; and we look in some detail at a set of real-world scenarios, discussing the interoperabitity approaches that best address the needs. These examples are drawn from IBM experience with real-world HIE engagements. [ABSTRACT FROM AUTHOR]

Summary: Objective: The main aim of this paper is to propose and discuss promising directions of research in the field of temporal representation and reasoning in medicine, taking into account the recent scientific literature and challenging issues of current interest as viewed from the different research perspectives of the authors of the paper. Background: Temporal representation and reasoning in medicine is a well-known field of research in the medical as well as computer science community. It encompasses several topics, such as summarizing data from temporal clinical databases, reasoning on temporal clinical data for therapeutic assessments, and modeling uncertainty in clinical knowledge and data. It is also related to several medical tasks, such as monitoring intensive care patients, providing treatments for chronic patients, as well as planning and scheduling clinical routine activities within complex healthcare organizations. Methodology: The authors jointly identified significant research areas based on their importance as for temporal representation and reasoning issues; the subjects were considered to be promising topics of future activity. Every subject was addressed in detail by one or two authors and then discussed with the entire team to achieve a consensus about future fields of research. Results: We identified and focused on four research areas, namely (i) fuzzy logic, time, and medicine, (ii) temporal reasoning and data mining, (iii) health information systems, business processes, and time, and (iv) temporal clinical databases. For every area, we first highlighted a few basic notions that would permit any reader—including those who are unfamiliar with the topic—to understand the main goals. We then discuss interesting and promising directions of research, taking into account the recent literature and underlining the yet unresolved medical/clinical issues that deserve further scientific investigation. The considered research areas are by no means disjointed, because they share common theoretical and methodological features. Moreover, subjects of imminent interest in medicine are represented in many of the fields considered. Conclusions: We propose and discuss promising subjects of future research that deserve investigation to develop software systems that will properly manage the multifaceted temporal aspects of information and knowledge encountered by physicians during their clinical work. As the subjects of research have resulted from merging the different perspectives of the authors involved in this study, we hope the paper will succeed in stimulating discussion and multidisciplinary work in the described fields of research. [Copyright &y& Elsevier]

This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them. After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause. This is followed by proposals for interventions aimed at strengthening the overall process. Finally, potential limitations on the application of this framework at the country level are addressed. [ABSTRACT FROM AUTHOR]

Summary: Purpose: Over recent years, there has been a growing interest in extracting entities and relations from biomedical literature. There are a vast number of systems and approaches being proposed to extract biological relations, but none of them achieves satisfactory results. These methodologies are either parsing-based or pattern-based, which are not competent to handle the grammatical complexities of biomedical texts, or too complicated to be adapted. It is well known that appositive, coordinative propositions and such grammatical structures are extremely common in biomedical texts, particularly in full texts. However, these problems are still untouched for most of researchers. Methods: In this paper, we have proposed a new approach, which is hybrid with both shallow parsing and pattern matching, to extract relations between proteins from scientific papers of biomedical themes. In the method, appositive and coordinative structures are interpreted based on the shallow parsing analysis, with both syntactic and semantic constraints. Then long sentences are splitted into sub-ones, from which relations are extracted by a greedy pattern matching algorithm, along with automatically generated patterns. Results: Our approach is experimented to extract protein–protein interactions from full biomedical texts, and has achieved an average F-score of 80% on individual verbs, and 66% on all verbs. With the help of shallow parsing analysis, pattern matching is improved remarkably. Compared with the traditional pattern matching algorithm, our approach achieves about 7% improvement of both precision and F-score. In contrast to other systems, our approach achieves performance comparable to the best. A demo system has been available at http://spies.cs.tsinghua.edu.cn. [Copyright &y& Elsevier]

Nanotechnology is concerned with materials and systems whose structures and components exhibit novel physical, chemical, and biological properties due to their nanoscale size. This paper focuses on what is known as nanomedicine, referring to the application of nanotechnology to medicine. We consider the use and potentials of emerging nanoscience techniques in medicine such as nanosurgery, tissue engineering, and targeted drug delivery, and we discuss the ethical questions that these techniques raise. The ethical considerations involved in nanomedicine are related to risk assessment in general, somatic-cell versus germline-cell therapy, the enhancement of human capabilities, research into human embryonic stem cells and the toxicity, uncontrolled function and self-assembly of nanoparticles. The ethical considerations associated with the application of nanotechnology to medicine have not been greatly discussed. This paper aims to balance clear ethical discussion and sound science and so provide nanotechnologists and biotechnologists with tools to assess ethical problems in nanomedicine. [ABSTRACT FROM AUTHOR]

