Sunday, November 22, 2015

Understanding maths, or writing down the answers

Bipods have two legs, and tripods have three.   At least two of each land on earth, and they have 23 legs.  How many of each are there?

Well, I thought of solving it with equations.  But there are two unknowns and only one equation.  So I borrowed two primary maths books from the excellent Educational Resource Collection (for trainee teachers - hope they also got the ones they wanted!) at work.   Starting with a guess, was the suggestion.  So we did, and with a bit of use of the 2 and 3 times tables, we arrived at an answer.

There is more than one answer, so we tried to find another.   But we did not understand how we had got to the first answer, so we could go not go any further.

I was not sure what to do next.  I am a Primary PGCE drop out.   So, I recommended we (well, my son) ask his teacher.

The next night, my son wrote down his own fraction problems.  He wanted to do them himself, and take them to school to show his teacher.  An admirable application of what he had learned. 

Some were easily solved using the techniques he had learned at school.

One was 5/10 of 48.  He drew 10 boxes and proceeded to share 48 dots between them.  He ended up with some boxes with 6 and some with 5 dots and was not sure what to do next.   I asked how else you could write 5/10?    1/2, he said.   He tried again, with two boxes, and worked it out.  

Then the next was 6/9 of 50.  The same problem with the boxes, and with no solution in sight, he was very upset that he would have to take the answers to school with blank spaces in.  One of his friends had written out some questions and had no blank spaces, he said.   Maybe, I said, he had not come up with any questions that he had not done at school.  Remember, these were questions my son had written himself, and however many times I told him not to worry, because he had come up against some maths he did not know, he was most upset.   Having the answers was more important than knowing how you got there, and more important than saying "I don't know" and realising that the methods you know don't work, even if you don't know why.

So, when devising assessments or assignments, I need to remember - make them so people have to understand a process, as well as having an answer.

Talking with children about the news


Son #2 has become fascinated by skyscrapers, especially the Burj Khalifa in Dubai, the world's tallest building and definitely a tremendous piece of engineering.  His fascination extends beyond this building, and includes skyscrapers in New York.  His mum and I were lucky enough to visit the city some years ago, and came back with a lovely illustrated book about the city's skyscrapers.  He can also tell you, if you want to know, some of the world's previous tallest buildings, which include several in New York, of course, and also the Eiffel Tower, which has also been met at school as part of a project about "Fantastic France".

The news?   Recent news.  Our son's class spent some time at circle time earlier this week remembering the recent terrible events in Paris, after a classmate had mentioned seeing about it.

The Guardian reported what the French education ministry had done to help teachers. 

And older news.  From 1970 to 1973, the tallest building in the world was the original World Trade Center in New York.  It appears in books we had read, but so does the new one (as a design), and so I had said that the original one was no longer there, that it had been replaced by new buildings, including the "Freedom Tower", which we had read about.  

And that was going to be that, until he was older.

And then, there we were, watching a documentary about building an enormous artificial island in Dubai.  The island was designed to increase tourist visits to Dubai, to start to develop alternative sources of income to replace, in due course, oil.   Work started in August 2001, and was affected by the global downturn in tourism that followed 9/11.   And the programme showed, briefly, what happened to the World Trade Center.  I am glad I was watching it with him.  So, we had to talk about what had happened.

I don't think the answer he needs now to the question of "why" is the one that he will need when he is older.  For now, I hope it was ok to tell him that it was not an accident, and that people did die (he asked both those things, and he had seen a photo of a plane that crashed some years back into the Empire State Building). 

So, how do you talk to children about the news?    I am not thinking here about breaking bad news to them about their health or the health of family members.  That should be the subject of a separate post.   But, how you talk to them about difficult stories in the news.  You can, as I tried to, not tell them, but they will find out about the news story sooner or later and they will want to know.

Here are a few things that look useful. 

BBC's Newsround has advice for children/young people on what to do if you are upset by the news.


PBS Parents


Common Sense Media

HealthyChildren.org - an American Academy of Pediatrics site.  

