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PubMedDate not supplied

Using Six Sigma to improve the film library.

The film library of a film-based radiology department is a mission-critical component of the department that is frequently underappreciated and under-staffed. A poorly performing film library causes operational problems for not only the radiology department, but for the institution as a whole. Since Six Sigma techniques had proved successful in an earlier CT throughput improvement project, the University of Texas M.D. Anderson Cancer Center Division of Diagnostic Imaging decided to use Six Sigma techniques to dramatically improve the performance of its film library. Nine mini-project teams were formed to address the basic operating functions of the film library. The teams included film library employees, employees from other sections of radiology, employees from stakeholders outside of radiology, and radiologists and referring physicians, as appropriate to the team's mission. Each Six Sigma team developed a process map of the current process, reviewed or acquired baseline quantitative data to assess the current level of performance, and then modified the process map to incorporate their recommendations for improving the process. An overall project steering committee reviewed recommendations from each Six Sigma team to assure that all of the teams' efforts were coordinated and aligned with the overall project goals. The steering committee also provided advice on implementation strategies, particularly for changes that would have an immediate effect on stakeholders outside of the radiology department. After implementation of recommendations, quantitative data were collected again to determine if the changes were having the desired effect. Improvement in both quantitative metrics and in employee morale have been experienced. We continue to collect data as assurance that the improvements are being sustained over the long haul. Six Sigma techniques, which are as quantitatively-based as possible, are useful in a service-oriented organization, such as a film library. The primary problem we encountered was that most of the important film library customer services are not automatically captured in the RIS or in any other information system. We had to develop manual data collection methods for most of our performance metrics. These collection methods were burden-some to the frontline employees who were required to collect the data. Additionally, we had to invest many hours of effort into assuring that the data were valid since film library employees rarely have the educational background to readily grasp the importance of the statistical methods employed in Six Sigma. One of the most important lessons we learned was that film library employees, including supervisory personnel, must be held accountable for their performance in a manner that is objective, fair and constructive. The best methods involved feedback collected by the employees themselves in the ordinary course of their duties. Another important lesson we learned was that film library employees, as well as stakeholders outside of the film library, need to understand how important the film library is to the smooth functioning of the entire institution. Significant educational efforts must be expended to show film library employees how their duties affect their film library co-workers and the institution's patients. Physicians, nurses and employees outside of the film library must do their part too, which requires educational efforts that highlight the importance of compliance with film library policies.

Academic Medical Centers↗

PubMed1984

Analysis of reference transactions using packaged computer programs.

Motivated by a continuing education class attended by the authors on the measurement of reference desk activities, the reference department at Scott Memorial Library initiated a project to gather data on reference desk transactions and to analyze the data by using packaged computer programs. The programs utilized for the project were SPSS (Statistical Package for the Social Sciences) and SAS (Statistical Analysis System). The planning, implementation and development of the project are described.

Computers↗

PubMed1990

The consequences of offering fee-based services in a medical library.

Fee-based services may influence, both subtly and dramatically, the operation of a medical library. Fears that have been raised about the consequences of fee-based services are recalled and applied to the context of medical librarianship. Specifically covered are the effects of fee-based services on service to traditional user groups, collection development, interlibrary cooperation, and management style. The discussion includes references to the program of fee-based services offered by the New York Academy of Medicine Library.

Fees and Charges↗

PubMed1971

Creating the library itself: collection, staff, and space.

It is stressed that many points must be settled between the librarian and the planners. Relationships between the library and the medical school and the university library should be made clear. The librarian must be intimately involved with the architect, with the selection of faculty, and with the planning of curriculum. Consideration is given to problems of collection building in the areas overlapping with other institutions and of journal collections. Cataloging is considered, and the need to develop accounting procedures.

Book Collecting↗

PubMed1996

Developing multidisciplinary library services in trust hospitals: a case study at the City Hospitals Sunderland NHS Trust.

