A patient's guide to choosing unconventional therapies

Unconventional therapies (UTs) are therapies not usually provided by Canadian physicians or other conventionally trained health care providers. Examples of common UTs available in Canada are herbal preparations, reflexology, acupuncture and traditional Chinese medicine. UTs may be used along with conventional therapies (complementary) or instead of conventional therapies (alternative). Surveys have shown that many Canadians use UTs, usually as complementary therapies, for a wide range of diseases and conditions. Reliable information about UTs is often difficult to find. Your doctor may be unable to give you specific advice or recommendations, since UTs are often not in a physician''s area of expertise. However, he or she will usually be able to provide some general advice and help supervise your progress. For your own health and safety, it is important to keep your doctor informed of the choices you make. This document is intended to (a) provide you with questions to consider when making your treatment choices, (b) help you find information about UTs, (c) help you decide whether a specific UT is right for you, and (d) provide tips to help you evaluate the information you find.     

Navajo Filmmakers

This paper is a report of research in visual (film) communication investigating questions in anthropology and communication. Six Navajos, aged 17–25, and one monolingual, aged 55, living on the reservation were taught only the technology of a 16mm movie camera and splicer and were asked to make films about "anything you want to." We review the theoretical questions underlying the research, describe our method of teaching, and analyze the films they made and their verbalizations about them, relating their cultural, verbal grammar, and narrative style to their methods and social organization of learning filmmaking, choice of subjects and actors for their films, and their methods, both syntactic and semantic, of structuring the image events they photographed.     

Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients – A Study of Pain Rehabilitation

ObjectiveThere is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.MethodsIn the overarching project named “Equal care in rehabilitation” we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.ResultsThe process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.ImplicationsThe clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.ConclusionsThus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.     

哈民忙哈遗址之石器工具

哈民忙哈遗址以发现大量凌乱堆弃的人骨而闻名,了解当时生产方式、文化生态关系对于了解史前灾难的原因很有意义。通过石器工具组合的功能分析,可以较清晰地了解到,其石器组合缺乏真正的农耕工具,当时人们依赖的是一种以狩猎采集兼营农业的生产方式,强调植物根茎与坚果的利用。结合当时的文化背景与自然环境条件分析,则进一步了解到,哈民忙哈先民利用了一个从前很少利用的农业边缘环境,他们选择了一种与其经济基础不相宜的集中居住模式,这为史前灾难埋下了祸根。     

Using the ALPHA form in practice to assess antenatal psychosocial health

BACKGROUND: The assessment of the psychosocial health of pregnant women and their families, although recommended, is not carried out by most practitioners. One reason is the lack of a practical and evidence-based tool. In response, a multidisciplinary group created the Antenatal Psychosocial Health Assessment (ALPHA) form. This article describes the development of this tool and experience with it in an initial field trial. METHODS: A systematic literature review revealed 15 antenatal psychosocial risk factors associated with poor postpartum family outcomes of woman abuse, child abuse, postpartum depression, marital/couple dysfunction and increased physical illness. The ALPHA form, incorporating these risk factors, was developed and refined through several focus groups. It was then used by 5 obstetricians, 10 family physicians, 7 midwives and 4 antenatal clinic nurses in various urban, rural and culturally diverse locations across Ontario. After 3 months, these health care providers met in focus groups to discuss their experiences. A sample of pregnant women assessed using the ALPHA form were interviewed about their experience as well. Results were analysed according to qualitative methods. RESULTS: The final version of the ALPHA form grouped the 15 risk factors into 4 categories--family factors, maternal factors, substance abuse and family violence--with suggested questions for each area of enquiry. The health care providers uniformly reported that the form helped them to uncover new and often surprising information, even when the women were well known to them. Incorporating the form into practice was usually accomplished after a period of familiarization. Most of the providers said the form was useful and would continue to use it if it became part of standard care. The pregnant women in the sample said they valued the enquiry and felt comfortable with the process, unless there were large cultural barriers. INTERPRETATION: The ALPHA form appears to be an important tool in assessing psychosocial health in pregnancy and to be readily integrated into practice. More study is required to quantify the number of risks identified and resources used, to determine the form''s reliability and validity and, ultimately, to assess the effect of its use on postpartum outcomes.     

SinicView: A visualization environment for comparisons of multiple nucleotide sequence alignment tools

Background  

Deluged by the rate and complexity of completed genomic sequences, the need to align longer sequences becomes more urgent, and many more tools have thus been developed. In the initial stage of genomic sequence analysis, a biologist is usually faced with the questions of how to choose the best tool to align sequences of interest and how to analyze and visualize the alignment results, and then with the question of whether poorly aligned regions produced by the tool are indeed not homologous or are just results due to inappropriate alignment tools or scoring systems used. Although several systematic evaluations of multiple sequence alignment (MSA) programs have been proposed, they may not provide a standard-bearer for most biologists because those poorly aligned regions in these evaluations are never discussed. Thus, a tool that allows cross comparison of the alignment results obtained by different tools simultaneously could help a biologist evaluate their correctness and accuracy.     