A lot of British advice that I found was about dealing with bereavement, abuse or illness, but Cranmer Primary School in Mitcham, Surrey, has taken some American advice and amended it for a British context. 

A interesting newspaper item is this one from the New York Times, reporting French sources and media.
   

Saturday, November 21, 2015

HIV

American actor Charlie Sheen recently announced on a television chat show that he was living with HIV, which has got some media coverage, including some that suggested that not everyone knows how HIV is spread.   

I don't know how typical this Guardian story is, but it does suggest that some people do need more information, and up to date accurate information, about HIV.

When I started working in health libraries in 1986, AIDS was a very current topic.  I remember hearing ideas about who was most at risk, and what some people said definitely conveyed the idea that it was a condition that affected gay men, and not anyone else.  I also remember learning about Edinburgh, where I had just moved from, that the group most affected there was not that group at all.  Richard Holloway, who became Bishop of Edinburgh the year after I left the city, realised when he moved there that the community affected in Edinburgh was not the same as the one affected in Boston, Massachusetts, where he had lived and worked before.

Then there was the government's television advert and leaflet, "Don't Die of Ignorance", preserved here at the National Archives.

For today's information about HIV, including how it is spread, and all the developments in treatment and pre- and post-exposure prophylaxis, have a look at these:

NHS Choices: symptoms, causes, diagnosis, prevention and living with HIV and AIDS, plus stories, details of clinical trials, and a discussion forum.

Clinical Knowledge Summaries: for primary care health practitioners, covering diagnosis and management, with scenarios.  CKS links to supporting evidence, but in this case it is guidelines and review articles, with no information about anti retroviral treatments, which are beyond the scope of the information.  CKS information was last updated in September this year.  CKS is one of the sources picked up by NICE Evidence Search, which you should try for other sources.

The Terrence Higgins Trust, founded in 1982 and named after one of the first men to die of AIDS, has publications, information on sexual health and on living with HIV, and the history of the Trust gives an insight into the history of what is known about HIV and AIDS.  There is also information on the activities of the Trust itself, and its local centres.

Thanks to the THT site, I know that National HIV Testing Week begins today, 21st November.

In the United States there is information at Aids.gov (managed by the Department of Health and Human Services), CDC, and Aidsinfo, from the NIH.  Aidsinfo uses Google Translate to provide information in other languages, and the other sites are available also in Spanish.

The World Health Organization has information, including data and statistics, information on treating children, on mother to child transmission, and on co-infections.  Use the links at the top right to get the information in Arabic, Chinese, French, Russian and Spanish.



Friday, November 13, 2015

Elizabeth Blackwell


We read the excellent Judy Moody books to son #1, and now we have started reading the first one in the series to son #2.  I can't remember how we first came across the books, but if you are not familiar with them, you can find out more about Judy and the books on her website.

You may by now be wondering what Judy has to do with the title of this post.  Well, Judy knows about Elizabeth Blackwell, first woman doctor, and wants to be a doctor too.  Elizabeth Blackwell was the first woman to be awarded an MD degree in the United States, in 1849.  She supported medical education for women, and wrote books about it, and founded a hospital in New York in 1857 as a way to enable women to get medical internships.  She was actually born in Bristol, England, and moved to the United States as a child.

Here are some places to find out more:

National Library of Medicine - Changing the Face of Medicine.  This site celebrates America's women physicians, with biographies of physicians past and present.

National Women's History Museum, Alexandria, Virginia (as it happens, Judy Moody's home state).

Schlesinger Library Newsletter, Radcliffe Institute for Advanced Study, Harvard.   The Library has information about the Blackwell family, which included Elizabeth's sister Emily, who with her promoted medical education for women.  Other family members included important people in the abolition movement, and the first woman church minister in the United States.  The Library's information about the family includes a link to digitised family papers.  

Wellcome Trust

Hobart and William Smith Colleges,  New York State.  The colleges are the successor to Geneva Medical College, where Blackwell studied.

Science Museum, London.

