Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^

Abortion and Clinical Practice. Abortion Review Papers from the bpas conference: London, 25 - 26 June 2008

The groundbreaking bpas conference The Future of Abortion: Controversies and Care brought together clinicians, academics, policymakers and advocates from the UK, Europe and the USA for a discussion about all aspects of abortion provision. Taking place during a critical Parliamentary debate about the UK abortion law, the conference generated great excitement and presented a number of important research findings and policy suggestions.In order to maximise the strides made by The Future of Abortion conference in taking forward an international, interdisciplinary discussion, Abortion Review is producing a series of special editions in which we have published edited transcripts of the presentations. In this third edition, Abortion and Clinical Practice, the presentations examine developments in abortion research and practice, and what these might indicate for the kind of abortion service that should be provided.

Migration to an a on.line laboratory in mechanical engineering. The case of a cam follower design practice.

The European Higher Education Area (EHEA) has leaded to a change in the way the subjects are taught. One of the more important aspects of the EHEA is to support the autonomous study of the students. Taking into account this new approach, the virtual laboratory of the subject Mechanisms of the Aeronautical studies at the Technical University of Madrid is being migrated to an on-line scheme. This virtual laboratory consist on two practices: the design of cam-follower mechanisms and the design of trains of gears. Both practices are software applications that, in the current situation, need to be installed on each computer and the students carry out the practice at the computer classroom of the school under the supervision of a teacher. During this year the design of cam-follower mechanisms practice has been moved to a web application using Java and the Google Development Toolkit. In this practice the students has to design and study the running of a cam to perform a specific displacement diagram with a selected follower taking into account that the mechanism must be able to work properly at high speed regime. The practice has maintained its objectives in the new platform but to take advantage of the new methodology and try to avoid the inconveniences that the previous version had shown. Once the new practice has been ready, a pilot study has been carried out to compare both approaches: on-line and in-lab. This paper shows the adaptation of the cam and follower practice to an on-line methodology. Both practices are described and the changes that has been done to the initial one are shown. They are compared and the weak and strong points of each one are analyzed. Finally we explain the pilot study carried out, the students impression and the results obtained.

Strategies and good practice for sustainable and liveable cities of tomorrow

This contribution deals with the question, what makes cities sustainable and integrative, and suggests an approach for "liveable cities of tomorrow" designed to sustain mobility. The liveable city of tomorrow needs to meet both ecological and social requirements in an integrative approach. To design urban patterns appropriate or “sustainable mobility” based on a concept of mobility defined as the number of accessible destinations (different to that for “fossil mobility” defined as the ability to cover distances) is a key element of such an approach. Considering the limited reserves of fossil fuels and the long lifetime of the built structure, mobility needs to rely on modes independent of fossil fuels (public transport and pedestrians) to make it sustainable and the urban pattern needs to be developed appropriately for these modes. Crucial for the success of public transport is the location of buildings within the catchment area of stops. An attractive urban environment for pedestrians is characterised by short distances in a compact settlement with appropriate/qualified urban density and mixed land use as well as by attractive public space. This, complemented by an integrative urban development on the quarter level including neighbourhood management with a broad spectrum of activity areas (social infrastructure, integration of diverse social and ethnic groups, health promotion, community living, etc.), results in increased liveability. The role of information technology in this context is to support a sustainable use of the built structures by organisational instruments. Sustainable and liveable communities offer many benefits for health, safety and well-being of their inhabitants.

Computer analysis and design of concrete shell roofs

This paper is a preliminary version of Chapter 3 of a State-of-the-Art Report by the IASS Working Group 5: Concrete Shell Roofs. The intention of this chapter is to set forth for those who intend to design concrete shell roofs information and advice about the selection, verification and utilization of commercial computer tools for analysis and design tasks.The computer analysis and design steps for a concrete shell roof are described. Advice follows on the aspects to be considered in the application of commercial finite element (FE)computer programs to concrete shell analysis, starting with recommendations on how novices can gain confidence and competence in the use of software. To establish vocabulary and provide background references, brief surveys are presented of, first,element types and formulations for shells and, second, challenges presented by advanced analyses of shells. The final section of the chapter indicates what capabilities to seek in selecting commercial FE software for the analysis and design of concrete shell roofs. Brief concluding remarks summarize advice regarding judicious use of computer analysis in design practice.