The paper describes an example of good practice in the establishment of multidisciplinary library services at a Trust hospital. In 1995, City Hospitals Sunderland NHS Trust commissioned a survey to determine their needs for library services for all staff. The results of the survey and the recommendations are described. The Trust's further actions are briefly noted. This case study is set into the wider context of the need for well-resourced library and information services within the NHS. The constraints under which such developments operate are listed.

Accreditation↗

PubMed2001

Identification of receptor ligands by screening phage-display peptide libraries ex vivo on microdissected kidney tubules.

A novel method to identify receptor ligands for defined renal tubular segments has been developed. Ex vivo screening of phage-display peptide libraries on isolated intact rat proximal convoluted tubules (PCT) and cortical collecting ducts (CCD) allowed the direct access of phage to the basolateral surface of tubular epithelial cells. Two distinct peptide motifs were selected for CCD and PCT, indicating differential expression of some membrane receptors on the basolateral surface of defined kidney tubule segments. Using the linear peptide motif ELRGD(R/M)AX(W/L), recovered from freshly isolated rat CCD, mediated 16-fold selectivity of phage binding to CCD compared with PCT. Binding to CCD was 39-fold higher than that of a random control phage. Binding and subsequent internalization of phage, most likely by an integrin-mediated endocytosis pathway, was abolished by the addition of the corresponding synthetic peptide. Furthermore, the results demonstrate that presentation and flanking amino acids determine the specific binding properties of RGD ligands to their putative integrin receptors. The results emphasize the need of a native cell system for the identification of renal epithelial cell surface ligands. Such ligands are of potential relevance for the analysis of interactions between extracellular matrix and kidney tubules or for the development of improved vectors for kidney-specific drug delivery or gene transfer.

Animals↗

PubMedDate not supplied

The combinatorial library: a multifunctional resource.

About 10 years ago Dr. Mario Geysen introduced a method for synthesizing a large number of peptides on solid supports simultaneously. This work has subsequently been generalized by many other research groups to develop technologies that allow from hundreds to thousands to millions of compounds to be synthesized in parallel. These large collections of compounds have been now termed combinatorial libraries. Much of the effort in this field has been directed to drug discovery. However, in recent years, these libraries have been shown to be very useful for finding compounds (such as inhibitors, binding agents, enzymes, and antibodies) that satisfy specific requirements. Thus these techniques represent a very excellent resource for the discovery of compounds for a variety of biotechnological process needs.

Amino Acid Sequence↗

PubMed2025

Inference and visualization of complex genotype-phenotype maps with gpmap-tools.

Understanding how biological sequences give rise to observable traits, that is, how genotype maps to phenotype, is a central goal in biology. Yet our knowledge of genotype-phenotype maps in natural systems is limited due to the high dimensionality of sequence space and the context-dependent effects of mutations. The emergence of Multiplex assays of variant effect (MAVEs), along with large collections of natural sequences, offer new opportunities to empirically characterize these maps at an unprecedented scale. However, tools for statistical and exploratory analysis of these high-dimensional data are still needed. To address this gap, we developed gpmap-tools (https://github.com/cmarti/gpmap-tools), a python library that integrates a series of models for inference, phenotypic imputation, and error estimation from MAVE data or collections of natural sequences in the presence of genetic interactions of every possible order. gpmap-tools also provides methods for summarizing patterns of epistasis and visualization of genotype-phenotype maps containing up to millions of genotypes. To demonstrate its utility, we used gpmap-tools to infer genotype-phenotype maps containing 262,144 variants of the Shine-Dalgarno sequence from both genomic 5'UTR sequences and experimental MAVE data. Visualization of the inferred landscapes consistently revealed high-fitness ridges that link core motifs at different distances from the start codon. In summary, gpmap-tools provides a flexible, interpretable framework for studying complex genotype-phenotype maps, opening new avenues for understanding the architecture of genetic interactions and their evolutionary consequences.

Gaussian process↗

PubMed1984

Building an archives in a medical library.

