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PubMed1980

Implementation of adjuvant therapy for breast cancer in the St. Louis Metropolitan area: 1976-1977.

In order to determine the extent of implementation of adjuvant chemotherapy for stage II carcinoma of the breast in the St. Louis area, records of all patients with stage II carcinoma of the breast treated with standard or modified radical mastectomy in five different St. Louis hospitals were reviewed. Between July 1, 1976, and July 1, 1977 (17 months after publication of preliminary L-PAM results and 4 months after publication of preliminary L-PAM results and 4 months after publication of preliminary CMF results), 73% of 24 premenopausal patients and 55% of 58 postmenopausal patients received adjuvant chemotherapy. Ten percent of premenopausal and 31% of postmenopausal patients received therapy other than CMF or L-PAM. Compared to premenopausal patients in university-affiliated hospitals, premenopausal patients in community hospitals tended to receive radiation therapy more commonly and chemotherapy alone less often (P < 0.1). Compared to postmenopausal patients in university-affiliated hospitals, postmenopausal patients in community hospitals more commonly received chemotherapy alone, and less often received no adjuvant therapy (P < 0.05). We conclude that results of adjuvant chemotherapy trials can be rapidly implemented into standard practice both in university-affiliated and community hospitals. Since 12 of 52 patients receiving adjuvant chemotherapy in fact received nonstandard, unpublished regimens, improvements in phase IV drug development may be required to prevent potentially deleterious modifications of published recommendations.

Adult↗

PubMed1996

Implementation of a fast gradient-echo SVD encoding technique for dynamic imaging.

In the paper, the results of a fast gradient-echo implementation of the singular value decomposition (SVD) encoding technique for dynamic imaging are presented. The method used is an adaptation with several critical modifications of a keyholetype approach previously proposed but not implemented. The method was tested by imaging the events following injection of a contrast agent into a phantom, producing a series of dynamic image updates. It is demonstrated that, for this type of application, the SVD encoding technique adequately follows dynamic changes with even a small number of encodes. The result is compared qualitatively to that obtained by standard Fourier-based keyhole imaging and is shown to provide improved spatial resolution of dynamic events when updating with the same number of encodes.

Algorithms↗

PubMed2006

Implementation and effects of an individual stress management intervention for family caregivers of an elderly relative living at home: a mixed research design.

The purpose of this project was to evaluate the implementation and effects of a stress management intervention for family caregivers of elderly persons. The intervention was implemented through an action research design with the collaboration of case managers working in community health centers. A total of 81 caregivers participated in the study. The quasi-experimental design used to test the effects of the intervention showed significant effects on perceived challenge associated with caregiver role, control by self, use of social support, and use of problem solving. Qualitative data demonstrate caregiver empowerment with respect to the caregiving role. This study illustrates the relevance of using a mixed research design in order to provide evidence for changes in practice.

Adaptation, Psychological↗

PubMed2005

Changes in isotretinoin prescribing before and after implementation of the System to Manage Accutane Related Teratogenicity (SMART) risk management program.

PURPOSE: To assess changes in isotretinoin prescribing following the implementation of the System to Manage Accutane Related Teratogenicity (SMART) risk management program. METHODS: Using nationally representative commercial data resources on prescription drug dispensing patterns, surveys of office-based physician practices, and a large, claims database from a pharmacy benefits manager (PBM), we examined the total number of isotretinoin prescriptions (new and refill), prescriber speciality, and patient characteristics (age, gender, severity of acne indication) in the year before (April 2001-March 2002) and the year following (April 2002-March 2003) implementation of the SMART program. RESULTS: In the 12-months prior to SMART, 1 508 000 prescriptions were dispensed for isotretinoin, declining approximately 23% to 1 160 000 prescriptions in the year following SMART. There was little or no change in prescriber specialty, severity of acne, and patient age and gender. CONCLUSION: SMART may have lead to a decrease in isotretinoin prescriptions. Further research is needed to determine whether the reduced number of isotretinoin prescriptions reflects appropriate use or inhibited use resulting in loss of access to the product's benefits.