Polyolefin fibre-reinforced concrete : from material behaviour to numerical and design considerations

La presente Tesis proporciona una gran cantidad de información con respecto al uso de un nuevo y avanzado material polimérico (con base de poliolefina) especialmente adecuada para ser usada en forma de fibras como adición en el hormigón. Se han empleado fibras de aproximadamente 1 mm de diámetro, longitudes entre 48 y 60 mm y una superficie corrugada. Las prometedoras propiedades de este material (baja densidad, bajo coste, buen comportamiento resistente y gran estabilidad química) justifican el interés en desarrollar el esfuerzo de investigación requerido para demostrar las ventajas de su uso en aplicaciones prácticas. La mayor parte de la investigación se ha realizado usando hormigón autocompactante como matriz, ya que este material es óptimo para el relleno de los encofrados del hormigón, aunque también se ha empleado hormigón normal vibrado con el fin de comparar algunas propiedades. Además, el importante desarrollo del hormigón reforzado con fibras en los últimos años, tanto en investigación como en aplicaciones prácticas, también es muestra del gran interés que los resultados y consideraciones de diseño que esta Tesis pueden tener. El material compuesto resultante, Hormigón Reforzado con Fibras de Poliolefina (HRFP o PFRC por sus siglas inglesas) ha sido exhaustivamente ensayado y estudiado en muchos aspectos. Los resultados permiten establecer cómo conseguidos los objetivos buscados: -Se han cuantificado las propiedades mecánicas del PFRC con el fin de demostrar su buen comportamiento en la fase fisurada de elementos estructurales sometidos a tensiones de tracción. -Contrastar los resultados obtenidos con las bases propuestas en la normativa existente y evaluar las posibilidades para el uso del PFRC con fin estructural para sustituir el armado tradicional con barras de acero corrugado para determinadas aplicaciones. -Se han desarrollado herramientas de cálculo con el fin de evaluar la capacidad del PFRC para sustituir al hormigón armado con las barras habituales de acero. -En base a la gran cantidad de ensayos experimentales y a alguna aplicación real en la construcción, se han podido establecer recomendaciones y consejos de diseño para que elementos de este material puedan ser proyectados y construidos con total fiabilidad. Se presentan, además, resultados prometedores en una nueva línea de trabajo en el campo del hormigón reforzado con fibras combinando dos tipologías de fibras. Se combinaron fibras de poliolefina con fibras de acero como refuerzo del mismo hormigón autocompactante detectándose sinergias que podrían ser la base del uso futuro de esta tecnología de hormigón. This thesis provides a significant amount of information on the use of a new advanced polymer (polyolefin-based) especially suitable in the form of fibres to be added to concrete. At the time of writing, there is a noteworthy lack of research and knowledge about use as a randomly distributed element to reinforce concrete. Fibres with an approximate 1 mm diameter, length of 48-60 mm, an embossed surface and improved mechanical properties are employed. The promising properties of the polyolefin material (low density, inexpensive, and with good strength behaviour and high chemical stability) justify the research effort involved and demonstrate the advantages for practical purposes. While most of the research has used self-compacting concrete, given that this type of matrix material is optimum in filling the concrete formwork, for comparison purposes standard vibration compacted mixes have also been used. In addition, the interest in fibre-reinforced concrete technology, in both research and application, support the significant interest in the results and considerations provided by the thesis. The resulting composite material, polyolefin fibre reinforced concrete (PFRC) has been extensively tested and studied. The results have allowed the following objectives to be met: -Assessment of the mechanical properties of PFRC in order to demonstrate the good performance in the post-cracking strength for structural elements subjected to tensile stresses. -- Assessment of the results in contrast with the existing structural codes, regulations and test methods. The evaluation of the potential of PFRC to meet the requirements and replace traditional steel-bar reinforcement applications. -Development of numerical tools designed to evaluate the capability of PFRC to substitute, either partially or totally, standard steel reinforcing bars either alone or in conjunction with steel fibres. -Provision, based on the large amount of experimental work and real applications, of a series of guidelines and recommendations for the practical and reliable design and use of PFRC. Furthermore, the thesis also reports promising results about an innovative line in the field of fibre-reinforced concrete: the design of a fibre cocktail to reinforce the concrete by using two types of fibres simultaneously. Polyolefin fibres were combined with steel fibres in self-compacting concrete, identifying synergies that could serve as the base in the future use of fibre-reinforced concrete technology.

