EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Videos & Podcasts

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 4): Causality, Airplanes and GIDEON

As accident re-enactments go, this one is pretty Riveting

Links courtesy of NJ.com and Exosphere3D – All rights reserved – Copyright 2011

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The focus and calm of U.S. Airways Captain Chesley Sullenberger can be appreciated by listening to the audio portion of this re-enactment, as he made critical analyses – over a period of only a few minutes – on how (and where) to land a disabled aircraft sinking earthward over a densely populated area. His decisions saved 100% of the lives on board that day.

Hang out with a bunch of epidemiologists long enough and eventually the conversation while turn to Causality. They will tell you that there are some big differences in semantics between linking causation, etiology and “proof” that X exposure caused Z disease or health condition. When I looked up the terms “causation” and “causality” (on Google) there were major sidetracks, such as WBA (Why-Because-Analysis) as in, Why did the airplane crash? Why did the reactor experience a meltdown?

Why? From the viewpoint of a physician, an engineer or an epidemiologist… because of X-Y-Z.  

X-Y-Z could be bird strikes, human error, engine failure, weather conditions, crazed people bearing guns, lack of fuel or a thousand other accidents waiting to happen. Often the causes can be identified. Sometimes one can only attribute unanticipated events to gauzy, fuzzy concepts such as “it was a one in a million chance” or “this was God’s will”,  “causes unknown” or just plain Karma. The harder (non-fuzzy) data can be applied towards improvements in systems design, development of new vaccines, engineering safety… all targeted towards avoidance of future accidents (or disease outbreaks).

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Epidemiologists save lives.  Sometimes this association accumulates slowly… as in proving associations between Exposure X and development of Disease Y decades later.  In other cases, evidence mounts up as an emergency, such as the identification of a novel virus identified as SARS in 2002.  But linking health effects of exposures over a human life-span is so much more elusive than showing evidence that birds got sucked into a jet engine at 2,500 feet (as above).

Turning to the PubMed database, a screenshot below from Medical Subject Headings List (MeSH) reveals how the term “causation” is mapped in the online thesaurus of medical indexing terms:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

One way to search a large database such as PubMed is to simply type in some words – for an example, Liver Cancer AND Epidemiology.  This pulls up over 18,000 retrievals…  too many (!), but by then selecting and applying standard Limit Fields such as Language, Journal Subset, Age Group, Gender and others, the retrievals can be filtered down to a more-manageable number.

A more precise way to search a large database like PubMed is to use the Medical Subject Headings list. In the example below, the term Liver Cancer was typed into the MeSH search page, which maps automatically to the preferred MeSH term — Liver Neoplasms. While this search still retrieves thousands of citation, they can be limited by selecting and applying any MeSH Subheading (or clinical qualifiers) that are appropriate to the search. These subheadings include clinical concepts such as Virology, Immunology, Genetics, Epidemiology, Transmission and 80 others.  Following is a screenshot of that type of search:

Image Source: NLM (http://www.ncbi.nlm.nih.gov/mesh) – All rights reserved – copyright 2011

Remember that a librarian’s idea of “causality” could be defined, in part, by the number or types of clinical subqualifiers selected (immunology, virology, epidemiology and those types of “background” concepts) to be combined with the formal MeSH term.

There are many ways to search. It helps a novice medical searcher sometimes to tell them just that: There is no one right way to search. Sounds enigmatic and it is.

Here is an example which I found recently in the medical literature, a 2010 article which discusses application of Bradford Hill criteria (listed here):

  • strength of association
  • consistency
  • specificity
  • temporality
  • biological gradient (dose-response)
  • biological plausibility
  • biological coherence
  • experimental evidence and
  • analogy

 Image: http://www.ncbi.nlm.nih.gov/pubmed/20644061 – All rights reserved – Copyright 2011

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Those searching for practical answers about causality, transmissible agents, disease etiology, global prevalence or current treatments might want to search GIDEON (Global Infectious Disease Epidemiology Online Network), an interesting “niche” information source targeting the research requirements of epidemiologists, clinical & translational researchers, MPH students, toxicologists or anyone interested in tracking or diagnosing infectious diseases on a country- or world-wide scale (subscription required). Updated weekly, the database is produced by Gideon Informatics and hosted on the EBSCO platform.