Adolescent↗

PubMed2006

The use of an alternative food source (red clover) as a means of reducing slug pest damage to winter wheat: towards field implementation.

Slugs are major pests of many crops in the UK, including winter wheat, yet current methods of control are often unreliable. The aim of this study was to investigate three issues key to the successful field implementation of a control strategy that uses red clover as an alternative food source to reduce the amount of damage caused to winter wheat by the field slug, Deroceras reticulatum (Müller). A series of three experiments was designed to assess this aim. Firstly, under laboratory conditions, red clover was consumed in greater quantities than wheat, even when wheat was presented as a novel food. Secondly, red clover had no significant effects on the emergence and early growth of wheat in a polytunnel experiment. Both these results are crucial to the successful implementation of a strategy that uses red clover as an alternative food source. Lastly, the results of a field experiment were consistent with the results of the polytunnel experiment, in that red clover did not significantly affect wheat emergence. However, plots in which red clover was left to grow until the time of wheat harvest resulted in significantly lower (43%) wheat yields than plots without red clover. These results suggest that red clover must be removed from the field after the wheat has passed its vulnerable seedling stage. Recommendations for the potential use of red clover as an alternative food source for reducing damage to winter wheat in field conditions are discussed and opportunities for further work are suggested.

Agriculture↗

PubMed2004

Implementation of data-dependent acquisitions in the study of melphalan DNA adducts by miniaturized liquid chromatography coupled to electrospray tandem mass spectrometry.

The study of defects in DNA caused by xenobiotics, more particularly the study of DNA adducts, is an important field in cancer aetiology. The analysis of low abundance DNA adducts formed in vivo both in animals and humans requires the development and implementation of highly sensitive analytical methods. Since only a minute amount of DNA can be isolated (ca. 100 microg) it is evident that the amount of sample consumed per analysis should be as small as possible in order to gather as much analytical information as possible. In this article an example is given of how this problem can be solved by the implementation of data-dependent acquisitions using capillary liquid chromatography coupled to electrospray tandem mass spectrometry. As a case study the alkylation of DNA by melphalan is presented. Slight modifications of the chromatographic conditions (mobile and stationary phases) can allow the automated analysis of other kinds of DNA adducts.

Animals↗

PubMedDate not supplied

Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine.

A safe and effective rotavirus vaccine is urgently needed, particularly in developing countries. Critical to vaccine development and implementation is a knowledge base concerning the epidemiology of rotavirus G and P serotypes/genotypes throughout the world. The temporal and geographical distribution of human rotavirus G and P types was reviewed by analysing a total of 45571 strains collected globally from 124 studies reported from 52 countries on five continents published between 1989 and 2004. Four common G types (G1, G2, G3 and G4) in conjunction with P[8] or P[4] represented over 88% of the strains analysed worldwide. In addition, serotype G9 viruses associated with P[8] or P[6] were shown to have emerged as the fourth globally important G type with the relative frequency of 4.1%. When the global G and/or P type distributions were divided into five continents/subcontinents, several characteristic features emerged. For example, the P[8]G1 represented over 70% of rotavirus infections in North America, Europe and Australia, but only about 30% of the infections in South America and Asia, and 23% in Africa. In addition, in Africa (i) the relative frequency of G8 was as high as that of the globally common G3 or G4, (ii) P[6] represented almost one-third of all P types identified and (iii) 27% of the infections were associated with rotavirus strains bearing unusual combinations such as P[6]G8 or P[4]G8. Furthermore, in South America, uncommon G5 virus appeared to increase its epidemiological importance among children with diarrhea. Such findings have (i) confirmed the importance of continued active rotavirus strain surveillance in a variety of geographical settings and (ii) provided important considerations for the development and implementation of an effective rotavirus vaccine (e.g. a geographical P-G type adjustment in the formulation of next generation multivalent vaccines).

Diarrhea↗

PubMed2003

Kinematics and the implementation of an elephant's trunk manipulator and other continuum style robots.