Capacity Building through education, research and collaboration: AFRICA BUILD, an eHealth Case Study

AFRICA BUILD (AB) is a Coordination Action project under the 7th European Framework Programme having the aim of improving the capacities for health research and education in Africa through Information and Communication Technologies (ICT). This project, started in 2012, has promoted health research, education and evidence-based practice in Africa through the creation of centers of excellence, by using ICT,?know-how?, eLearning and knowledge sharing, through Web-enabled virtual communities.

Determination of spectral variations by means of component cells useful for CPV rating and design

A methodology is presented to determine both the short-term and the long-term influence of the spectral variations on the performance of Multi-Junction (MJ) solar cells and Concentrating "This is the peer reviewed version of the following article: R. Núñez, C. Domínguez, S. Askins, M. Victoria, R. Herrero, I. Antón, and G. Sala, “Determination of spectral variations by means of component cells useful for CPV rating and design,” Prog. Photovolt: Res. Appl., 2015., which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1002/pip.2715/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving [http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms]." Photovoltaic (CPV) modules. Component cells with the same optical behavior as MJ solar cells are used to characterize the spectrum. A set of parameters, namely Spectral Matching Ratios (SMRs), is used to characterize spectrally a particular Direct Normal Irradiance (DNI) by comparison to the reference spectrum (AM1.5D-ASTM-G173-03). Furthermore, the spectrally corrected DNI for a given MJ solar cell technology is defined providing a way to estimate the losses associated to the spectral variations. The last section analyzes how the spectrum evolves throughout a year in a given place and the set of SMRs representative for that location are calculated. This information can be used to maximize the energy harvested by the MJ solar cell throughout the year. As an example, three years of data recorded in Madrid shows that losses lower than 5% are expected due to current mismatch for state-of-the-art MJ solar cells.

Analysis and Design Considerations of an Electric Vehicle Powertrain regarding Energy Efficiency and Magnetic Field Exposure