A search for causality or epidemiology done in the resources indexed by GIDEON is quite unlike a search done in PubMed about the etiology of Liver Cancer. The producers collect, review and index factual data collected from around the globe; their data encompasses a wide and diverse group of human cultures, agricultural, societal, economic or environmental practices.

Below is a screenshot of one example of the type of data that can be searched on GIDEON: bacterium (causative agent), typhoid (identifiable infectious agent) and United States (location, recorded incidence over time):

.Finally, a screenshot of What’s New at GIDEON (May 11 2011):

Image Source: GIDEON – All rights reserved – copyright 2011


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News, University of Connecticut, New Leadership: Radio Interview with Dr. Susan Herbst

Spring has finally arrived.  At this time of year March Madness – it is so easy to get caught up in the hoopla and excitement surrounding men and womens’ College Basketball.  In 2011, this is made easier by the fact that both the UConn women and the men are doing very well in tournament play… Go Huskies!

However, a lasting and more significant change in academic leadership is set to take place in July 2011, with the arrival of the next University of Connecticut president, Dr. Susan Herbst.

This month on Connecticut Public Broadcasting Network (CPTV), local affiliate of National Public Radio (NPR), Dr. Herbst was interviewed on the talk-radio series Where We Live.  Host John Dankosky conducted the hour-long interview on Mar 22 2011.

Below is a screenshot of the Where We Live site and a link to the transcript of the interview:

Image credit: http://www.cpbn.org/where-we-live-full-episode-archive – All rights reserved – copyright 2011

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Welcome to Dr. Herbst!  For more current news about University of Connecticut, click on  http://today.uconn.edu (main campus) or for UCHC news, go to: http://today.uchc.edu.  

Clinical Tutorials, Teaching & Learning in Medicine: That Old Krebs Cycle, with Singing

I apologize for the lack of blog-posts this month… it’s been pretty busy around here.

Today’s post is about metabolic pathways, which the first-year students are deep into studying this month. Here is a link to a pretty illustration which was found on Wikipedia:

Image Source: http://en.wikipedia.org/wiki/Template:Metabolic_pathways – All rights reserved – Copyright 2010

Each year in PBL, I struggle to re-remember facts about biochemistry, cellular signaling and metabolism including steps in the Krebs cycle*. (Why? Because I never took biochemistry.) Two years ago, I found the illustration below so useful that I decided to post it on the blog for the second time!

Image Source: http://en.wikipedia.org/wiki/Krebs_cycle – All rights reserved – Copyright 2010
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Next, a small joke: WWSD (or, what would Setlow do)? He could sing along to this Krebs Cycle song, found on ScienceGroove.com.

Image Source: http://www.science-groove.org/Now/Krebs.html – All rights reserved – Copyright 2010
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Publisher McGraw-Hill has placed some content from their textbook Anatomy & Physiology (7th edition) online for free, including this tutorial and quiz titled “How the Krebs Cycle Works“.  After you take the quiz, relax by working a few of their Crossword Puzzles:

Image Source:  http://highered.mcgraw-hill.com/sites/0072507470/student_view0/chapter25/crossword_puzzles.html – All rights reserved – Copyright 2010
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Salman Khan founded a non-profit group, The Khan Academy, with the goal of providing high quality free online educational materials to anyone in the world.  This year, their collection of videos about Science, Math, Humanities, History, Finance and other academic subjects has grown to 1,800. A 10-minute video describing the educational content is here: Khan Academy.

Found on their ScienceBiology category: a 13-minute lecture describing the ATP (adenosine-triphosphate) process.

