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.^

Biomass and substrate utilization of cold adapted bacteria in Fram Strait and the Western Greenlad Sea

During the 'Polarstern' expedition ARK-IV/2 in June 1987, water samples from 8 stations were taken to study biomass and substrate utilization of cold adapted bacteria. Bacterial biomasses determined from acridine orange direct counts (AODC) were between 0.4 and 31.4 µ/g C/l, and ATP concentrations amounted from <0.1 to 40 ng/l. Colony counts on seawater agar reached only 0.1% of AODC, but with the MPN-method 1 to 10% of AODC were recorded. With 14C-glutamic acid or 14C-glucose as tracer substrate in oligotrophic broth containing 0.5 mg trypticase and 0.05 mg yeast extract per liter of seawater, obligately oligotrophic bacteria could be detected in one water sample. Although incubation was at 2 °C, only psychrotrophic bacteria showing growth temperatures between 1 and 30 °C were obtained. Organic substrate utilizations by 106 isolates were tested at 4 and 20 °C. Most carbohydrates, organic acids, alcohols, and alanine were assimilated at both temperatures, but arginine, aspartate and ornithine were utilized only at 20 °C by almost all strains.

Selection and utilization of the early harvest list : evidence from the Free Trade Agreement between China and Taiwan

In this paper, we conducted an empirical investigation into the determinants of FTA utilization in exports from Taiwan to China. To do this, we first estimated the selection equation to see what kinds of products are included in the early harvest list. As a result, we found that Taiwan includes products with a medium magnitude of benefits from tariff removal in the early harvest list. Taiwan also includes products for which ASEAN countries have better access to the China market. We then estimated the equation for the determinants of FTA utilization by introducing an inverse of the Mills ratio estimated in the selection equation. The findings are that, as usual, the FTA rates are more likely to be utilized for products with a larger tariff margin. In addition, some rules of origin are found to be relatively restrictive in terms of discouraging trade.

Evaluation of the utilization of electric vehicles for building energy management in hotels

Governments are working in new policies to slow down total energy consumption and greenhouse gases (GHG) emissions, promoting the deployment of electric vehicles (EVs) in all countries. In order to facilitate this deployment and help to reduce the final costs of their batteries, additional utilization of EVs when those are parked has been proposed. EVs can be used to minimize the total electricity cost of buildings (named vehicle to building applications, V2B). In this paper an economic evaluation of EVs in the Building Energy Management System is shown. The optimal storage capacity and its equivalent number of EVs are determined. This value is then used for determining the optimal charging schedule to be applied to the batteries. From this schedule, the total expected profit is derived for the case of a real hotel in Spain.

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi

Acknowledgements This article was based on the first author’s PhD which was financed by the Malawi Health Research Capacity Strengthening Initiative. We thank Mr Patrick Naphini formerly of the Ministry of Health and Mrs Mafase Sesani at CHAM Secretariat for helping with the data. We also thank Mr Jacob Mazalale for useful comments on the article.

Simple neural networks for the amplification and utilization of small changes in neuron firing rates

I describe physiologically plausible “voter-coincidence” neural networks such that secondary “coincidence” neurons fire on the simultaneous receipt of sufficiently large sets of input pulses from primary sets of neurons. The networks operate such that the firing rate of the secondary, output neurons increases (or decreases) sharply when the mean firing rate of primary neurons increases (or decreases) to a much smaller degree. In certain sensory systems, signals that are generally smaller than the noise levels of individual primary detectors, are manifest in very small increases in the firing rates of sets of afferent neurons. For such systems, this kind of network can act to generate relatively large changes in the firing rate of secondary “coincidence” neurons. These differential amplification systems can be cascaded to generate sharp, “yes–no” spike signals that can direct behavioral responses.

Utilization of ADR Concepts to Bridge the Gap Between the Extractive Industry and Environmental Interests: An Anticipatory Cooperative Effort (ACE)

The extractive industry, more than any other sector of the economy, often finds itself mired in conflicts with various environmental and community interests. As traditional legal avenues of resolution gave way to the collaborative ideas of alternative dispute resolution, the outcomes, especially the relational outcomes, were less than desirable. This capstone project proposes that an Anticipatory Cooperative Effort (ACE) can help to bridge the gap between industry and environmental interests by encouraging a pro-active and pre-emptive engagement. The point of the ACE concept is not that it defines a new set of principles so much as it repositions where established ADR principles are entertained.