Traditionally, robot manipulators have been a simple arrangement of a small number of serially connected links and actuated joints. Though these manipulators prove to be very effective for many tasks, they are not without their limitations, due mainly to their lack of maneuverability or total degrees of freedom. Continuum style (i.e., continuous "back-bone") robots, on the other hand, exhibit a wide range of maneuverability, and can have a large number of degrees of freedom. The motion of continuum style robots is generated through the bending of the robot over a given section; unlike traditional robots where the motion occurs in discrete locations, i.e., joints. The motion of continuum manipulators is often compared to that of biological manipulators such as trunks and tentacles. These continuum style robots can achieve motions that could only be obtainable by a conventionally designed robot with many more degrees of freedom. In this paper we present a detailed formulation and explanation of a novel kinematic model for continuum style robots. The design, construction, and implementation of our continuum style robot called the elephant trunk manipulator is presented. Experimental results are then provided to verify the legitimacy of our model when applied to our physical manipulator. We also provide a set of obstacle avoidance experiments that help to exhibit the practical implementation of both our manipulator and our kinematic model.

Animals↗

PubMed2000

Vector subtraction implemented neurally: a neurocomputational model of some sequential cognitive and conscious processes.

Although great progress in neuroanatomy and physiology has occurred lately, we still cannot go directly to those levels to discover the neural mechanisms of higher cognition and consciousness. But we can use neurocomputational methods based on these details to push this project forward. Here we describe vector subtraction as an operation that computes sequential paths through high-dimensional vector spaces. Vector-space interpretations of network activity patterns are a fruitful resource in recent computational neuroscience. Vector subtraction also appears to be implemented neurally in primate frontal eye field activity, which computes dimensions of saccadic eye movements. We use this apparent neural implementation as a model and construct from it a general neurocomputational account of an important type of sequential cognitive and conscious process. We defend the biological plausibility of all components of the general model and show that it yields testable anatomical and physiological predictions. We close by suggesting some interesting consequences for consciousness if our model characterizes correctly the neural mechanisms producing a common type of episode in our conscious streams.

Cognition↗

PubMed1997

Implementation of EPA Revised Cancer Assessment Guidelines: Incorporation of Mechanistic and Pharmacokinetic Data.

A workshop entitled "Implementation of EPA Revised Cancer Assessment Guidelines: Incorporation of Mechanistic and Pharmacokinetic Data" was held in Anaheim, California, in 1996 at the 35th Annual Meeting of the Society of Toxicology (SOT). This workshop was jointly sponsored by the Carcinogenesis, Risk Assessment, and Veterinary Specialty Sections of the SOT. The thrust of the workshop was to discuss the scientific basis for the revisions to the EPA Guidelines for cancer assessment and EPA's plans for their implementation. This is the first revision to the original EPA guidelines which have been in use by EPA since 1986. The principal revisions are intended to provide a framework for an increased ability to incorporate biological data into the risk assessment process. Two cases were presented, for chloroform and triclioroethylene, that demonstrated the use of the revised guidelines for specific cancer risk assessments. Using these new guidelines, nonlinear margin of exposure analyses were proposed for these chemicals instead of the linearized multistage model previously used by the EPA as the default method. The workshop participants generally applauded the planned revisions to the EPA guidelines. For the most part, they considered that the revised guidelines represented a positive step which should allow for and encourage the use of biological information in the conduct of cancer risk assessments. Several participants cautioned however that the major problem with cancer risk assessments would continue to be the inadequacy of available data on which to conduct more scientific risk assessments.

Animals↗

PubMed2001

High-performance implementation and analysis of the Linkmap program.

Linkage analysis uses information from family pedigrees to map genes and locate disease genes on particular chromosomes. A recombination fraction denoted as theta is estimated as a measure of crossing over between two loci. Genetic linkage calculations are very time-consuming particularly for large family pedigrees, a large number of theta values, and an increased number of markers. This paper reports the implementation of a dynamic master-slave scheme for the parallelization of the Linkmap program on a high-performance cluster such as the Origin 2000 (O2K) consisting of 56 R12000 processors. The Linkmap program is one of four programs in the LINKAGE/FASTLINK legacy package widely used by the medical research community. Implementations issues are addressed and results are compared with previous results on a cluster of DEC Alphas, and with the sequential execution on the O2K machine.