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On YouTube, author Faxe14011991 has posted this series of short animations/tutorials on cellular mechanisms, each of which is less than two minutes in length:

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Finally, a video found on YouTube called Cellular Respiration (hey there Delilah)

Image Source: http://YouTube.com – All rights reserved – Copyright 2010

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* Dr. Krebs was a Nobel Prize laureate.  Read the following text, found on the nobelprize.org page: ” The Nobel Prize in Physiology or Medicine 1953 was divided equally between Hans Adolf Krebs for his discovery of the citric acid cycle, and Fritz Albert Lipmann for his discovery of co-enzyme A and its importance for intermediary metabolism.

News, Questions: Celebrating a 3rd Blogiversary… And Stay or Go?

Today, Tuesday, Jul 27 2010, is the third Blogiversary of the EBM & Clinical Support Librarians@UCHC blog on WordPress.

My question for today is:

After 380 posts, 280 comments, 1,598 tags and 89,000+ spam comments, the question is: should I keep blogging or should I hang it up after three years?

Please, dear readers, provide me with some direction on whether to continue blogging… or not.

While you listen to this classic by The Clash

Video Credit: http://www.youtube.com – All rights reserved – copyright 2010

Thanks!

Oncology, Statistics, Summary Reports: Treating Cancer, Living with Cancer

Ask almost anyone you know about cancer, and they will have stories to relate about parents or family, close friends or co-workers (or themselves) who have received a diagnosis of cancer, or are going through treatments, or who have been declared cancer-free.  Living as a cancer survivor has become more common, thankfully, than in previous decades, and represents one of the health success stories of our era.

This post presents a short, eclectic sample of recent cancer-related news, statistics, research or summary reports.  The final portion of the post links to video presentations given by two UCHC research faculty as they discuss clinical and translational cancer research (filmed in November 2009).

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First: The National Conference of State Legislatures (NCSL) website provides an assortment of statistics or background pieces on state-based social or economic indicators, health initiatives, legislation or other current issues.  This site is a valuable resource for reference librarians, epidemiologists, policy-makers or anyone seeking current statistics about state-sponsored programs.

NCSL provides a collection of documents about Cancer Data, Trends and Policy 2009 reports, free and open to anyone to access (although registration is required to view some of the tables).  That page is where the table describing U.S. Cancer Incidence, 2009 shown below. According to statistics from the American Cancer Association, lung, prostate or breast cancers represent the most common diagnoses in the United States in 2009:

Image Source: http://www.ncsl.org/Portals/1/Documents/magazine/articles/2009/SL0110_Statestats.pdf – All rights reserved – Copyright 2009

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Next:  Several paragraphs from a December 2009 article written by Harmon J. Eyre, formerly chief medical officer of the American Cancer Society, entitled “Winning the Cancer Fight: Looking at the Future“:

” The medical management of cancer for the past 100 years has grouped cancers by the organ in which they originate and used standard interventions such as surgery, radiation, and chemotherapy.  With the development of the cancer genome anatomy of various cancer sites, individualized cancer therapy will quickly follow.

Specific genetic profiles are being introduced to project the risk of breast cancer recurrence and to shape the choice of treatment agents. We have decades of data on outcomes using estrogen receptor, progesterone receptor, and human growth factor receptor 2 testing which dictates treatment in breast cancer. Tests such as these are needed for lung, colon, prostate, lymphoma, leukemia, and other cancers. They are beginning to be developed and disseminated, with encouraging early results.