En esta tesis se analiza el sistema de tracción de un vehículo eléctrico de batería desde el punto de vista de la eficiencia energética y de la exposición a campos magnéticos por parte de los pasajeros (radiación electromagnética). Este estudio incluye tanto el sistema de almacenamiento de energía como la máquina eléctrica, junto con la electrónica de potencia y los sistemas de control asociados a ambos. Los análisis y los resultados presentados en este texto están basados en modelos matemáticos, simulaciones por ordenador y ensayos experimentales a escala de laboratorio. La investigación llevada a cabo durante esta tesis tuvo siempre un marcado enfoque industrial, a pesar de estar desarrollada en un entorno de considerable carácter universitario. Las líneas de investigación acometidas tuvieron como destinatario final al diseñador y al fabricante del vehículo, a pesar de lo cual algunos de los resultados obtenidos son preliminares y/o excesivamente académicos para resultar de interés industrial. En el ámbito de la eficiencia energética, esta tesis estudia sistemas híbridos de almacenamiento de energía basados en una combinación de baterías de litio y supercondensadores. Este tipo de sistemas son analizados desde el punto de vista de la eficiencia mediante modelos matemáticos y simulaciones, cuantificando el impacto de ésta en otros parámetros tales como el envejecimiento de las baterías. Respecto a la máquina eléctrica, el estudio se ha centrado en máquinas síncronas de imanes permanentes. El análisis de la eficiencia considera tanto el diseño de la máquina como la estrategia de control, dejando parcialmente de lado el inversor y la técnica de modulación (que son incluidos en el estudio como fuentes adicionales de pérdidas, pero no como potenciales fuentes de optimización de la eficiencia). En este sentido, tanto la topología del inversor (trifásico, basado en IGBTs) como la técnica de modulación (control de corriente en banda de histéresis) se establecen desde el principio. El segundo aspecto estudiado en esta tesis es la exposición a campos magnéticos por parte de los pasajeros. Este tema se enfoca desde un punto de vista predictivo, y no desde un punto de vista de diagnóstico, puesto que se ha desarrollado una metodología para estimar el campo magnético generado por los dispositivos de potencia de un vehículo eléctrico. Esta metodología ha sido validada mediante ensayos de laboratorio. Otros aspectos importantes de esta contribución, además de la metodología en sí misma, son las consecuencias que se derivan de ella (por ejemplo, recomendaciones de diseño) y la comprensión del problema proporcionada por esta. Las principales contribuciones de esta tesis se listan a continuación: una recopilación de modelos de pérdidas correspondientes a la mayoría de dispositivos de potencia presentes en un vehículo eléctrico de batería, una metodología para analizar el funcionamiento de un sistema híbrido de almacenamiento de energía para aplicaciones de tracción, una explicación de cómo ponderar energéticamente los puntos de operación par-velocidad de un vehículo eléctrico (de utilidad para evaluar el rendimiento de una máquina eléctrica, por ejemplo), una propuesta de incluir un convertidor DC-DC en el sistema de tracción para minimizar las pérdidas globales del accionamiento (a pesar de las nuevas pérdidas introducidas por el propio DC-DC), una breve comparación entre dos tipos distintos de algoritmos de minimización de pérdidas para máquinas síncronas de imanes permanentes, una metodología predictiva para estimar la exposición a campos magnéticos por parte de los pasajeros de un vehículo eléctrico (debida a los equipos de potencia), y finalmente algunas conclusiones y recomendaciones de diseño respecto a dicha exposición a campos magnéticos. ABSTRACT This dissertation analyzes the powertrain of a battery electric vehicle, focusing on energy efficiency and passenger exposure to electromagnetic fields (electromagnetic radiation). This study comprises the energy storage system as well as the electric machine, along with their associated power electronics and control systems. The analysis and conclusions presented in this dissertation are based on mathematical models, computer simulations and laboratory scale tests. The research performed during this thesis was intended to be of industrial nature, despite being developed in a university. In this sense, the work described in this document was carried out thinking of both the designer and the manufacturer of the vehicle. However, some of the results obtained lack industrial readiness, and therefore they remain utterly academic. Regarding energy efficiency, hybrid energy storage systems consisting in lithium batteries, supercapacitors and up to two DC-DC power converters are considered. These kind of systems are analyzed by means of mathematical models and simulations from the energy efficiency point of view, quantifying its impact on other relevant aspects such as battery aging. Concerning the electric machine, permanent magnet synchronous machines are studied in this work. The energy efficiency analysis comprises the machine design and the control strategy, while the inverter and its modulation technique are taken into account but only as sources of further power losses, and not as potential sources for further efficiency optimization. In this sense, both the inverter topology (3-phase IGBT-based inverter) and the switching technique (hysteresis current control) are fixed from the beginning. The second aspect studied in this work is passenger exposure to magnetic fields. This topic is approached from the prediction point of view, rather than from the diagnosis point of view. In other words, a methodology to estimate the magnetic field generated by the power devices of an electric vehicle is proposed and analyzed in this dissertation. This methodology has been validated by laboratory tests. The most important aspects of this contribution, apart from the methodology itself, are the consequences (for instance, design guidelines) and the understanding of the magnetic radiation issue provided by it. The main contributions of this dissertation are listed next: a compilation of loss models for most of the power devices found in a battery electric vehicle powertrain, a simulation-based methodology to analyze hybrid energy storage performance in traction applications, an explanation of how to assign energy-based weights to different operating points in traction drives (useful when assessing electrical machine performance, for instance), a proposal to include one DC-DC converter in electric powertrains to minimize overall power losses in the system (despite the new losses added by the DC-DC), a brief comparison between two kinds of loss-minimization algorithms for permanent magnet synchronous machines in terms of adaptability and energy efficiency, a predictive methodology to estimate passenger magnetic field exposure due to power devices in an electric vehicle, and finally some useful conclusions and design guidelines concerning magnetic field exposure.