NNDB. Biographical site, whose NNDB Mapper enables you to explore links between the subjects of the biographies and learned societies.  There are no links for Blackwell, not yet, anyway.

Blackwell's Wikipedia entry is quite extensive and has links to a range of other material.

Elizabeth Garrett Anderson, the first woman in England to qualify in medicine, met Blackwell, and needs to have a post all to herself.

Tuesday, November 10, 2015

Hans Krebs

The University of Sheffield is currently holding its Krebs Festival, a celebration of the work of Hans Krebs, who won the Nobel Prize in Physiology and Medicine in 1953, for work done at the University.  The Festival is the reason for the giant E. coli in the Winter Gardens, as described in an earlier post.

Hans Krebs was born in Hildesheim in 1900.  He was Jewish and was dismissed from a University post when Hitler came to power in 1933.  He came to England, working in Cambridge before taking up a post at the University of Sheffield in 1935. After 3 years in Sheffield, he became a professor in the newly formed Department of Biochemistry, and then led an MRC funded research unit.  He moved to Oxford in 1954 and took this unit with him.

Here are a few sites about Hans Krebs and his work. 

The official website about the Nobel Prize: information about Hans Krebs and Fritz Zimmer, winners of the 1953 prize in physiology or medicine.  Click the links on the left to read a biography of Krebs, his Nobel lecture and a speech given at dinner.

University of Sheffield: KrebsFest

To discover how the Krebs Cycle is linked to the Tour de France, have a look at this page from the Deconstructing the Tour site, also from the University of Sheffield.

School of Biomedical Sciences wiki, University of Newcastle upon Tyne,  last updated in October 2015.

This is a search of PubMed for articles with H Krebs as a personal subject.   The list of results includes obituaries (Krebs died in 1981), a paper from the Biographical Memoirs of the Fellows of the Royal Society of London and a supplement to FEBS Letters published in 1980, containing papers to mark his 80th birthday.

To discover the Krebs Cycle through music, look at Science Music Videos, for a video of the song, interactive lyrics, diagrams and flashcards.  The songwriter is Glenn Wolkenfield, a high school teacher in Berkeley, California.    The song is also on YouTube

This made me think of the Biochemists' Songbook, which I encountered a long time ago, and looking it up on Amazon reveals the second edition had a foreword by Hans Krebs.  The songs are available as MP3 files on a site hosted at California State University, Long Beach, and also on this site at Queen's University Belfast.  And that seems a good place to end this post.



Friday, November 06, 2015

Critically appraised topics

Via social media I find out about this paper from the British Journal of Dermatology (you will need a subscription to see the full paper).  It is a critically appraised topic about the use of diphenylcyclopropenone to treat alopecia areata, and involves a literature search carried out by Jacqueline Limpens, a medical librarian at the Academic Medical Center in Amsterdam, which is how I found out about it.

What is a "critically appraised topic"?  

Also known as a "CAT", a critically appraised topic is "is a short summary of the best available evidence, created to answer a specific clinical question", quoting from the University of Groningen listed below.  

Here are some resources about what a CAT is and how to carry one out:

BestBETs - Best Evidence Topics are a modification of the CAT.

CATMaker, software for creating CATs, from the Centre for Evidence Based Medicine, Oxford. 

CATWalk: a guide to critically appraised topics (University of Alberta)


LibGuide from the University of Groningen (in English)


Occupational therapy critically appraised topic
 
Physiopedia: Critically Appraised Topics

University of Texas Health Science Center - what is a CAT?

And here are some articles with links to PubMed:


Kelly AM, Cronin P.
AJR Am J Roentgenol. 2011 Nov;197(5):1039-47.
PMID: 22021494

Kelly AM, Cronin P.
AJR Am J Roentgenol. 2011 Nov;197(5):1048-55.
PMID: 22021495

Sadigh G, Parker R, Kelly AM, Cronin P.
Acad Radiol. 2012 Jul;19(7):872-88.


There is also this:

Sauve S, Lee HN, Meade MD, et al. The critically appraised topic: a practical approach to learning critical appraisal. Ann Roy Soc Phys Surg Can 1995; 28:396–398
 
(One of the et al. is David Sackett, and I wonder if this is the original description of the idea).