Despite keeping records in cancer registries for many decades, widespread evaluation of the level of quality care in cancer is lacking. We know that large variations in the delivery of care occur by hospital, city, state, and region. There are a number of groups working to develop indicators of quality cancer care, but there is a lack of agreement on these indicators and they are not being widely collected. For optimal outcomes, quality care has to be delivered nationwide to all cancer patients. ”

Text Source: Page 863 – Primary Care, Vol. 36:859-865 (December 2009) – All rights reserved – Copyright 2010

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An 18-page annual report from American Society of Clinical Oncology entitled “Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report
From the American Society of Clinical Oncology
” was published in December, 2009.  Following is an excerpt from this report:

This report [from ASCO] now it its fifth year, was developed under the guidance of a 18-person editorial board made up of leading oncologists and other cancer specialists… The editors reviewed research published in peer-reviewed scientific journals and the results of research presented at major scientific meetings over a 1-year period (October 2008 to September 2009).

Only studies that significantly altered the way a cancer is understood or had an important impact on patient care were included. Research in each section is divided into “major advances” and “notable advances,” depending on the impact of the advance on patient care and survival. “

Excerpt from ” Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report“, published Dec 10 2009 in Journal of Clinical Oncology – Vol. 27, No. 35:6052-606

ASCO provides links to reference information about current cancer treatments for physicians or other clinical staff, called Cancer Portal, which can be accessed at this link.

The society also provides free cancer information targeted for people living with cancer on their website, Cancer.net.

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Next: Two segments from a lecture series given in 2009 by UCHC faculty.  Oncologist Susan Tannenbaum is Medical Director of the Clinical & Translational ResearchProgram at UCHC, is shown in a 54-minute presentation on trends and improvements in the treatment of metastatic breast cancer.

The second video is a presentation on translational research given by Kevin P. Claffey, PhD, who is co-director of the UConn Health Center Breast Cancer Translational Research Group and an associate professor in Cell Biology, Center for Vascular Biology.

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Video Credits: http://mediasite.uchc.edu/Mediasite41/Viewer/?peid=22f078e3c075411380af60acdab8da83 – All rights reserved – Copyright UCHC 2010

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Next: Regarding a May 6 2010 New York Times editorial written by Nicholas D. Kristof:

In “New Alarm Bells About Chemicals and Cancer” (column, May 5 2010) writer Nicholas D. Kristof drew attention to a document being released by the President’s Cancer Panel that warns that – in Mr. Kristof’s words – “our lackadaisical approach to regulation may have far-reaching consequences for our health. ”

Text Source: The New York Times – All rights reserved – Copyright 2010

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I found readers’ comments as (or more) interesting to read as the original editorial.  There are 200+  comments which can be read at this link:  http://www.nytimes.com/2010/05/08/opinion/l08kristof.html

The Friday Post #50: Nerd, Geek or Dork? Fish or Search? and a Vintage Cartoon

Here’s the 50th Friday Post!

OK, I have taken the “Nerd? Geek? or Dork? Test“. You can too.

Here are my results:

Image/Source credit: http://www.okcupid.com/tests/the-nerd-geek-or-dork-test – All rights reserved – Copyright 2010

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“Fishing”  as “searching” parable

(Apologies to John Steinbeck)

There are good things so in the tide pools and interesting thoughts to be generated from the seeing.   Every new eye applied to the peephole which looks out at the world may fish in some new beauty and some new pattern, and the world of the human mind must be enriched by such fishing. “

Source: From a foreword written by John Steinbeck for the 3rd edition of Between Pacific Tides, written by Ed Ricketts and Jack Calvin’s book (originally published in 1939).

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Here is a nerdy-librarian transposition of such an elegant statement about marine life and cephalopods:

” There are good things so in the tide pools databases, and interesting thoughts to be generated from the seeing searching.   Every new eye applied to the peephole Google, which looks out at the world, may fish in some new beauty and or discover some new pattern [of relational knowledge], and the world of the human mind must be enriched by such fishing knowledge retrieval. “

Source:  Creaky being silly (or stupid or both)

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Anyone who reads this blog might recall that I’m fond of cephalopods. However, even I am very doubtful about this unusual video (dialog in Japanese) called Baby Octopus (claymation), circa 1960’s:

Source:  http://www.YouTube.com – All rights reserved – Copyright 2010

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My goodness, what happened to the baby octopus? Is that anyway to treat a cephalopod?  No.