Ontario Maternal Serum Screening Program: practices,knowledge and opinions of health care providers

OBJECTIVE: To determine the practices, knowledge and opinions of health care providers regarding a prenatal genetic screening program in Ontario. DESIGN: Cross-sectional self-reported survey. SETTING: Ontario. PARTICIPANTS: Random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in the province. Among subjects who were eligible (those providing antenatal care or attending births) the response rates were 91% (778/851), 76% (273/359) and 78% (46/59) respectively. MAIN OUTCOME MEASURES: Which patients were offered maternal serum screening (MSS), how results were being communicated, knowledge of the test''s sensitivity, likes and dislikes about MSS and recommendations regarding the program. RESULTS: Most (97%) of respondents stated that they were offering MSS to the pregnant women in their practices; 88% were offering it routinely to all pregnant women (87% of the family physicians, 90% of the obstetricians and 100% of the midwives). Most (92%) of the respondents stated that they communicate positive results to their patients personally as soon as they are received; 23% did so for negative results. The respondents correctly identified the initial positive rate but underestimated the false-positive rate. About one-third did not respond to these knowledge questions. Of those who gave feedback on the screening program, 50% recommended that it not be changed, 29% suggested that it be changed, and 22% recommended that it be scrapped. CONCLUSIONS: Participation in the Ontario Maternal Serum Screening Program by health care providers has been good, although knowledge about MSS is far from ideal. Many providers have reservations about the program. In light of concerns raised about the high false-positive rate and the anxiety such results generate in pregnant women, there is a need for more education of providers and patients and a better understanding of women''s experiences with genetic screening.     

What Users Want and May Need

An increasing number of software tools support designers and other decision makers in making design, production, and purchasing decisions. Some of these tools provide quantitative information on environmental impacts such as climate change, human toxicity, or resource use during the life cycle of these products. Very little is known, however, about how these tools are actually used, what kind of modeling and presentation approaches users really want, or whether the information provided is likely to be used the way the developers intended. A survey of users of one such software tool revealed that although users want more transparency, about half also want an easy-to-use tool and would accept built-in assumptions; that most users prefer modeling of environmental impacts beyond the stressor level, and the largest group of respondents wants results simultaneously on the stressor, impact potential, and damage level; and that although many users look for aggregated information on impacts and costs, a majority do not trust that such an aggregation is valid or believe that there are tradeoffs among impacts. Further, our results show that the temporal and spatial scales of single impact categories explain only about 6% of the variation in the weights between impact categories set by respondents if the weights are set first. If the weights are set after respondents specify temporal and spatial scales, however, these scales explain about 24% of the variation. These results not only help method and tool developers to reconsider some previous assumptions, but also suggest a number of research questions that may need to be addressed in a more focused investigation.     

Bioinformatics enrichment tools: paths toward the comprehensive functional analysis of large gene lists

Functional analysis of large gene lists, derived in most cases from emerging high-throughput genomic, proteomic and bioinformatics scanning approaches, is still a challenging and daunting task. The gene-annotation enrichment analysis is a promising high-throughput strategy that increases the likelihood for investigators to identify biological processes most pertinent to their study. Approximately 68 bioinformatics enrichment tools that are currently available in the community are collected in this survey. Tools are uniquely categorized into three major classes, according to their underlying enrichment algorithms. The comprehensive collections, unique tool classifications and associated questions/issues will provide a more comprehensive and up-to-date view regarding the advantages, pitfalls and recent trends in a simpler tool-class level rather than by a tool-by-tool approach. Thus, the survey will help tool designers/developers and experienced end users understand the underlying algorithms and pertinent details of particular tool categories/tools, enabling them to make the best choices for their particular research interests.     

