Mining the Web for Medical Hypothesis: A Proof-of-Concept System

As the prevalence of blogs, discussion forums, and online news services continues to grow, so too does the portion of this Web content that relates to health and medicine. We propose that everyday, medically-oriented Web content is a valuable and viable data source for medical hypothesis generation and testing, despite its being noisy. In this paper, we present a proof-of-concept system supporting this notion. We construct a corpus comprising news articles relating to the drugs Vioxx, Naproxen and Ibuprofen, that were published between 1998-2002. Using this corpus, we show that there was a significant link between Vioxx and the concept “Myocardial Infarction” well before the drug was withdrawn from the market in 2004. Indeed, within the Vioxx-related content, the concept ranks amongst the top 3.3% in terms of importance. When compared with the Naproxen and Ibuprofen control literatures, the term occurs significantly more frequently in the Vioxx-related content.Engineering and Applied Science

Mindfulness in medical education: Students’ perceptions and four recommendations for implementation of a mindfulness intervention

Background: Faculties of Medicine around the globe have implemented mindfulness-based curricula to deal with medical student’s burnout, anxiety and depression. The purpose of this qualitative study is to assess students’ perception of a mandatory mindfulness intervention and their recommendations for further curricula development and implementation.Methods:  Third-year medical students participated in a mandatory three-hour mindfulness workshop embedded in their family medicine academic week. Eleven students consented to two interviews which explored their perceptions of mindfulness and the workshop in relation to their personal and professional wellbeing as well as their views for the implementation of a longitudinal mindfulness curriculum.Results:  Student and institutional benefits and barriers relating to the curriculum were identified.  Student’s benefits included positive changes in stress, self-awareness and personally   that also translated into self-reported better patient care. Students reported lack of time, forgetting to practice and lack of knowledge about mindfulness as barriers. Institutional pride for their support of student wellness and an overfilled curriculum, were the major institutional benefits and barriers respectively, to the expansion of this curriculum. Among developing an implementing a longitudinal mindfulness curriculum, we found four key features to consider: Firstly to engage the stakeholders; secondly, to incorporate the mindfulness intervention into the curriculum with both a mandatory and elective component; thirdly, to emphasize the clinical implications of the mindfulness intervention and fourthly, to have protected time for wellness interventions.Conclusions: Introducing mindfulness into the undergraduate medical school curriculum through this workshop resulted in perceived personal, institutional and professional benefits. For faculties of medicine that want to implement a mindfulness intervention, we found four key components for implementing a mindfulness intervention in their institutions. Further research is needed to better quantify the benefits and to identify ways to manage barriers at both individual and institutional levels.

Choosing a Data Model and Query Language for Provenance

The ancestry relationships found in provenance form a directed graph. Many provenance queries require traversal of this graph. The data and query models for provenance should directly and naturally address this graph-centric nature of provenance. To that end, we set out the requirements for a provenance data and query model and discuss why the common solutions (relational, XML, RDF) fall short. A semistructured data model is more suited for handling provenance. We propose a query model based on the Lorel query language, and briefly describe how our query language PQL extends Lorel.Engineering and Applied Science

Une étude pilote d’un programme cursus longitudinal de méditation pleine conscience durant le doctorat en médecine

Background: To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. Methods: Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. Results: In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p<0.01) and resilience (r=.539, p<0.01), and negatively with stress scores (r=-.380, p<0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p=0.008), empathy (5%, p=0.045), and resilience scores (12%, p=0.002) with a trend toward lower stress scores (8%, p=0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p<0.001; 6% increased empathy scores p<0.001, 10% increased resilience scores p=0.003; 11% decreased stress scores p= 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. Conclusion: A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Contexte : Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. Méthodes :  Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l’empathie (Échelle de Jefferson sur l’empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l’expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. Résultats : Chez les répondants, un degré de stress élevé (19,2 (ET = 6)) et une faible résilience (71,2 (ET = 12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l’empathie (r = 0,17, p < 0,01) et de la résilience (r = 0,539, p < 0,01), et négative avec le stress (r = -0,380, p < 0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12 %, p = 0,008), l’empathie (5 %, p = 0,045) et la résilience (12 %, p = 0,002) avec une tendance vers des résultats inférieurs pour le stress (8 %, p = 0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14 % pour la pleine conscience (p < 0,001), de 6 % pour l’empathie (p < 0,001) et de 10 % pour la résilience (p = 0,003), et réduits de 11 % pour le stress (p = 0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l’assiduité des étudiants aux sessions optionnelles était faible. Conclusion : Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D’autres études sont requises