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That’s the Friday Post #50 for May 21 2010, folks.

Enjoy this beautiful weather.

News: Today is Earth Day – Happy 40th Anniversary!

April 22 2010 is Earth Day

Image Credit: Courtesy of NASA – The Blue Marble – All rights reserved – Copyright 2010

Today marks the 40th Anniversary Celebration of Earth Day

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Matt Harding has visited many different places on this beautiful globe

(and admits to dancing badly while visiting all of them)

Image Credit: Courtesy of youTube.com – All rights reserved – Copyright 2010

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Thank you, Planet Earth ~ Sit in the sun ~  Plant a tree ~ Enjoy!

News, Healthy Communities: This is Public Health

Today – April 7 – is World Health Day

in addition to

National Public Health Week 2010

Image credit:  http://www.nphw.org/nphw10/home1.htm – All rights reserved – Copyright 2010

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First, two items about international community health projects:

The Comprehensive Rural Health Project (CRHP) has been working among the rural poor and marginalized [in rural Jamkhed, India] for over 37 years. By partnering with village communities and expanding upon local knowledge and resources, the project aims to effectively meet the immediate and long-term needs of these groups, especially women. With values of compassion, justice, respect and trust, CRHP works to empower people, families and communities, regardless of caste, race or religion, through integrated efforts in health and development. ”

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010

These videos (filmed in 2007) briefly describe two of the CRHP projects:

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Video credit: http://www.youtube.com – All rights reserved – Copyright 2010

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The CRHP in Jamkhed operates a 40-bed low-cost secondary care hospital providing quality emergency, medical, surgical, and outpatient care for the 1.5 million people residing in the surrounding 8 block catchment area. Each year about 20,000 outpatients receive treatment, 250 deliveries take place (high-risk referrals), and 400 surgical procedures are performed. Most deliveries take place in the village and because we provide extensive training for VHWs (village health workers) and birth attendants these deliveries are very safe. “

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010

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Video credit: http://www.youtube.com – All rights reserved – Copyright 2010

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Next:  A novel community mental health outreach program.

Data collected by staff at the U.S. Department of Veterans Affairs (VA) agency show that approximately 20% of American veterans returning from Iraq or Afghanistan are diagnosed with mental health disorders.

Dr. Karen H. Seal was lead author on a recent research study published in the Journal of Traumatic Stress (Vol. 23-1  Feb 2010) which examined how former combat veterans are being diagnosed and treated for mental health disorders within the Veteran Affairs health system including post traumatic stress disorder (for years 2002 through 2008).

The authors’ conclusions?  Only about 30% of the population studied received the recommended treatments for PTSD through the VA healthcare system.

Janie Lorber wrote an article in The New York Times (Apr 2 2010) entitled “For the Battle-Scarred, Comfort at Leash’s End”  which describes the mission and work of a non-profit foundation called Puppies Behind Bars (PBB) that selects and trains volunteer prisoners to provide 24×7 care and training for puppies chosen to become companion-service animals for disabled veterans whose mental or physical disabilities have prevented them from easing back into the practical daily challenges of civilian life.

View this video link from the New York Times website for interviews with prisoners who are now actively caring for and training service puppies. 

PBB has established canine training programs for inmates housed in six prisons in New York, New Jersey or Connecticut;  there are currently 90 animals in the program.  PBB also trains dogs to serve a very different aspect of public health and safety: detection of explosive devices.

This therapeutic community effort extends benefits to both disabled veterans and the groups of incarcerated men and women training the dogs.  The dogs look like they are enjoying themselves too.

Photo credit: http://www.newyorktimes.com – All rights reserved – Copyright 2010

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Finally: Here’s a link and calendar to special events at UConn this week that celebrate National Public Health Week 2010.