Objectives: Overcoming health disparities between majority and minority populations is a significant national challenge. This paper assesses outreach to Native Americans (American Indians, Alaska Natives, and Native Hawaiians) by the National Library of Medicine (NLM). A companion paper details NLM's portfolio of Native American outreach projects. Method: NLM's Native American outreach is assessed in light of the presentations at a community-based health information outreach symposium and the goals set by NLM's plan to reduce health disparities. Results: NLM's current portfolio of Native American outreach projects appears most advanced in meeting the goal set in area 1 of the health disparities plan, "Promote use of health information by health professionals and the public." NLM's portfolio also shows significant strength and good progress regarding area 2 of the plan, "Expand partnerships among various types of libraries and community-based organizations." The portfolio is weaker in area 3, "Conduct and support informatics research." More knowledge-building efforts would benefit NLM, the National Network of Libraries of Medicine, and Native American and community-based organizations. Implications: The current Native American outreach portfolio should be continued, but new approaches are needed for evaluating Native American outreach and for forging collaborations with Native American groups, approaches grounded in consultation and mutual understanding of needs and perspectives. [ABSTRACT FROM AUTHOR]

Summary: Clinical Practice Guidelines (CPGs) are being developed as a tool to promote best practice in medicine. However, the diffusion of paper guidelines has been shown to only have a limited impact. This is why computerization of CPGs has recently been suggested as a means to improve their dissemination as well as physicians’ compliance. The Guideline Elements Model (GEM) has been proposed to facilitate the encoding of CPGs and support the automatic processing of marked-up documents. In this paper, we explore the automatic generation of a rule base from a textual guideline using GEM. In this study, we propose an extension of the GEM model that introduces additional levels of structuring centered on decision variables. This allows a more efficient representation of the decision processes, which supports the automatic generation of decision rules from textual guidelines. The 1999 Canadian recommendations for the management of hypertension have been marked-up as a GEM-encoded instance of our extended DTD. We derived a rule base using an XML parser to extract the relevant elements to instantiate the IF and THEN clauses of decision rules. The rule base automatically generated compares favourably with the manual generation of decision rules in the ASTI project. This approach is an interesting case study in the computerization of CPGs, as it illustrates processing steps that are relevant to the various aspects of CPGs lifecycle, from production to consultation and use. [Copyright &y& Elsevier]

Objectives: The objective of this study was to identify trends in academic health sciences libraries (AHSLs) as they adapt to the shift from a print knowledgebase to an increasingly digital knowledgebase. This research was funded by the 2003 David A. Kronick Traveling Fellowship. Methods: The author spent a day and a half interviewing professional staff at each library. The questionnaire used was sent to the directors of each library in advance of the visit, and the directors picked the staff to be interviewed and set up the schedule. Results: Seven significant trends were identified. These trends are part of the shift of AHSLs from being facility and print oriented with a primary focus on their role as repositories of a print-based knowledgebase to a new focus on their role as the center or "nexus" for the organization, access, and use of an increasingly digital-based knowledgebase. Conclusion: This paper calls for a national effort to develop a new model or structure for health sciences libraries to more effectively respond to the challenges of access and use of a digital knowledgebase, much the same way the National Library of Medicine did in the 1960s and 1970s in developing and implementing the National Network of Libraries of Medicine. The paper then concludes with some examples or ideas for research to assist in this process. [ABSTRACT FROM AUTHOR]

Provides instructions to authors of the "British Journal of Pharmacology." Classification of the contributions accepted by the journal into full papers, Review Articles and Commentaries; Directions for papers which describe experiments on animals that do not fall clearly within the current laws governing animal experimentation in Great Britain; Ways of submitting the manuscripts.