Cultural Competence in Diabetes Mellitus Care: An Urgent Need

Background:Multicultural societies exist worldwide. Two important challenges can be appreciated in this scenario. Minority populations, due to a combination of genetic and lifestyle factors, have a particularly high risk for developing type 2 diabetes mellitus (DM). In addition, the quality of health care provided to minority populations, including that for DM, has lagged behind that provided to the white population. Because multiple medical, social, and cultural factors influence the development and progression of type 2 DM, management of patients becomes even more challenging if health care providers cannot identify and address the many contributing factors.Objective:The objective of this article was to raise awareness about the most common social and cultural factors that may influence the development of type 2 DM, progression of the disease, and adherence to treatment plans in patients from culturally diverse populations.Methods:A PubMed search of English-language articles published primarily between 1996 and 2006 was conductedusing the search terms Latino, Hispanic, culture, and diabetes, and a list of social and cultural factors associated with type 2 DM was created based on relevant articles and on the author's expertise and experience in the Latino Diabetes Initiative at the Joslin Diabetes Center.Results:There is increasing evidence that social and cultural factors such as body image, educational level, fears, general family integration and support, health literary, language, myths, and nutritional preferences, among others, may affect the success of the physician patient relationship and influence patients' adherence to treatment. Specific strategies to help clinicians remember to address multiple factors in the day-to-day management of patients with type 2 DM who are from culturally diverse populations include asking questions about patients' personal goals, ascertaining what behaviors they have adopted from mainstream culture, understanding how family ties may affect DM care and prevention, and being aware of patients' educational level when implementing any educational activity.Conclusions:The standards of DM care apply to every individual with this disease and should continue to be the core of every clinicians practice. However, improving health care providers' cultural competence may help improve the quality of care provided to minority groups and may ultimately reduce health care disparities. Increased cultural competence may also improve patient-provider trust and communication, as well as help patients adhere to prevention and treatment plans.     

Amnesia,Anesthesia, and Warranted Fear

Is a painful experience less bad for you if you will not remember it? Do you have less reason to fear it? These questions bear on how we think about medical procedures and surgeries that use an anesthesia regimen that leaves patients conscious – and potentially in pain – but results in complete ‘drug‐induced amnesia’ after the fact. I argue that drug‐induced amnesia does not render a painful medical procedure a less fitting object of fear, and thus the prospect of amnesia does not give patients a reason not to fear it. I expose three mistakes in reasoning that might explain our tendency to view pain or discomfort as less fearful in virtue of expected amnesia: a mistaken view of personal identity; a mistaken view of the target of anticipation; and a mistaken method of incorporating past evidence into calculations about future experiences. Ultimately my argument has implications for whether particular procedures are justified and how medical professionals should speak with anxious patients about the prospect of drug‐induced amnesia.     

Some final responses to Dr. Waugh

OBJECTIVE: To describe alcohol disorders in the general Canadian population, using as a standard indicator the CAGE questionnaire (Have you felt you needed to cut down on your drinking? Have you felt annoyed by criticism of your drinking? Have you felt guilty about drinking? Have you felt you needed a drink first thing in the morning [eye-opener]?). DESIGN: Secondary analysis of data from Canada''s Alcohol and Other Drugs Survey (CADS), a national telephone survey conducted in 1994 of a representative sample of 12,155 people aged 15 years or more. PARTICIPANTS: The CAGE questionnaire was administered to 5894 drinkers who had consumed alcohol in the 12 months before the CADS survey. MAIN OUTCOME MEASURES: Respondents with positive (2 or more affirmative responses) and negative results on the CAGE questionnaire were compared as to demographic characteristics, alcohol consumption and harmful consequences of their drinking. Independent predictors of a positive result were identified by means of logistic regression analysis. RESULTS: A total of 5.8% of CAGE-tested current drinkers had a positive result on the past-year CAGE in 1994. The proportion of respondents reporting alcohol-related problems in one or more areas of their life was 7 times greater among drinkers with a positive result on the CAGE questionnaire than among those with a negative result (66.8% v. 9.5%) (p < 0.0001). When all demographic characteristics were controlled for simultaneously, male sex, residence in the Atlantic provinces, Quebec or the Prairies, single/never married or divorced/separated marital status, and low education level were found to be independent risk factors for a positive result on the CAGE questionnaire. About 85% of the respondents with a positive result had not sought help for their drinking. Applying the estimated sensitivity and specificity of the CAGE questionnaire in detecting alcohol dependence, as per criteria of the Diagnostic and Statistical Manual, in a general US population, the authors estimated that 4.1% of Canadians had an alcohol dependence in 1994. CONCLUSION: The large proportion of current drinkers with a positive result on the CAGE questionnaire who did not seek help for their drinking underscores the need for identification and brief interventions by physicians. Further research is needed to elucidate the underlying reasons for regional differences in CAGE status.     

The versatile worm: genetic and genomic resources for Caenorhabditis elegans research

Since its establishment as a model organism, Caenorhabditis elegans has been an invaluable tool for biological research. An immense spectrum of questions can be addressed using this small nematode, making it one of the most versatile and exciting model organisms. Although the many tools and resources developed by the C. elegans community greatly facilitate new discoveries, they can also overwhelm newcomers to the field. This Review aims to familiarize new worm researchers with the main resources, and help them to select the tools that are best suited for their needs. We also hope that it will be helpful in identifying new research opportunities and will promote the development of additional resources.     