Chromosome Mapping↗

PubMed1999

Construction and implementation of NMR quantum logic gates for two spin systems.

The implementation of small prototype quantum computers has been studied through ensemble quantum computing via NMR measurements. In such laboratory studies it is convenient to have access to a wide array of logic gates. Here a systematic approach to reduce the logic gate to an NMR pulse sequence is introduced. This approach views the truth table for a quantum logic operation as a permutation matrix that corresponds to a propagator for an NMR transition. This propagator is then used as the starting point for the derivation of a pulse sequence. Pulse sequences for all the permutations of a four level system are reported along with implementations of representative examples on a two spin-1/2 system, 13C-labeled chloroform.

Magnetic Resonance Spectroscopy↗

PubMed2002

Design and implementation of a protection system for NMR spectrometers.

We have implemented a scheme, SPECMON, for monitoring various parameters of a spectrometer, such as nitrogen pressure and sample temperature, and taking corrective action. The scheme is based on considerations of protection management which are of general application. Evaluation of the spectrometer state is incorporated in macros of the application software (VNMR) and is therefore very flexible. In contrast, corrective action is limited to the single one which is deemed fully safe: complete shutdown of the spectrometer and logging. Shutdown is implemented by a minor hardware modification of the spectrometer: the introduction of a second input to a relay already present for protection of the spectrometer power supply. Monitoring is handled by the host computer, and the shutdown command is transmitted via control lines of its series port, independent of the standard connection between the host computer and the NMR system console. The monitoring system (software and hardware) is unobtrusive in normal conditions, and it can be tested without affecting the operation of the spectrometer.

Journal Article↗

PubMed2002

Are subitizing and counting implemented as separate or functionally overlapping processes?

Enumeration of small groups of four or fewer objects is very fast and accurate (often called "subitizing"), but gets slower and more error prone for more than four items ("counting"). Many theories have been proposed to account for this dichotomy, most suggesting that "subitizing" and "counting" are two qualitatively different and separable processes. Others, in contrast, have proposed that the two operations reflect two different levels along a continuum of complexity. In this paper we present a PET study that attempts to characterize subitizing and counting at a neural level in order to investigate whether they are implemented as separate or functionally overlapping processes. Subjects performed an enumeration task on visual arrays of dots that varied in numerosity (1-4 and 6-9 dots) and spatial arrangement (canonical and random). The results demonstrated a common network for subitizing and counting that comprises extrastriate middle occipital and intraparietal areas. The intensity and spatial extent of this network were modulated by the number of dots and their spatial arrangement: activation increased as the number of items in the visual array increased, reaching maximum peak and extent for counting 6-9 randomly arranged items. Direct comparison between subitizing and counting showed that counting, relative to subitizing, was correlated with increased activity in this occipitoparietal network, while subitizing did not show areas of increased activation with respect to counting. Results speak against the idea of the two processes being implemented in separable neural systems.

Adult↗

PubMed2002

Primary care physicians' awareness and implementation of screening guidelines for colorectal cancer.