Feasibility and effectiveness of an online mindfulness meditation program for medical students

Background: The need to incorporate tools to promote medical student wellness in medical education is underscored by the concerning rates of psychological distress among them. The objective of this prospective cohort study was to obtain preliminary data on the feasibility and effectiveness of an online mindfulness intervention for medical student wellness.Methods: A convenience sample of 52 medical students consented to participate in this study. Feasibility was assessed by ease of recruitment, number of modules completed, satisfaction with the program, and adherence to a regular meditation practice. Participants completed the Maslach Burnout Inventory, the Jefferson Scale of Empathy-medical student version, the Five Face of Mindfulness Questionnaire-short form, and the Self Compassion Scale-short form pre and post intervention.Results: The convenience sample was recruited within a two-month period. Forty-five participants completed at least one of seven modules. Descriptive statistics (mean±standard deviation) revealed that the mean number of modules completed was 4.85±2.7. Mean satisfaction with the modules was 7.07±1.1 out of 10. Adherence to a regular formal meditation practice was poor; the average amount of formal meditation practice per module was 34.14±27.44 minutes. Self-compassion and the “observe and describe” facets of mindfulness practice significantly statistically increased from baseline, but no such change was observed for levels of burnout and empathy.Conclusion: The present study indicates that an online mindfulness meditation program may be of interest to medical students. The results did not provide any evidence that the program was effective but we believe further research and development is warranted

Layering in Provenance Systems

Digital provenance describes the ancestry or history of a digital object. Most existing provenance systems, however, operate at only one level of abstraction: the sys- tem call layer, a workflow specification, or the high-level constructs of a particular application. The provenance collectable in each of these layers is different, and all of it can be important. Single-layer systems fail to account for the different levels of abstraction at which users need to reason about their data and processes. These systems cannot integrate data provenance across layers and cannot answer questions that require an integrated view of the provenance. We have designed a provenance collection structure facilitating the integration of provenance across multiple levels of abstraction, including a workflow engine, a web browser, and an initial runtime Python provenance tracking wrapper. We layer these components atop provenance-aware network storage (NFS) that builds upon a Provenance-Aware Storage System (PASS). We discuss the challenges of building systems that integrate provenance across multiple layers of abstraction, present how we augmented systems in each layer to integrate provenance, and present use cases that demonstrate how provenance spanning multiple layers provides functionality not available in existing systems. Our evaluation shows that the overheads imposed by layering provenance systems are reasonable.Engineering and Applied Science

Alterations in mGluR5 Expression and Signaling in Lewy Body Disease and in Transgenic Models of Alpha- Synucleinopathy – Implications for Excitotoxicity

