A dosimetry and radiobiological model for intravascular brachytherapy treatment planning with radioisotope emitting stents

The aim of this study was to develop a practical, versatile and fast dosimetry and radiobiological model for calculation of the 3D dose distribution and radiobiological effectiveness of radioactive stents. The algorithm was written in Matlab 6.5 programming language and is based on the dose point kernel convolution. The dosimetry and radiobiological model was applied for evaluation of the 3D dose distribution of 32P, 90Y, 188Re and 177Lu stents. Of the four, 32P delivers the highest dose, while 90Y, 188Re and 177Lu require high levels of activity to deliver a significant therapeutic dose in the range of 15-30 Gy. Results of the radiobiological model demonstrated that the same physical dose delivered by different radioisotopes produces significantly different radiobiological effects. This type of theoretical dose calculation can be useful in the development of new stent designs, the planning of animal studies and clinical trials, and clinical decisions involving individualized treatment plans.

Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

Judging psychology experts: Can judges and attorneys distinguish between clinical and experimental psychologists?

A trial judge serves as gatekeeper in the courtroom to ensure that only reliable expert witness testimony is presented to the jury. Nevertheless, research shows that while judges take seriously their gatekeeper status, legal professionals in general are unable to identify well conducted research and are unable to define falsifiability, error rates, peer review status, and scientific validity (Gatkowski et al., 2001; Kovera & McAuliff, 2000). However, the abilities to identify quality scientific research and define scientific concepts are critical to preventing "junk" science from entering courtrooms. Research thus far has neglected to address that before selecting expert witnesses, judges and attorneys must first evaluate experts' CVs rather than their scientific testimony to determine whether legal standards of admissibility have been met. The quality of expert testimony, therefore, largely depends on the ability to evaluate properly experts' credentials. Theoretical models of decision making suggest that ability/knowledge and motivation are required to process information systematically. Legal professionals (judges and attorneys) were expected to process CVs heuristically when rendering expert witness decisions due to a lack of training in areas of psychology expertise.^ Legal professionals' (N = 150) and undergraduate students' (N = 468) expert witness decisions were examined and compared. Participants were presented with one of two versions of a criminal case calling for the testimony of either a clinical psychology expert or an experimental legal psychology expert. Participants then read one of eight curricula vitae that varied area of expertise (clinical vs. legal psychology), previous expert witness experience (previous experience vs. no previous experience), and scholarly publication record (30 publications vs. no publications) before deciding whether the expert was qualified to testify in the case. Follow-up measures assessed participants' decision making processes.^ Legal professionals were not better than college students at rendering quality psychology expert witness admissibility decisions yet they were significantly more confident in their decisions. Legal professionals rated themselves significantly higher than students in ability, knowledge, and motivation to choose an appropriate psychology expert although their expert witness decisions were equally inadequate. Findings suggest that participants relied on heuristics, such as previous expert witness experience, to render decisions.^