We examine the bibliometric profile ofTropical Medicine and International Healthusing the subjects of the articles published and the geographical distribution of the authors. The most common subject areas of papers published during 1996–2003 are highlighted, and the most cited papers indicated. [ABSTRACT FROM AUTHOR]

This paper reviews the worldwide situation regarding avian influenza infections in poultry from 1997 to March 2004. The increase in the number of primary introductions and the scientific data available on the molecular basis of pathogenicity have generated concerns particularly for legislative purposes and for international trade. This has led to a new proposed definition of 'avian influenza' to extend all infections caused by H5 and H7 viruses regardless of their virulence as notifiable diseases, although this has encountered some difficulties in being approved. The paper also reviews the major outbreaks caused by viruses of the H5 or H7 subtype and the control measures applied. The zoonotic aspects of avian influenza, which until 1997 were considered to be of limited relevance in human medicine, are also discussed. The human health implications have now gained importance, both for illness and fatalities that have occurred following natural infection with avian viruses, and for the potential of generating a reassortant virus that could give rise to the next human influenza pandemic. [ABSTRACT FROM AUTHOR]

Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury. Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population. Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH. Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11 .2), headache 1 .02 (95% CI 0.62 to 1 .69), vomiting 0.88 (95% CI 0.67 to 1 .15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0). Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups. [ABSTRACT FROM AUTHOR]

The process of bringing new drugs to market interweaves commercialism, science, clinical medicine, and governmental regulation. Through their authority and public persona as medical experts, academic clinical trial researchers studying these pharmaceuticals are integral to this process, serving as mediators between producers (the pharmaceutical companies) and consumers (clinicians and patients) of new drugs through a complex set of exchange networks. Using examples from my ethnographic research on the search for pharmaceuticals to treat what has become known as female sexual dysfunction, this paper explores the links academic researchers make with drug manufacturers and consumer markets. Academic researchers have become an integral aspect of drug development, not only by conducting clinical trial research, but also by participating in a number of other activities that assist pharmaceutical companies in identifying and creating new markets. In this paper, I examine how researchers attend professional meetings where they present clinical trial data, lecture at continuing medical education conferences, and offer themselves as `experts' to raise awareness about disorders and their treatments. Modifying a sociology of technology approach, this paper focuses on the actors in the social network who mediate the junctions between technological producers and consumers. This extends work in this area through theorizing the linkages between exchange networks, commodification techniques, and technoscientific developments. [ABSTRACT FROM AUTHOR]

This paper describes the fuzzy knowledge representation framework of the medical computer consultation system MedFrame/CADIAG-IV as well as the specific knowledge acquisition techniques that have been developed to support the definition of knowledge concepts and inference rules. As in its predecessor system CADIAG-II, fuzzy medical knowledge bases are used to model the uncertainty and the vagueness of medical concepts and fuzzy logic reasoning mechanisms provide the basic inference processes. The elicitation and acquisition of medical knowledge from domain experts has often been described as the most difficult and time-consuming task in knowledge-based system development in medicine. It comes as no surprise that this is even more so when unfamiliar representations like fuzzy membership functions are to be acquired. From previous projects we have learned that a user-centered approach is mandatory in complex and ill-defined knowledge domains such as internal medicine. This paper describes the knowledge acquisition framework that has been developed in order to make easier and more accessible the three main tasks of: (a) defining medical concepts; (b) providing appropriate interpretations for patient data; and (c) constructing inferential knowledge in a fuzzy knowledge representation framework. Special emphasis is laid on the motivations for some system design and data modeling decisions. The theoretical framework has been implemented in a software package, the Knowledge Base Builder Toolkit. The conception and the design of this system reflect the need for a user-centered, intuitive, and easy-to-handle tool. First results gained from pilot studies have shown that our approach can be successfully implemented in the context of a complex fuzzy theoretical framework. As a result, this critical aspect of knowledge-based system development can be accomplished more easily. [Copyright &y& Elsevier]

Purpose: This paper reports on a course developed for school nurses. The course focused on locating reliable and high-quality medical information resources on the Internet. Setting/Participants/Resources: The Health Sciences Library System (HSLS) of the University of Pittsburgh formed a partnership with the Pennsylvania Association of School Nurses and Practitioners (PASNAP). Through this partnership, a hands-on course was offered at the PASNAP annual conference. Brief description: As one component of the Health Information for the Public Project, a subcontract of the National Library of Medicine, HSLS collaborated with PASNAP This collaboration resulted in HSLS librarians' offering a course titled "Access to Electronic Health Information for School Nurses" at PASNAP's annual conference. This paper describes the school nurse population, their professional information needs, and the development of the course curriculum. Results/Outcome: This course provided participants with the skills to effectively utilize the Internet to locate high-quality medical information. Evaluation method: A course evaluation and impact survey were used to assess the effectiveness of the instruction. [ABSTRACT FROM AUTHOR]