Enabling, empowering, inspiring: research and mentorship through the years*

The interrelationship between research and mentorship in an association such as the Medical Library Association (MLA) is revealed through the contributions of individuals and significant association activities in support of research. Research is vital to the well-being and ultimate survival of health sciences librarianship and is not an ivory tower academic activity. Mentorship plays a critical role in setting a standard and model for those individuals who want to be involved in research and, ultimately, for the preparation of the next generation of health sciences librarians. Research and mentorship are discussed in the context of personal experiences, scholarship, and problem solving in a practice environment. Through research and mentorship, we are enabled to enhance our services and programs, empowered to look beyond our own operations for information puzzles to be solved, and inspired to serve society by improving health.

Identification of receptor-binding domains on human interleukin 5 and design of an interleukin 5-derived receptor antagonist.

A detailed structure-function analysis of human interleukin 5 (hIL5) has been performed. The hIL5 receptor is composed of two different polypeptide chains, the alpha and beta subunits. The alpha subunit alone is sufficient for ligand binding, but association with the beta subunit leads to a 2- to 3-fold increase in binding affinity. The beta chain is shared with the receptors for IL3 and granulocyte/macrophage-colony-stimulating factor--hence the descriptor beta C (C for common). All hIL5 mutants were analyzed in a solid-phase binding assay for hIL5R alpha interaction and in a proliferation assay using IL5-dependent cell lines for receptor-complex activation. Most residues affecting binding to the receptor alpha subunit were clustered in a loop connecting beta-strand 1 and helix B (mutants H38A, K39A, and H41A), in beta-strand 2 (E89A and R91A; weaker effect for E90A) and close to the C terminus (T109A, E110A, W111S, and I112A). Mutations at one position, E13 (Glu13), caused a reduced activation of the hIL5 receptor complex. In the case of E13Q, only 0.05% bioactivity was detected on a hIL5-responsive subclone of the mouse promyelocytic cell line FDC-P1. Moreover, on hIL5-responsive TF1 cells, the same mutant was completely inactive and proved to have antagonistic properties. Interactions of this mutant with both receptor subunits were nevertheless indistinguishable from those of nonmutated hIL5 by crosslinking and Scatchard plot analysis of transfected COS-1 cells.

Towards a New (European Research) Deal: The Case for Enhanced Fiscal Policy Coordination on Research and Innovation. Bruges European Economic Policy (BEEP) Briefing 20/2008

The paper reviews the evolution of research and innovation in the EU and assesses how current policies and programmes have influenced the development of Europe's research landscape. Based on existing literature, evaluation reports and practice, the paper critically examines the effectiveness of current European research funding instruments in a context of open innovation and in the presence of global spillovers. It therefore develops a subsidiarity test to assess whether current rationales still prove sufficient to justify policy intervention in this area. The paper sheds light on how to improve the effectiveness of EU action by enriching it by the use of coordinated fiscal policy for research funding. This will constitute an incentive to genuine bottom-up research, development and innovation (R&D&I) and a stimulus to local investments in innovation. The paper also assesses the potentials of a reinforced open method of coordination as well as a review of state aid law in the field of research funding in the EU.

Augmentation of research and analysis capabilities for timely support of automotive fuel economy activities. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Improved commercial vehicle conspicuity and signalling systems. Task II: analyses, experiments and design recommendations. Interim report.

National Highway Traffic Safety Administration, Washington, D.C.

Systems analysis and design guidelines for highway advisory radio. Executive summary. Final report.

Federal Highway Administration, Office of Research and Development, Washington, D.C.