Influence, Information Overload, and Information Technology in Health Care

We investigate whether information technology can help physicians more efficiently acquire new knowledge in a clinical environment characterized by information overload. Our analysis makes use of data from a randomized trial as well as a theoretical model of the influence that information technology has on the acquisition of new medical knowledge. Although the theoretical framework we develop is conventionally microeconomic, the model highlights the non-market and non-pecuniary influence activities that have been emphasized in the sociological literature on technology diffusion. We report three findings. First, empirical evidence and theoretical reasoning suggests that computer based decision support will speed the diffusion of new medical knowledge when physicians are coping with information overload. Secondly, spillover effects will likely lead to "underinvestment" in this decision support technology. Third, alternative financing strategies common to new information technology, such as the use of marketing dollars to pay for the decision support systems, may lead to undesirable outcomes if physician information overload is sufficiently severe and if there is significant ambiguity in how best to respond to the clinical issues identified by the computer.

ANTIDEPRESSANT ACTIVITY OF AQUEOUS EXTRACTS OF FRUITS OF TERMINALIA CHEBULA AND PHYLLANTHUS EMBLICA IN BEHAVIOURAL MODELS OF DEPRESSION: INVOLVEMENT OF MONOAMINERGIC SYSTEM

Objectives: Terminalia chebula (TCh) and Phyllanthus emblica (PE) posses wide range of central nervous system activity. This study was conducted to investigate the antidepressant activity and mechanism action of aqueous extract of TCh & PE using forced swimming test (FST) and tail suspension test (TST). Methods: Aqueous extracts of TCh (390, 780 & 1560mg/kg) and PE (390, 780, 1560 & 3120 mg/kg) were administered for seven days to mice and immobility time was measured in FST & TST. Extracts were administered for 14 days and immobility time was measured in chronic FST. The mechanisms of antidepressant effect of TCh and PE were studied using prazosin (1mg/kg), levosulpiride (20mg/kg) and p-CPA (300mg/kg) in TST. Results: In FST, 780 & 1560 mg/kg of TCh and 1560 & 3120 mg/kg of PE reduced immobility time while in TST, 1560 mg/kg of TCh and 3120 mg/kg of PE decreased immobility significantly compared to control. In chronic FST, only 780 & 1560 mg/kg of TCh showed significant reduction. Antidepressant effect of TCh was reversed by prazosin while antidepressant effect of PE was reversed by prazosin and levosulpiride significantly in TST. Conclusions: The aqueous extracts of TCh and PE possess antidepressant activity at higher doses. This effect was possibly mediated through mono aminergic pathways

Structure-based stabilization of insulin as a therapeutic protein assembly via enhanced aromatic-aromatic interactions

Key contributions to protein structure and stability are provided by weakly polar interactions, which arise from asymmetric electronic distributions within amino acids and peptide bonds. Of particular interest are aromatic side chains whose directional π-systems commonly stabilize protein interiors and interfaces. Here, we consider aromatic-aromatic interactions within a model protein assembly: the dimer interface of insulin. Semi-classical simulations of aromatic-aromatic interactions at this interface suggested that substitution of residue TyrB26 by Trp would preserve native structure while enhancing dimerization (and hence hexamer stability). The crystal structure of a [TrpB26]insulin analog (determined as a T3Rf3 zinc hexamer at a resolution of 2.25 Å) was observed to be essentially identical to that of WT insulin. Remarkably and yet in general accordance with theoretical expectations, spectroscopic studies demonstrated a 150-fold increase in the in vitro lifetime of the variant hexamer, a critical pharmacokinetic parameter influencing design of long-acting formulations. Functional studies in diabetic rats indeed revealed prolonged action following subcutaneous injection. The potency of the TrpB26-modified analog was equal to or greater than an unmodified control. Thus, exploiting a general quantum-chemical feature of protein structure and stability, our results exemplify a mechanism-based approach to the optimization of a therapeutic protein assembly