A World Health Organisation survey indicated that about 70–80% of the world populations rely on non-conventional medicine mainly of herbal sources in their primary healthcare. In recent years, we have witnessed the increasing growth in popularity of over-the-counter (OTC) health foods, nutraceuticals, and medicinal products from plants or other natural sources in developed countries. This indirectly indicates that the public is not satisfied with their orthodox medical (OM) treatment. Such increase in popularity has also brought concerns and fears over the professionalism of practitioners, and quality, efficacy and safety of their treatment methods and products from herbal and natural sources available in the market. Over the past decade several news-catching episodes in developed communities indicated adverse effects, sometimes life threatening, allegedly arisen consequential to taking of OTC herbal products or traditional medicines from various ethnic groups. These OTC products may be contaminated with excessive or banned pesticides, microbial contaminants, heavy metals, chemical toxins, and for adulterated with orthodox drugs. Excessive or banned pesticides, heavy metals and microbial contaminants may be related to the source of these herbal materials, if they are grown under contaminated environment or during collection of these plant materials. Chemical toxins may come from unfavourable or wrong storage conditions or chemical treatment due to storage. The presence of orthodox drugs can be related to unprofessional practice of manufacturers. Some of these environment related factors can be controlled by implementing standard operating procedures (SOP) leading to Good Agricultural Practice (GAP), Good Laboratory Practice (GLP), Good Supply Practice (GSP) and Good Manufacturing Practice (GMP) for producing these medicinal products from herbal or natural sources. The public’s belief that herbal and natural products are safer than synthetic medicines can only be ascertained by imposing regulatory standards on these products that should be manufactured using these Good Practices.Using Chinese medicines, as examples, this paper illustrate how advances in chemical and biomedical analysis would help to detect intentional and unintentional toxic contaminants in herbal substances. The paper also summarises how modernization and progress are being carried out to get the best out of Chinese medicines for public healthcare. [Copyright &y& Elsevier]

The medical procedures at the patient bedside are out of the scope of current HIS/RIS systems, which means that patient record and image data access during the medical visit or the execution, recording and confirmation of the medicine prescriptions, still do not enjoy computerized support. As a consequence, the necessary inclusion of new data to the patient record, still needs to be carried out through notations on paper and later typed, causes delays on the availability of this information (Mobile computing in a hospital: the Ward-In-Hand project. SAC 2000-ACM Symposium on Applied Computing, Marc¸o, 2000, Villa Olmo, Como, Italy). This paper presents a software technology where the medical and nursing staff will be equipped with a handheld computer connected by radio to a central server that provides access to the electronic patient records and that will actively inform about tasks pending distribution. The server acts as a database for multimodal electronic patient record information, storing patient data from computerized tomography (CT), ultrasonography (US), magnetic resonance (MRI) images and also medical findings, observations and prescriptions coded as DICOM Structured Reports (Digital Image and Communications in Medicine). The prototype described in this article implements a medical images and structured reports server that makes the search and recovery of data stored in the DICOM standard possible. [Copyright &y& Elsevier]

Researchers who design intelligent systems for medical decision support, are aware of the need for response to real clinical issues, in particular the need to address the specific ethical problems that the medical domain has in using black boxes. This means such intelligent systems have to be thoroughly evaluated, for acceptability. Attempts at compliance, however, are hampered by lack of guidelines. This paper addresses the issue of inherent performance evaluation, which researchers have addressed in part, but a Medline search, using neural networks as an example of intelligent systems, indicated that only about 12.5% evaluated inherent performance adequately. This paper aims to address this issue by concentrating on the possible evaluation methodology, giving a framework and specific suggestions for each type of classification problem. This should allow the developers of intelligent systems to produce evidence of a sufficiency of output performance evaluation. [Copyright &y& Elsevier]

This paper argues that the on-going reforms to the UK's National Health Service initiated in the 1990s represent potentially profound institutional change to the values underpinning the process of care. The market-orientation of the reforms is highlighted, and it is asserted that the theoretical rationale for this is informed by the nascent neoclassical health economics and new institutionalist literatures, which exhibit utilitarian propensities in that both stress outcomes and at best relegate process. Drawing from the seminal contribution of Thorstein Veblen, the paper argues that market-oriented reform in the UK may induce a shift from a Hippocratic ethos to a more individualistic value system. [ABSTRACT FROM AUTHOR]

Introduction: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. Aim and Methods: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and efficacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course efficacy by a pre/post-paper-and-pencil test. Findings and Discussion: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centredness resulted after the course. The pilot study represents the first Italian CME seminar on patient-centred medicine. Results obtained both in terms of satisfaction and efficacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended. [ABSTRACT FROM AUTHOR]