In 1979 the University of Medicine and Dentistry of New Jersey established an archives to collect, preserve, and retrieve important documentation related to its history. This paper examines various steps in building an archives and the development of a coherent collection policy, including potential sources for archival material. Problems and possible solutions concerning what to preserve from the vast quantities of material generated by an institution are considered. The relationship between the archives and the medical library and the requirements of the physical plant are discussed, including the storage and preservation of materials.

Archives↗

PubMed1994

Faxon Finder/Faxon Xpress: report from a beta test site.

In this environment of expanding information needs, spiraling journal costs, and curtailed financial resources, medical libraries must take advantage of the rapid evolution in document delivery services. There are exciting developments in transmission technology, from fax machines to scanners to the Internet. There is also a notable shift away from the traditional reliance on library networks toward use of commercial vendors as document providers. These changes require reevaluation of interlibrary loan (ILL) and document delivery systems on many levels, including pricing structures, work flow, and impact on collection development. As commercial vendors develop increasingly effective products, librarians can test, evaluate, and incorporate them into their ILL operations to enhance service to users and relieve the pressure to acquire new resources; in this way, librarians can move from the "just in case" practice of building an on-site collection to the "just in time" model of providing timely delivery of materials to users as needed. This paper describes a beta test of the Faxon Finder/Faxon Xpress table of contents and document delivery services conducted by the Treadwell Library of the Massachusetts General Hospital.

Databases, Bibliographic↗

PubMed2002

Spreadsheets for automated data collection, analysis, and report generation for diagnostic medical physics: publicly available on the world wide web.

A library of spreadsheets has been developed to facilitate the practice of diagnostic physics quality assurance. Each spreadsheet follows a standard template and uses the highest ranking controlling authority (within the United States) for pass/fail criteria and testing procedures. Sheets are now available for CT (computed tomography), MR (magnetic resonance), US (ultrasound), screen-film mammography, stereotactic breast, radiographic, fluoroscopic, computed radiography, film digitizer, and display quality control. Use is made of spreadsheet "workbooks" so that each testing event is a single sheet in the workbook. Thus, results over the lifetime of the device are gathered in a single file, and historical control charts are gathered on the first sheet. The spreadsheets are available at http://radweb.mcis.washington.edu/~sglanger, and are released under the Gnu (a recursive acronym. Gnu's Not Unix) public license. It is expected that others will add improvements, and they are expected and requested to submit them back to the author to be shared with the diagnostic physicist community at large.

Diagnostic Imaging↗

PubMed1979

A regional cooperative acquisition program for monographs.

A cooperative acquisition program for monographs for the twelve resource libraries in Region IX of the Regional Medical Library Network is described. Each of the participating libraries has agreed to purchase all books of an assigned publisher which fall within a prescribed subject-format profile. It is hoped that this will help to reduce unnecessary duplication and contribute toward the development of resources in the region.

Book Classification↗

PubMed1972

Document delivery capabilities of major biomedical libraries in 1968: results of a national survey employing standardized tests.

The standardized Document Delivery Tests (DDT's) developed earlier (Bulletin 56: 241-267, July 1968) were employed to assess the capability of ninety-two medical school libraries for meeting the document needs of biomedical researchers, and the capability of fifteen major resource libraries for filling I-L requests from biomedical libraries. The primary test data are summarized as statistics on the observed availability status of the 300 plus documents in the test samples, and as measures expressing capability as a function of the mean time that would be required for users to obtain test sample documents. A mathematical model is developed in which the virtual capability of a library, as seen by its users, equals the algebraic sum of the basic capability afforded by its holdings; the combined losses attributable to use of its collection, processing, relative inacessibility, and housekeeping problems; and the gain realized by coupling with other resources (I-L borrowing). For a particular library, or group of libraries, empirical values for each of these variables can be calculated easily from the capability measures and the status statistics. Regression equations are derived that provide useful predictions of basic capability from collection size. The most important result of this work is that cost-effectiveness analyses can now be used as practical decision aids in managing a basic library service. A program of periodic surveys and further development of DDT's is recommended as appropriate for the Medical Library Association.