Proof firm downsizing and diagnosis-specific disability pensioning in Norway

<br>Background: We wanted to investigate if firm downsizing is related to an increased rate of disability pensions among the former employed, especially for those with musculoskeletal and psychiatric diagnoses, and for those having to leave the firm.</br> <br>Methods: Statistics Norway provided a linked file with demographic information and all social security grants from the National Insurance Administration for 1992–2004 for all inhabitants in Norway. Our sample was aged 30–55 years in 1995, being alive, employed and not having a disability pension at the end of 2000. Downsizing was defined as percent change in number of employed per firm from 1995 to end 2000. Employment data were missing for 25.6% of the sample.</br> <br>Results: Disability pension rates in the next four years were 25% higher for those experiencing a 30-59% downsizing than for those not experiencing a reduction of the workforce. 1-29% and 60-100% downsizing did not have this effect. Stayers following down-sizing had higher disability pension rates than leavers. What we have called complex musculoskeletal and psychiatric diagnoses were relatively most common.</br> <br>Conclusion: Moderate downsizing is followed by a significant increase in disability pension rates in the following four years, often with complex musculoskeletal and psychiatric diagnoses.</br&gt

Capacity building for sustainable use of animal genetic resources in developing countries. ILRI-SLU Project progress report for the period 1999-2003

To promote a sustainable and improved use of animal genetic resources in developing countries, ILRI in collaboration with the Swedish University of Agricultural Sciences (SLU), and supported by Sida (Sweden), launched a project training the trainers, for national agricultural research systems (NABS) scientists (national university teachers and researchers) in developing countries. The main objectives of the project were to strengthen subject knowledge and skills, and teaching and communication skills of scientists teaching and supervising students in animal breeding and genetics at least up to MSc level. Other objectives were to catalyse curriculum development, stimulate contacts and networking, and to develop computer-based training resources relevant for use by NARS scientists in teaching and research. This capacity building project was an integrated component of the ILRI research agenda on Animal Genetic Resources. It was also an endeavour by ILRI to collaborate with and strengthen NARS institutions and scientists. The project was initially planned to include regions in sub-Saharan Africa, SouthEast Asia and South Asia, resources allowing, Latin America. The activities in each region or sub-region included: planning activities (questionnaire, country visits, planning workshop), training course for university teachers and researchers (three weeks, combining training in animal genetics/breeding and teaching methodologies), development of an Animal Genetics Training Resource' (on CD-ROM, and later also on the Web), follow-up activities, including impact assessment (questionnaires and follow-up workshops). During the period 1999 to 2003 a full round of activities was completed for sub Saharan Africa. The training course was conducted for Eastern/Southern Africa (20 scientists from 10 countries) and for Western/Central Africa (18 scientists from 10 countries). The planning and follow-up workshops were performed jointly for the region. In addition, the planning activities and training course (18 scientists from 9 countries) were completed for South-East Asia. Version 1 of the computer-based training resource (CD) was released in late 2003. The resource contains modules, i.e. core texts on issues related with farm animal genetic resources, quantitative methods and teaching methods, and Resources containing case studies, breed information, maps, examples, exercises, video clips, a glossary and a virtual library. It also contains references to web links, books and other CDs. The participants found the training courses very useful; average score for Overall Impression was 8.2 (scale 1-9). They also indicated that the computer-based training resource would be a valuable tool both in teaching and in research, but had not yet had a chance to explore and use it fully. Impact assessments for Africa (questionnaire and follow-up workshop) showed that the training course has already had a substantial impact in many of the participants. Impact assessments for Africa (questionnaire and follow-up workshop) showed that the training course has already had a substantial impact in many of the participants' home institutions, both on teaching methods and on course content. Students have shown more interest and understanding of animal breeding and genetics. The impact on participants' research has been just as large; more focus on research involving indigenous animal genetic resources, improved research proposal writing, research methodologies and science communication skills, and also more efficient supervision of students' research. Many of the participants have actively disseminated materials and experiences from the course to colleagues in their home institutions. Other important outcomes have been increased contacts and an open e-mail network `Afrib' formed by the African course participants. The project also strengthened Swedish knowledge and expanded PhD activities on animal genetic resources in developing countries; these were valuable `spin-off effects' of the project. The 'training the trainers' approach adopted in the ILRI-SLU project seems to be a good model for effective capacity building to promote a sustainable use of animal genetic resources in developing countries. The approach was innovative and has functioned well; the model could be extended to other disciplines. Furthermore, linking universities from the North to those of the South, with a CGIAR institute playing both a facilitating and catalytic role was beneficial. The project will now proceed to South Asia and version 2 of the computer-based training resource will be developed. More impact analyses will also be performed