This paper briefly outlines health advisor L.W. Harrison's contribution to venereology or genitourinary (GU) medicine, and shows how his principles of good practice fulfil many of the principles of clinical governance. The paper then outlines some general principles of clinical governance and indicate how they relate to GU medicine. Harrison set up the specialty on a firm foundation of clinical excellence that fulfils many of the latest requirements. He would have been thrilled to see how the specialty has broadened and would have applauded the drive for excellence. However, he might have been concerned over the literature on clinical governance, reminding that the pursuit is excellence of clinical care for the patient, and that clinical governance must not become an end in itself.

Background: Health communication research and guidelines often recommend that medical terminology be avoided when communicating with patients due to their limited understanding of medical terms. However, growing numbers of e ‐ patients use the Internet to equip themselves with specialized biomedical knowledge that is couched in medical terms, which they then share on participatory media, such as online patient forums. Objective: Given possible discrepancies between preconceptions about the kind of language that patients can understand and the terms they may actually know and use, the purpose of this paper was to investigate medical terminology used by patients in online patient forums. Design: Using data from online patient–patient communication where patients communicate with each other without expert moderation or intervention, we coded two data samples from two online patient forums dedicated to thyroid issues. Results: Previous definitions of medical terms (dichotomized into technical and semi ‐ technical) proved too rudimentary to encapsulate the types of medical terms the patients used. Therefore, using an inductive approach, we developed an analytical framework consisting of five categories of medical terms: dictionary ‐ defined medical terms, co ‐ text ‐ defined medical terms, medical initialisms, medication brand names and colloquial technical terms. The patients in our data set used many medical terms from all of these categories. Discussion and conclusions: Our findings suggest the value of a situated, condition ‐ specific approach to health literacy that recognizes the vertical kind of knowledge that patients with chronic diseases may have. We make cautious recommendations for clinical practice, arguing for an adaptive approach to medical terminology use with patients. [ABSTRACT FROM AUTHOR]

This paper gives publicity to the article written by the physician and naturalist Francisco Freire Allemão de Cysneiros - present in Tomo II of the Archivo Medico Brasileiro de Medicina, Cirurgia e Sciencias Accessorias de 1845 -, referring to a research carried out with the Geissospermum vellosii (pau-pereira). In the study, Freire Allemão talks about the medical potentiality, the phytochemical components, the geographical distribution, as well as the taxonomic classification and morphological description of the species. The document is rare in nature, with only one copy available in the National Library Foundation and it is something of great importance regarding research on the history of science and health. [ABSTRACT FROM AUTHOR]

Background: Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline). Methods: To build MM capacity at health facilities, health workers were trained as MM supervisors to visit health facilities, assess MM performance, and use the findings to provide support and standardize MM practices. Performance is assessed based on 25 MM indicators covering five domains: dispensing quality (7 indicators), prescribing quality (5), stock management (4), storage management (5) and ordering and reporting (4). From the end of 2010 to 2013, MM supervisors assessed baseline MM performance of 1384 government (85 %) and private not-for-profit facilities at all levels of care in about half of Uganda's districts. Results: The overall MM baseline median score was 10.3 out of a maximum of 25 with inter-quartile range (IQR) of 8.7-11. 7. Facility domain scores (out of a maximum of 5) were as follows: storage management, median score of 2.9 (IQR 2.3-3.4); stock management 2.3 (IQR 2.0-2.8), ordering and reporting 2.2 (IQR 1.3-2.5), and dispensing quality 2.1 (IQR 1.7-2.7). Performance in prescribing quality was 0.9 (IQR 0.4-1.4). Significant regional differences were found: overall scores were highest in the Northern region (10.7; IQR 9.2-12.4) and lowest in the Eastern region (9.6; (IQR 7.8-11.2) (p<0.001). Overall scores did not differ by facility ownership; however, government facilities scored lower in dispensing and storage and higher in ordering and reporting. Hospitals scored higher overall and in domains other than prescribing and stock management. Districts classified a priori as having high capacity for implementing SPARS had higher scores at baseline compared to lower-capacity districts. Conclusion: Assessing and building national capacity in MM is needed in both private not-for-profit and government facilities at all levels of care. The indicator-based, multipronged SPARS assessment has been described here, while the strategy's impact has yet to be documented. [ABSTRACT FROM AUTHOR]