Costs and Cost Analysis↗

PubMed1996

Management of otitis media with effusion in young children.

OBJECTIVE: To summarize and critique the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for the management of otitis media with effusion (OME) in children. DATA SOURCES: The AHCPR Clinical Practice Guideline, Otitis Media with Effusion in Young Children; the Quick Reference Guide for Clinicians, Managing Otitis Media with Effusion in Young Children; and the Parent Guide, Middle Ear Fluid in Young Children, were the primary data sources. The AHCPR developed the Guideline based on a comprehensive literature review from multiple bibliographic databases, including the National Library of Medicine. Data were also collected during open hearings and from unpublished sources derived from a call in the Federal Register. Additional citations from the biomedical literature were used for supporting evidence. STUDY SELECTION: Peer-reviewed reports of controlled, randomized studies were preferred, but other study designs were considered. Over 3000 abstracts were identified, of which 378 articles were used for data extraction, and an additional 100 articles were included from bibliography review and panel recommendations. An expert panel reviewed the data and incorporated clinical expertise into the development of consensus statements. DATA EXTRACTION: Data were extracted to apply to a base case with OME to narrow the scope of the Guideline. The base case was defined as a child who is 1-3 years old, is otherwise healthy, and has no underlying craniofacial, neurologic, or sensory conditions. Multiple meta-analyses were done to help the panel come to conclusions on several issues. DATA SYNTHESIS: The Guideline documents carefully outlined treatment algorithms for the management of OME in otherwise healthy children. The main areas that need to be further clarified are the role of more aggressive identification of causative pathogens, when antimicrobial therapy should be initiated, and which antimicrobial agents are preferred for the treatment of OME. There are many vague areas in the Guideline that allow for multiple interpretations. Data regarding the use of corticosteroids were influenced heavily by the expert opinion of the panel rather than the literature-based evidence and potential cost implications. The Guideline provided specific recommendations for the surgical management of OME. Confounding patient factors that would affect decisions on management of OME, such as underlying disease states and physical or mental abnormalities, were not addressed in the Guideline. CONCLUSIONS: The documents were well organized and provide detailed explanation of the recommendations. The Guideline provides specific criteria for the surgical management of OME, but is vague in its recommendations on the medical management of OME with antibiotics, corticosteroids, and the use of invasive tympanocentesis in the evaluation of OME in otherwise healthy children.

Anti-Bacterial Agents↗

PubMedDate not supplied

A combinatorial approach toward the discovery of non-peptide, subtype-selective somatostatin receptor ligands.

The tetradecapeptide somatostatin is widely distributed throughout the body and is thought to be involved with a variety of regulatory functions. Recently, five human somatostatin receptors (hSSTR1-5) have been cloned and characterized. Several selective peptidal agonists of the hSSTR receptors are known, and we sought to apply this information to the design of novel non-peptide small molecule ligands for each receptor. Initial computational methods identified a 200 nM murine SSTR2 active compound via a database search of our sample collection. A combinatorial library was designed around the structural class of the compound with the goal of rapidly developing this initial lead into the desired subtype-selective small molecules in order to characterize the pharmacology of each of the receptor subtypes. The library was synthesized using the resin-archive, iterative deconvolution format. The total number of unique compounds in the library was expected to be 131,670, present in 79 mixtures of 1330 or 2660 compounds per mixture. Through sequences of screening and mixture deconvolution, the components of selective and highly active (Ki = 50 pM to 200 nM) non-peptide small molecule ligands for somatostatin subtypes 1, 2, 4, and 5 were identified. In addition to discovering compounds with the desired activity and selectivity, useful structure/activity information was generated which can be used in the design of new compounds and second-generation combinatorial libraries.

Combinatorial Chemistry Techniques↗

PubMed2002

Science's signal transduction knowledge environment: the connections maps database.