Dementia with Lewy bodies (DLB) and Parkinson’s Disease (PD) are neurodegenerative disorders of the aging population characterized by the abnormal accumulation of alpha-synuclein (alpha-syn). Previous studies have suggested that excitotoxicity may contribute to neurodegeneration in these disorders, however the underlying mechanisms and their relationship to alpha-syn remain unclear. For this study we proposed that accumulation of alpha-syn might result in alterations in metabotropic glutamate receptors (mGluR), particularly mGluR5 which has been linked to deficits in murine models of PD. In this context, levels of mGluR5 were analyzed in the brains of PD and DLB human cases and alpha-syn transgenic (tg) mice and compared to age-matched, unimpaired controls, we report a 40% increase in the levels of mGluR5 and beta-arrestin immunoreactivity in the frontal cortex, hippocampus and putamen in DLB cases and in the putamen in PD cases. In the hippocampus, mGluR5 was more abundant in the CA3 region and co-localized with alpha-syn aggregates. Similarly, in the hippocampus and basal ganglia of alpha-syn tg mice, levels of mGluR5 were increased and mGluR5 and alpha-syn were co-localized and co-immunoprecipated, suggesting that alpha-syn interferes with mGluR5 trafficking. The increased levels of mGluR5 were accompanied by a concomitant increase in the activation of downstream signaling components including ERK, Elk-1 and CREB. Consistent with the increased accumulation of alpha-syn and alterations in mGluR5 in cognitive- and motor-associated brain regions, these mice displayed impaired performance in the water maze and pole test, these behavioral alterations were reversed with the mGluR5 antagonist, MPEP. Taken together the results from study suggest that mGluR5 may directly interact with alpha-syn resulting in its over activation and that this over activation may contribute to excitotoxic cell death in select neuronal regions. These results highlight the therapeutic importance of mGluR5 antagonists in alpha-synucleinopathies

Layering in Provenance-Aware Storage Systems

Digital provenance describes the ancestry or history of a digital document. Provenance provides answers to questions such as: “How does the ancestry of these objects differ?” “Are there source code files tainted by proprietary software?” “How was this object created?” Prior systems used to collect and maintain provenance operate within a single layer of abstraction: the system call boundary, a workflow specification language, or in a domain-specific application level. The provenance collected at each of these layers of abstraction is different, and all of it is important at one time or another. All of these solutions fundamentally fail to account for the different layers of abstraction at which users need to reason about their data and processes. None of these systems support queries across different layers of abstraction to answer a question such as “The calculated values in my spreadsheet have changed. Is this due to a change in the spreadsheet, a difference in the spreadsheet application, the libraries being used, or the operating system being used?” We present an architecture for provenance collection that facilitates the integration of provenance across multiple layers of abstraction and across network boundaries. We show how the need to support provenance collection at multiple layers drives the architecture. We present provenance-aware use cases from the field of thermography and quantify system overheads, showing that we can provide new functionality with acceptable overhead.Engineering and Applied Science

Attitudes of Mexican anesthesiologists to indicate preoperative fasting periods: A cross-sectional survey

BACKGROUND: In Mexico, guidelines for fasting periods, or any audits on this topic are unavailable, and therefore the attitudes of anesthesiologists for recommending preoperative fasting periods are unknown. MATERIAL AND METHODS: The study was a cross-sectional survey of anesthesiologists subscribed to the Annual Updated Course, organized by the Sociedad Mexicana de Anestesiologia in 2000. The response rate was 31.4%. RESULTS: Most respondents were general anesthesiologists, with 5 or more years experience in a clinical post, were working in both public and private hospitals, and were performing anesthetic procedures on both pediatric and adult patients and in both ambulatory and hospitalized patients. Approximately 23% of the respondents considered natural fruit juices to be clear liquids. For a pediatric patient ingesting breast milk 1 h before undergoing a surgical procedure, 45% thought that surgery should be delayed for 3h, followed by those delaying the surgical procedure for 6 to 8 h. Our results show that more than 50% of the anesthesiologists had better defined attitudes for fasting milk and clear liquids in patients of 6 month or under than for older children and adults. However, due to the poor definition or pre-operative fasting, using clear liquids, in all other patient groups, several patients are allowed to go without oral clear liquids administration for prolonged periods. CONCLUSION: Preoperative fasting periods recommended by Mexican anesthesiologists differ from international guidelines

The effects of Δ9-tetrahydrocannabinol on the dopamine system

Δ(9)-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, is a pressing concern to global mental health. Patterns of use are changing drastically due to legalisation, availability of synthetic analogues (‘spice’), cannavaping and aggrandizements in the purported therapeutic effects of cannabis. Many of THC’s reinforcing effects are mediated by the dopamine system. Due to complex cannabinoid-dopamine interactions there is conflicting evidence from human and animal research fields. Acute THC causes increased dopamine release and neuron activity, whilst long-term use is associated with blunting of the dopamine system. Future research must examine the long-term and developmental dopaminergic effects of the drug