Background: Involving doctors in management has been intended as one of the strategies to spread organizational principles in healthcare settings. However, professionals often resist taking on relevant managerial responsibility, and the question concerning by which means to engage doctors in management in a manner that best fit the challenges encountered by different health systems remains open to debate.Methods: This paper analyzes the different forms of medical management experienced over time in the Italian NHS, a relevant "lab" to study the evolution of the involvement of doctors in management, and provides a framework for disentangling different dimensions of medical management.Results: We show how new means to engage frontline professionals in management spread, without deliberate planning, as a consequence of the innovations in service provision that are introduced to respond to the changes in the healthcare sector.Conclusions: This trend is promising because such means of performing medical management appear to be more easily compatible with professional logics; therefore, this could facilitate the engagement of a large proportion of professionals rather than the currently limited number of doctors who are "forced" or willing to take formal management roles. [ABSTRACT FROM AUTHOR]

Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context.Main Text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes.Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures. [ABSTRACT FROM AUTHOR]

Introduction A critical task for health profession educators is to foster student appreciation of patient quality and safety issues. Although instructional methods vary, few focus on the direct communication of the patient experience to students. This qualitative study explores the experiences and learning of health profession students participating in a Safety Module in the Health Mentor Programme. Methods Small interprofessional groups of students were paired with a health mentor, an individual experiencing chronic health challenges. Students followed a 90-minute, semi-structured interview format exploring issues regarding quality care and safety. Following the interviews, students participated in a facilitated asynchronous online discussion and completed a reflective practice paper. An inductive thematic analysis of both of these text-based datasets revealed emerging themes. Results Themes identified in the data included: Patient partnerships as critical to optimal care; consideration of a variety of safety issues; importance of advocacy in promoting safety; improvement of future practice enabled through patient perspectives on clinical error; and embracing of interprofessional communication and collaboration. Conclusions The findings suggest that engagement with the health mentor narratives facilitated students' appreciation of quality and safety issues related to patient care. [ABSTRACT FROM AUTHOR]

Portraits of pregnant women are rare in Catholic Renaissance art. In seventeenth-century Holland, the Catholic rule of Spain had been thrown off and a Protestant Calvinistic republic emerged, freeing Dutch artists to choose an unorthodox subject matter for their paintings. The Golden Age of Holland was characterized by extreme wealth, originating from overseas trade, which fostered a marked interest in philosophy, science, medicine, as well as art. Despite this, portraiture of pregnancy remained uncommon. An exception to this rule was Jan Vermeer of Delft, who lived during the zenith of this era. Jan Vermeer painted fewer than 40 pictures, fathered 15 children, and died bankrupt and little appreciated at the age of 43. Vermeer confined himself almost entirely to images of women in various domestic situations, including three figures of pregnant women. In this framework, pregnancy could be viewed as an icon for fidelity and conformism to social expectations. In this paper we investigate the roots of this unusual icon in Vermeer's oeuvre, and suggest that the use of pregnancy in his paintings could have been inspired by his Delft-resident contemporaries Antony van Leeuwenhoek and Reinier de Graaf, fathers of well-known and opposing theories of reproduction. These eminent scientists and Vermeer's pregnant wife, who frequently served as his model, might have made pregnancy less mysterious and more realistic to the painter. [ABSTRACT FROM AUTHOR]

The objective of this research is to determine (i) the quantity and quality of publications in biomedical research in top-producing countries in West Africa during 2005-2014, as well as (ii) the characteristics of the journals used by the researchers and collaborative evidence in the area. Data was drawn from MEDLINE/PubMed and Google Scholar, while the impact factors of the journals were retrieved from the SCImago Journal and Country Rank portal. Quantity of publications was measured by counting the number of publications attributable to a country while h-index was extracted to measure quality. Productivity was analysed by sorting the data according to their first named authors, journals and publication dates, and analysed using MS Excel and LOTKA®. Nigeria, Ghana, Senegal, Burkina Faso and Mali had the highest number of publications. In respect to productivity, apart from Côte d'Ivoire that had an α value of less than 2, indicating a higher level of productivity, all other countries had an α value greater than 2. West African Journal of Medicine is the only journal of West African origin in the list of top ten journals where the authors from the subregion published their papers, and it ranked tenth in the top twenty journals used. Nigeria and Ghana published more research in local journals in comparison with other countries, but these journals have very low mean impact factors. This study reinforces the need for improved research production and collaboration between the big and small countries. [ABSTRACT FROM AUTHOR]