Reusing a search strategy

Other people's search strategies can be a useful source of search terms, and synonyms.   I wrote in an earlier post that you should not just reuse a strategy.  Using an existing strategy as a source of ideas is ok, but you need to understand how it works, and make sure that there is nothing missing. 

But, of course, you might be updating a review.  In which case, you would want to rerun the existing search.  I think these are the issues to look for, assuming that you are not changing the research question or topic of the review.

1.  Is there anything that should have been done differently?  Is there anything missing?  Is it ok to amend the strategy, just because you now see a better way to do it?    At the moment, I think this is a matter for your supervisor, tutor, or someone with more knowledge of systematic review methodology than me!

2.  Are there any new subject headings to include?   MeSH is updated annually, and perhaps since the search was first run, there is a new heading.  I think in these cases, it is ok to amend.   For example, there is a MeSH term Patient Handoff/.  It was first used in 2013.  If the original search predates that, it will not include the term, so you ought to add it.   What should you do to ensure you still find older references?  How are they indexed?   Checking MeSH (for example, in PubMed's MeSH database) may tell you. 

3.  Was the original search run in the same interface?   Perhaps it was run in Medline via Ebsco, and you have access to Medline via Ovid.  If this is the case, you need to translate the strategy and make sure that proximity operators and truncation are correct for the new interface.   I wrote an earlier post about this sort of thing.  It is also possible that the capabilities of the interface have changed since the search was first run, and this is a "translation" as well.


Translating search strategies

Not sure if I borrowed this term, or invented it, but I mean modifying a search strategy for use in another database.   For example, if you have a Medline strategy, what do you need to change to make it work in, say, PsycINFO or Embase?  Other databases might have different features or functionality.

There are two areas where translation is necessary, once you have finalised your strategy.  I have assumed in what follows that you have a Medline strategy, and want to translate it for use in other databases.

One area is search syntax (proximity operators, truncation, and so on), and the other is subject headings.

For example:

Proximity operators.   In Ovid Medline, adj finds your two terms adjacent to each other, so:

heart adj disease 

finds heart disease.

More usefully, perhaps, adjn finds your two terms within n words of each other, in either order.  So:

heart adj2 disease

finds heart disease, disease of the heart.

heart adj2 disease* 

finds those, and also diseases of the heart.

adj and adjn work in Ovid Embase, and also in the HDAS NHS England databases.

In PsycINFO via Ebsco, adjn is Nn.  In Web of Science and the Cochrane Library (via the Wiley interface) it is NEAR/n.

Truncation and wildcards.  In many databases truncation is done with *.  Ovid Medline, Embase and HDAS use * but will also accept $. So, disease* finds disease, diseases, diseas* finds those and diseased.  In many databases, you can use ? and # in the middle of words to stand for one character, or for one character or a space, respectively.  So:

wom?n finds woman, women
p#ediatrics finds paediatrics, pediatrics

You would need to check in your database that * is the truncation symbol, and if you can use wildcards like ?, #.

Phrase searching.   Ovid assumes that two adjacent words are a phrase, but NHS databases, Cochrane, Web of Science and PsycINFO via Ebsco do not and you need to mark phrases "like this", in speech marks/double quotes.

Subject headings.  Your Medline search will (or should!) include MeSH terms.  But your next database might not have MeSH.  Cochrane does use MeSH (but not in all databases), and you need to use the Search Manager to be able to browse headings.  Web of Science has no thesaurus, and PsycINFO and Cinahl have their own.  

In PsycINFO or Cinahl, identify the term that is used for the concept you are searching, by entering the MeSH term or another keyword and exploring the thesaurus.    

Cinahl's thesaurus is, I think, based on MeSH, but the term might differ, or it might be possible to explode it in Medline but not in Cinahl (Diabetes Mellitus, Type 2, is an example).

PsycInfo will have more detailed terms for psychological concepts, but possibly less detailed for other things.  For example, there is only one subject heading for Diabetes, which includes Type 1 and Type 2.   