The (Good) Friday Post #49: Easter Greetings, Volcanoes, Helen Mirren and A Nerd Test

Here’s the (Good) Friday Post #49 for Apr 2 2010

First:  Anyone want to take a stab at pronouncing the name of this city in Iceland, where a volcano erupted this week…  ??

Image credit/source:  http://www.youtube.com/user/AssociatedPress – All rights reserved – Copyright 2010

Hello! to those folks from Connecticut who are currently vacationing in Iceland.   Sure hope you got to witness this volcanic event which took place on Mar 31, 2010:

Image credit/source:  http://www.youtube.com/user/AssociatedPress – All rights reserved – Copyright 2010.

I enjoy watching Helen Mirren as an actress…  from Prime Suspect to The Queen.  She is so convincing.

In the 1980 film, The Long Good Friday, she plays the role of girlfriend to sullen gangster Bob Hoskins; it is a tough movie full of bad guys set in downscale London.  It would be a fine movie to watch on a Good Friday.

Image credit/source:  http://tinyurl.com/yfx9cv3 – All rights reserved – Copyright 2010

Would it surprise anyone to learn that a librarian got a test score of “Nerd” on the Geek? Nerd? or Dork? Test? (No!)

There’s also a Personality Defects Test on this website but, my friends, those results won’t be discussed on this blog.

That’s the Friday Post for Apr 2 2010, folks!

Let the Good Times roll

Photo credit/source: http://tinyurl.com/yjnvbku – All rights reserved – Copyright 2009
All Easter borders – Image credit/source: http://tinyurl.com/yhkp28u – All rights reserved – Copyright 2010

The Friday Post #46: That old Cardiac Rythmn, Medical Fiction and Jude Law

This is the Friday Post #46 for Feb 5 2010.  Let’s consider matters of the human heart because St. Valentine’s Day will be here soon, and because this is National Wear Red Day, a public service campaign aimed toward women which promotes awareness of cardiovascular health and fitness, sponsored by the American Heart Association.

Systole/Diastole Song

…. Ha ha ~  It’s a bit repetitious

Video Source/Credit: YouTube.com – All rights reserved – Copyright 2010

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The Mad Professor does the ECG Dance

What a way to learn Normal Sinus Rhythm!

Video Source/Credit: YouTube.com – All rights reserved – Copyright 2010

My goodness, don’t his arms get tired?

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Finally:  It’s no secret that this blogger needs some good strong coffee in the morning in order to get moving, wake up and be productive.  It snowed on Wednesday morning here in the Northeast, making for an ugly, accident-ridden commute.  Getting to work a bit late, and getting a cup of French Roast, I sat down to my computer to check my email and the latest medical news online.

Then I checked my blog statistics, which linked to an item on the Health Blog from Wall Street Journal, which led me to a news item on Digg advertising something called “The Union“.

(Disclaimer:  This is about medical fiction, Hollywood style, folks!)

Image Source: http://Digg.com – All rights reserved – Copyright 2010

It gets weirder: The link opens a website named UnionCares.com, a glossy page with sincere video testimonials, lush graphics and a catalog of high-tech mechanical human organs for sale, at high-cost and extreme profit to the ruthless company that created them.  And payment plans.

The fictional items “for sale” look like they were manufactured by the same industrial designers who created the Terminator.

Image Credit: http://www.theunioncares.com/ – All rights reserved – Copyright 2010

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This site gave me a nasty shock… did I miss hearing about something really big having to do with trends in transplantation?!  Was this a French Roast-coffee-deprivation thing clouding my reasoning abilities at 930am?

Thank God they’re not real.  The whole site is a promotion for a film (whew) due to be released in March 2010, called Repo Men.

This is not the same movie as the classic 1984 film, Repo Man, or the 2008 musical.  And Jude Law is in this film… !

However, seeing that artificial liver left me feeling a bit sick… so I finished the coffee, skipped the donut.

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That’s the Friday Post #46 for Feb 5 2010, folks.  Have a great weekend and good luck on exams next week!