Disability Pension Rates Among Immigrants in Norway

Immigrants from low-income countries are more likely than ethnic Norwegians to receive disability pensions. In a previous study in Oslo, we showed that occupational position probably accounted for all of this difference. The present article presents a study of the total population, with data on education and age at receipt of pension. Census and social security data for all persons living in Norway from 1992 to 2003 were used to identify new disability pensions to those aged 30–55 years and eligible in 1992, comprising 15.9% females and 11.4% males. Age-adjusted relative risk was 2.03 (95% CI 1.97–2.08) for non-Western males and 1.30 (1.26–1.36) for non-Western females compared with Westerners, and more than three times higher for males from North Africa/the Middle East. Education did not explain any of the risk differences, but when adjusting for age at pension receipt the differences disappeared completely. This is probably due to their being in predominantly unskilled occupations where there is also a low pension age among ethnic Norwegians

Celastrus paniculatus and memantine prevent alcohol dependence and improve decision making in alcohol dependent C57BL6 mice

Background: Alcohol use disorder poses a huge burden with only a handful of approved drugs. AUD is associated with impaired decision-making that leads to compulsive drinking despite negative consequences. A drug that decreases alcohol consumption as well as improves decision-making may thus prove more useful. This study was planned to evaluate the effect of two drugs, Celastrus paniculatus and memantine on alcohol preference and decision impairment in alcohol-dependent mice. Methods: In part 1, the effect of both the study drugs on alcohol consumption was studied using intermittent access model in 70 male C57BL6 mice. In part 2, effect of drugs on decision making was studied using the rodent version of Iowa gambling task. Mice were divided in seven study groups: Group 1-3: Celastrus paniculatus (140, 280, and 560 mg/kg), Group 4: memantine (25 mg/kg), Group 5: vehicle control 1 (Milk), Group 6: vehicle control 2 (normal saline) and Group 7: naltrexone(1mg/kg). Results: Percentage alcohol preference was lower in test groups i.e., Celastrus paniculatus at medium (40.90±15.18%) and high doses (31.79±7.46%) vs. milk (82.74±8.53%; p<0.05); and in memantine group (36.28±10.99%) vs. normal saline (83.27±5.51%; p<0.05). The results were not significantly different to Naltrexone (19.70±6.90%). Percentage preference to disadvantageous arms was also lower in Celastrus paniculatus, at medium (50.52±1.92%) and high doses (48.11±2.43%) compared to milk (54.47±2.73%; p<0.05) and memantine (47.45±1.67%) compared to normal saline (54.00±2.73%; p<0.05), indicating better decision-making ability in the test groups. The findings were comparable to Naltrexone group (45.43±2.52%). Conclusions: These results indicate that Celastrus paniculatus and memantine reduce alcohol consumption and improve decision making in alcohol-dependent mice

Thy-1 Attenuates TNF-α-Activated Gene Expression in Mouse Embryonic Fibroblasts via Src Family Kinase

Heterogeneous surface expression of Thy-1 in fibroblasts modulates inflammation and may thereby modulate injury and repair. As a paradigm, patients with idiopathic pulmonary fibrosis, a disease with pathologic features of chronic inflammation, demonstrate an absence of Thy-1 immunoreactivity within areas of fibrotic activity (fibroblast foci) in contrast to the predominant Thy-1 expressing fibroblasts in the normal lung. Likewise, Thy-1 deficient mice display more severe lung fibrosis in response to an inflammatory injury than wildtype littermates. We investigated the role of Thy-1 in the response of fibroblasts to the pro-inflammatory cytokine TNF-α. Our study demonstrates distinct profiles of TNF-α-activated gene expression in Thy-1 positive (Thy-1+) and negative (Thy-1−) subsets of mouse embryonic fibroblasts (MEF). TNF-α induced a robust activation of MMP-9, ICAM-1, and the IL-8 promoter driven reporter in Thy-1− MEFs, in contrast to only a modest increase in Thy-1+ counterparts. Consistently, ectopic expression of Thy-1 in Thy-1− MEFs significantly attenuated TNF-α-activated gene expression. Mechanistically, TNF-α activated Src family kinase (SFK) only in Thy-1− MEFs. Blockade of SFK activation abrogated TNF-α-activated gene expression in Thy-1− MEFs, whereas restoration of SFK activation rescued the TNF-α response in Thy-1+ MEFs. Our findings suggest that Thy-1 down-regulates TNF-α-activated gene expression via interfering with SFK- and NF-κB-mediated transactivation. The current study provides a novel mechanistic insight to the distinct roles of fibroblast Thy-1 subsets in inflammation