Embase's thesaurus goes into more detail with regard to things like drug delivery route, and may have different terms for a concept.  For example, type 2 diabetes in Medline is indexed under Diabetes Mellitus, Type 2, and in Embase under non insulin dependent diabetes mellitus.

In a database without a thesaurus, I would ensure I have searched for the MeSH term as free text.  

Finally, I have learned that having a Medline strategy where MeSH and freetext are on separate lines makes translation easier.

Identifying search terms

For any literature search, you will need to identify your search terms.  What words or phrases are you going to search for?   What thesaurus terms are you going to choose?

If you are doing a detailed search for evidence for a systematic review, or doing a systematic search for some other reason, identification of search terms will include identification of synonyms, that is, alternative terms for the concept you are interested in.

Here are some possible ways to identify thesaurus and free text terms, and synonyms. 


Scoping search

Use a PICO grid or similar to identify the search concepts, and search for those.   For example:

Search question: antibiotics to treat otitis media in children under 5.

P - under fives with otitis media
I - antibiotics
C - no stated comparision
O - no stated outcomes

So, search for otitis media and antibiotics, and see what terms are used in titles and abstracts of the articles you find.

Existing strategies

An existing systematic review should include the search strategy used.  Don't feel you have to copy it (of course, if you are doing this exercise for a dissertation, assignment or thesis, you should not and must not copy it!), but it may give you useful terminology.

Background research

Use clues from any background reading you have done about the topic, textbooks, reputable websites, NICE Evidence Search for any clinical topic.

Drug information sources

The British National Formulary is included in NICE Evidence Search, but also try Electronic Medicines Compendium, the European Medicines Agency, and Drugs.com.  Include generic names (long acting insulin) and brand names (glargine), include classes of drugs (antibiotics) and specific types (penicillin).  eMC is a collection of drug information sheets and patient information leaflets.

“Used for” in thesauri 

In a search of Medline, Embase or Cinahl, you must identify relevant thesaurus terms.   Your scoping search will help you - in Ovid or the NHS interface, when you type in a search term, thesaurus terms are suggested to you.  But use the "scope note" and check the "used for" entries.  Articles using those terms in title or abstract will be indexed using the thesaurus term you are looking at.   Therefore, those "used for" entries are useful synonyms to include in your search.

Other people

If you are working on a research project as part of a team, then team members will have suggestions for search terms.   So will patients with that condition, and the team may be able to ask them.  If you are working on an assignment, dissertation or thesis, you may be on your own (although if you have a supervisor, ask if they can advise you).   It is worth talking to others, and checking that you understand the search keywords in the same way as them, and that you know what they mean. 

Known items

You looked at titles and abstracts of items that appeared in the results of your scoping search.  But have a look at the titles and abstracts, and full text, of items that you know about already, and items you find in your actual search.   And look at the titles of references in the bibliographies of relevant items.

MeSH on Demand

This is a National Library of Medicine service, which identifies MeSH terms in text that you enter.  I have not yet tried this, but it seems to have possibilities.  I have written a separate post about this.

Tuesday, November 03, 2015

George Boole

What do you do with Boolean operators?  Play Booles with them.

That's the awful joke out of the way, that I used some time back in a quiz to check that students remembered what we had covered in a previous session.

Google's Doodle yesterday marked the 200th anniversary of the birth of George Boole, born in Lincoln on 2nd November 1815, and appointed Professor of Mathematics at Queen's College Cork in 1849.  University College Cork's Library is named after him.

The Doodle links to resources about him (by searching for George Boole).  Here are a few:

George Boole 200 - a website from University College Cork, including a life of Boole, the opportunity to sign up for school resources, reproductions of exam papers set by Boole while a professor in Cork, and news and events.

Scientific American - a blog about the bicentennial. 

George Boole - page from MacTutor History of Mathematics Archive at the University of St. Andrews.

If you want a Halloween themed image of Boolean operators (BOOlean!), try this from Librarian Design Share