Evidence-based implementation of evidence-based medicine.

BACKGROUND: The slow and haphazard process of translating research findings into clinical practice compromises the potential benefits of clinical research. Most quality improvement (QI) initiatives are based on the beliefs of decision makers rather than on the growing theoretical and empirical knowledge about organizational and provider behavior change. If future QI activities are to improve the translation of evidence into practice, they should be based on an understanding of the different models and strategies for implementing research evidence and the evidence base supporting their use. Evidence-based medicine should be complemented by evidence-based implementation. THE EVIDENCE FOR DIFFERENT STRATEGIES OF IMPLEMENTING CHANGE: A general framework for changing practice based on theoretical perspectives and research evidence considers a variety of theoretical approaches and their contribution to an understanding of provider behavior change. The framework summarizes evidence from systematic reviews of provider behavior change, which suggest the potential of several dissemination and implementation strategies that are effective under certain conditions. Passive dissemination approaches are largely ineffective; specific strategies to implement research-based recommendations appear to be necessary to ensure practice change. Multifaceted interventions that address specific barriers to change are more likely to lead to changes in practice. PRACTICAL, FIVE-STAGE FRAMEWORK: A practical, five-stage framework for changing practice, which is illustrated with experiences from a comprehensive program on implementing evidence-based clinical guidelines in primary care, includes development of a concrete proposal for change; analysis of the target setting and group to identify obstacles to change; linking interventions to needs, facilitators, and obstacles to change; development of an implementation plan; and monitoring progress with implementation.     

建筑与环境的平衡

分析了发达国家环境问题的历史与现状。论述了环境对人类生活的影响。提醒发展中国家应吸取发达国家的经验教训,以保护我们所居住的这个星球     

Design,implementation and evaluation of a virtual storage system

Large organizations always have a strong demand for storage from data‐intensive applications and instruments. In this paper, we present the design, implementation, and evaluation of a new virtual storage system, Storage@desk, which can aggregate a large number of distributed machines within an organization to provide storage services with quality of service guarantees. Because storage virtualization is the prominent goal, Storage@desk provides clients with the abstraction of a hard drive by utilizing the Internet SCSI protocol. As such, data access to new storage services is transparent so that clients do not need to modify any existing applications nor change their current practices. Storage@desk replicates data and employs version‐based journaling for high availability. It utilizes a market‐based model for resource management and a feedback controller for automated performance control. We have developed a prototype of Storage@desk that implements the core components. Copyright © 2010 John Wiley & Sons, Ltd.     

Easy-to-use object-oriented parallel processing with Mentat

Mentat, an object-oriented parallel processing system designed to directly address the difficulty of developing architecture-independent parallel programs, is discussed. The Mentat system consists of two components: the Mentat programming language and the Mentat runtime system. The Mentat programming language, which is based on C++, is described. Performance results from implementing the Mentat runtime system on a network of Sun 3 and 4 workstations, the Silicon Graphics Iris, the Intel iPSC/2, and the Intel iPSC/860 are presented     

Development of an equilibrium immunoassay using electrochemiluminescent detection for a novel recombinant protein product and its application to pre-clinical product development

In order for a biotechnology derived protein product to be considered 'well characterized', a thorough understanding of the pharmacokinetic and metabolic fate of the product is essential. Specifications for such products need to be based on historical data obtained in the pre-clinical, clinical and manufacturing experience through the use of specific, accurate, precise and validated assays. Typically, assays such as ELISA or RIA that have the disadvantages of limited dynamic range, matrix interactions and hazardous waste generation are used to gather this data. We present data in this abstract that demonstrates the utility of an equilibrium immunoassay that uses electrochemiluminescent detection in the assessment of the pharmacokinetic and metabolic fate of a biotechnology derived product based on either the human (AMG1h) or murine (AMG1m) protein sequence. The assay uses biotinylated antibody in a sandwich format with antibody labeled with the N-hydroxysuccinimide ester of a ruthenium (II) tris-bipyridine chelate for detection in the Origen System. Streptavidin-coated paramagnetic beads are used to capture the antibody-antigen-antibody sandwich complex and facilitate electrochemiluminescent detection. The assay standard curve for AMG1h ranges from a lower limit of quantitation (LOQ) of 2.5 ng ml(-1) to an upper limit of quantitation (ULQ) of 2000 ng ml(-1) with accuracy and precision of not greater then 15% CV and deviation from nominal over the range. The corresponding LOQ (0.5 ng ml(-1)) and ULQ (200 ng ml(-1)) values determined for AMG1m displayed similar accuracy and precision. In addition, we demonstrate that the assay as performed is insensitive to matrix effect up to addition of 7%, of the total reaction volume. General guidelines for developing similar electrochemiluminescent based assays and their applications, advantages and limitations will be discussed.     

Identification of alpha 1-acid glycoprotein (orosomucoid) in human synovial fluid by capillary electrophoresis

Capillary electrophoresis of human synovial fluid in a phosphate borate run buffer containing sodium dodecyl sulphate separates a hydrophilic glycoprotein, hyaluronan and a number of low-molecular-mass components. The hydrophilic glycoprotein is identified as alpha 1-acid glycoprotein (AGP), orosomucoid, by co-injection methods with human AGP and by reaction with neuraminidase which released N-acetylneuraminic acid. Finally, a sample of the glycoprotein was isolated by micropreparative capillary electrophoresis, examined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis methods and shown to give a positive reaction with AGP antibodies. The peak due to AGP in the capillary electrophoresis is broad and gives evidence for the presence of glycoforms.     

Metasystems: An Approach Combining Parallel Processing and Heterogeneous Distributed Computing Systems

A metasystem is a single computing resource composed of a heterogeneous group of autonomous computers linked together by a network. The interconnection network needed to construct large metasystems will soon be in place. To fully exploit these new systems, software that is easy to use, supports large degrees of parallelism, and hides the complexity of the underlying physical architecture must be developed. In this paper we describe our metasystem vision, our approach to constructing a metasystem testbed, and early experimental results. Our approach combines features from earlier work on both parallel processing systems and heterogeneous distributed computing systems. Using the testbed, we have found that data coercion costs are not a serious obstacle to high performance, but that load imbalance induced by differing processor capabilities can limit performance. We then present a mechanism to overcome load imbalance that utilizes user-provided callbacks.     

The growth of crystals of erbium hydride

Crystals of the rare-earth hydride ErH₂ have been produced with face areas greater than a square millimetre and corresponding volumes exceeding those of earlier crystals by orders of magnitude. The hydride, which was produced in bulk polycrystalline form by hydriding erbium metal at 950° C, has been examined by optical and X-ray techniques. For material of composition ErH₂ and ErH_1.8 the size of the grains and their degree of strain appears to depend more on oxygen contamination during formation and on the subsequent cooling procedure, than on the size of erbium metal crystals in the starting material.