Medical errors in surgery

Researchers at the Institute of Medicine have reported a staggering number of medical errors, that is, adverse effects as a result of treatment, in healthcare in America. This article argues against a no-faults systems view as a corrective for these events and calls us instead to trust the motivations of providers and the peer review process to bring about the needed cultural revolution. It sees healthcare as an honorable profession rather than an off-the-shelf commodity, and calls on providers to be courageous leaders who make safety their priority.     

Primate archaeology reveals cultural transmission in wild chimpanzees (Pan troglodytes verus)

Recovering evidence of past human activities enables us to recreate behaviour where direct observations are missing. Here, we apply archaeological methods to further investigate cultural transmission processes in percussive tool use among neighbouring chimpanzee communities in the Taï National Park, Côte d''Ivoire, West Africa. Differences in the selection of nut-cracking tools between neighbouring groups are maintained over time, despite frequent female transfer, which leads to persistent cultural diversity between chimpanzee groups. Through the recovery of used tools in the suggested natal territory of immigrants, we have been able to reconstruct the tool material selection of females prior to migration. In combination with direct observations of tool selection of local residents and immigrants after migration, we uncovered temporal changes in tool selection for immigrating females. After controlling for ecological differences between territories of immigrants and residents our data suggest that immigrants abandoned their previous tool preference and adopted the pattern of their new community, despite previous personal proficiency of the same foraging task. Our study adds to the growing body of knowledge on the importance of conformist tendencies in animals.     

Ethnic Elders and American Health Care—A Physician's Perspective

The aging process is a fugue composed of innumerable themes; the theme of “ethnicity” is by far one of its more dominant. Due to the increasing incidence of chronic, progressive infirmity and acute, catastrophic illness, the elderly are thrust into direct contact with the health care systems of their society. The experiences of ethnic elders in American health care situations are fraught with conflict and mutual dissatisfaction with the physician-patient relationship. Both providers and consumers of health care services harbor differing culture-bound perceptions of health, illness and the healing process; these cultural beliefs define personal and professional needs and expectations and notions of how those needs are to be met by others. Both physicians and patients can enhance their communication and their compassion for one another by acknowledgment of cultural differences and by increased willingness to interpret motives and behavior within native context.It behooves us in medicine to examine the cultural traditions underlying our own attitudes, beliefs and values about the aged in a universal sense, as well as in a culturally specific sense, that we may gain insight that will be helpful in serving elderly persons more effectively, and in solving some of the problems inherent in the aging process.     

Performance and scaling behavior of bioinformatic applications in virtualization environments to create awareness for the efficient use of compute resources

The large amount of biological data available in the current times, makes it necessary to use tools and applications based on sophisticated and efficient algorithms, developed in the area of bioinformatics. Further, access to high performance computing resources is necessary, to achieve results in reasonable time. To speed up applications and utilize available compute resources as efficient as possible, software developers make use of parallelization mechanisms, like multithreading. Many of the available tools in bioinformatics offer multithreading capabilities, but more compute power is not always helpful. In this study we investigated the behavior of well-known applications in bioinformatics, regarding their performance in the terms of scaling, different virtual environments and different datasets with our benchmarking tool suite BOOTABLE. The tool suite includes the tools BBMap, Bowtie2, BWA, Velvet, IDBA, SPAdes, Clustal Omega, MAFFT, SINA and GROMACS. In addition we added an application using the machine learning framework TensorFlow. Machine learning is not directly part of bioinformatics but applied to many biological problems, especially in the context of medical images (X-ray photographs). The mentioned tools have been analyzed in two different virtual environments, a virtual machine environment based on the OpenStack cloud software and in a Docker environment. The gained performance values were compared to a bare-metal setup and among each other. The study reveals, that the used virtual environments produce an overhead in the range of seven to twenty-five percent compared to the bare-metal environment. The scaling measurements showed, that some of the analyzed tools do not benefit from using larger amounts of computing resources, whereas others showed an almost linear scaling behavior. The findings of this study have been generalized as far as possible and should help users to find the best amount of resources for their analysis. Further, the results provide valuable information for resource providers to handle their resources as efficiently as possible and raise the user community’s awareness of the efficient usage of computing resources.     

Explorations in statistics: regression

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This seventh installment of Explorations in Statistics explores regression, a technique that estimates the nature of the relationship between two things for which we may only surmise a mechanistic or predictive connection. Regression helps us answer three questions: does some variable Y depend on another variable X; if so, what is the nature of the relationship between Y and X; and for some value of X, what value of Y do we predict? Residual plots are an essential component of a thorough regression analysis: they help us decide if our statistical regression model of the relationship between Y and X is appropriate.