OBJECTIVE: The objective was to determine primary care physicians' (PCPs) familiarity and implementation of screening guidelines for colorectal cancer (CRC) in central Israel. METHODS: Fifty PCPs were interviewed and 1000 charts of their asymptomatic patients ages 50-70 were examined. All CRC patients treated at the regional Oncology Institute in 1980-1984 and in 1993-1997 were then compared, with emphasis on the event leading to diagnosis and tumor stage. RESULTS: Almost all PCPs endorsed screening. Fecal occult blood testing (FOBT) was appropriately recommended by 40% (annually), and the use of flexible sigmoidoscopy (FS) was appropriately recommended by 12% of physicians (every 3-5 years). Only four (8%) were correct in the use of both techniques. Most PCPs estimated that >25% of their patients had been screened for CRC. In fact, 92/1,000 had FOBT (9.2%), 14/1,000 had screening FS (1.4%), and 3 patients only had both tests. Only 1.2% of CRC diagnoses in the 1980s (n = 175) and 2.6% in the 1990s (n = 343) were established as a result of screening (P > 0.25, NS). Tumor stage distribution at diagnosis was similar. CONCLUSIONS: PCPs studied endorse CRC screening but they are not familiar with accepted guidelines and do very little about implementing them, and this has not changed much over the past decade. CRC screening has a potential to markedly decrease mortality, yet the best screening strategy is worthless without physician education and compliance.

Aged↗

PubMed1996

CCPP-Copenhagen Community Psychiatric Project. Implementation of community mental health centres in Copenhagen: effects of service utilization, social integration, quality of life and positive and negative symptoms.

Deinstitutionalization of psychiatry in Denmark has been extensive and the number of psychiatric beds per 1,000 inhabitants is among the lowest in Europe. The effect of supplementing hospital treatment with treatment in community mental health centres was evaluated in a quasi-experimental design. The patient group examined consisted of patients with long-term contact with psychiatric services. When development in intervention and control districts was compared, the only significant difference was that the total patient group in the intervention district had an increased number of day attendances per year. Comparison of patients from intervention districts who attended day-centres regularly with patients from control districts before and after implementation of community mental health centres indicated that patients from intervention districts had a reduction in the use of inpatient services, a significant increase in quality of life and a significant decrease in the presence of the negative symptom, alogia. We concluded that implementation of community mental health centres can increase the quality of life for the patients and decrease the frequency of the negative symptom, alogia.

Adult↗

PubMed1996

Clinical consequences of the implementation of a weaning protocol.

OBJECTIVE: To analyze the clinical and economic consequences of the implementation of a weaning protocol in patients mechanically ventilated (MV) for more than 48 h. DESIGN: Comparative study. SETTING: General intensive care unit (ICU) in a county hospital covering 360000 inhabitants. PATIENTS: 51 patients weaned by a fixed protocol were studied prospectively and compared with 50 retrospective controls. MEASUREMENTS: The following variables were assessed: Acute Physiology and Chronic Health Evaluation (APACHE) II score, age, cause of respiratory failure, type of extubation (direct extubation or extubation using a weaning technique), number of days on MV before the weaning trial, weaning time, total duration of MV, complications (reintubations and tracheostomies), length of ICU stay, and mortality. RESULTS: The groups were comparable in terms of age, APACHE II score, and main cause of acute respiratory failure. Number of days on MV up to the weaning trial were similar in the two groups (8.4 +/- 7.7 in the protocol group vs 7.5 +/- 5.5 in the control group, NS). Most of the patients (80%) in the protocol group were directly extubated without a weaning technique, unlike the control group (10%) (p < 0.01). When a weaning technique was used, the weaning time was similar in both groups (3.5 +/- 3.9 days vs 3.6 +/- 2.2 days in the control group). Duration of MV was shorter in the protocol group (10.4 +/- 11.6 days) than in the control group (14.4 +/- 10.3 days) (p < 0.05). As a result, the ICU stay was reduced by using the weaning protocol (16.7 +/- 16.5 days vs 20.3 +/- 13.2 days in the control group, p < 0.05). We found no differences in reintubation rate (17 vs 14% in the control group) and need for tracheostomies (2 vs 8% in the control group). CONCLUSION: The implementation of a weaning protocol decreased the duration of MV and ICU stay by increasing the number of safe, direct extubations.

APACHE↗

PubMed1988

Keys to the successful implementation of an ICU patient data management system.

Implementation of an ICU data management system requires consideration of many factors, including site preparation for equipment, system backup, ICU & medical staff training and evaluation. This paper describes the strategy for implementing a patient data management system at Cedars-Sinai Medical Center and details our steps for planning, training, configuration and problem resolution.

California↗