Knowledge environment (KE) describes the collection of electronic networking tools that have been and continue to be developed by AAAS and Stanford University libraries. Knowledge environments use practical, production-quality tools to systematize the consensus knowledge within a scientific domain and facilitate users' access to that knowledge. Science's Signal Transduction Knowledge Environment (STKE) is the first in this new concept in electronic publishing that combines the traditional, albeit electronic, publishing of articles, such as reviews, perspectives, and protocols, with tools for organizing and collating information in the cross-disciplinary field of signal transduction. One of the major tools developed for the STKE is the Connections Map database and the software (called CMADES [Connections Maps Authority Data Entry Software]) created to facilitate data entry by Pathway Authorities. The Connections Maps are a graphical representation of a database of information about the molecules involved in cellular signaling cascades. CMADES automates many of the functions involved in adding data into the Connections Maps database, such as references and descriptors, as well as allowing the Authorities to indicate the relationships between the components in the pathway through the use of a graphing tool. CMADES and the Connections Maps represent evolving tools that assist the Authorities in systemizing information regarding a particular system at the organism- and cell-specific level and the canonical level, as well as provide the STKE user with organized and expert-supplied information about signal transduction pathways.

Biology↗

PubMed2000

Genome-wide expression profiling of mid-gestation placenta and embryo using a 15,000 mouse developmental cDNA microarray.

cDNA microarray technology has been increasingly used to monitor global gene expression patterns in various tissues and cell types. However, applications to mammalian development have been hampered by the lack of appropriate cDNA collections, particularly for early developmental stages. To overcome this problem, a PCR-based cDNA library construction method was used to derive 52,374 expressed sequence tags from pre- and peri-implantation embryos, embryonic day (E) 12.5 female gonad/mesonephros, and newborn ovary. From these cDNA collections, a microarray representing 15,264 unique genes (78% novel and 22% known) was assembled. In initial applications, the divergence of placental and embryonic gene expression profiles was assessed. At stage E12.5 of development, based on triplicate experiments, 720 genes (6.5%) displayed statistically significant differences in expression between placenta and embryo. Among 289 more highly expressed in placenta, 61 placenta-specific genes encoded, for example, a novel prolactin-like protein. The number of genes highly expressed (and frequently specific) for placenta has thereby been increased 5-fold over the total previously reported, illustrating the potential of the microarrays for tissue-specific gene discovery and analysis of mammalian developmental programs.

Amino Acid Sequence↗

PubMed1992

The medical libraries of Vietnam--a service in transition.

The medical libraries of Vietnam maintain high profiles within their institutions and are recognized by health care professionals and administrators as an important part of the health care system. Despite the multitude of problems in providing even a minimal level of medical library services, librarians, clinicians, and researchers nevertheless are determined that enhanced services be made available. Currently, services can be described as basic and unsophisticated, yet viable and surprisingly well organized. The lack of hard western currency required to buy materials and the lack of library technology will be major obstacles to improving information services. Vietnam, like many developing nations, is about to enter a period of technological upheaval, which ultimately will result in a transition from the traditional library limited by walls to a national resource that will rely increasingly on electronic access to international knowledge networks. Technology such as CD-ROM, Integrated Services Digital Network (ISDN), and satellite telecommunication networks such as Internet can provide the technical backbone to provide access to remote and widely distributed electronic databases to support the information needs of the health care community. Over the long term, access to such databases likely will be cost-effective, in contrast to the assuredly astronomical cost of building a comparable domestic print collection. The advent of new, low-cost electronic technologies probably will revolutionize health care information services in developing nations. However, for the immediate future, the medical libraries of Vietnam will require ongoing sustained support from the international community, so that minimal levels of resources will be available to support the information needs of the health care community. It is remarkable, and a credit to the determination of Vietnam's librarians that, in a country with a legacy of war, economic deprivation, and international isolation, they have somehow managed to provide a sound basic level of information services for health care professionals.

Communism↗