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Jackson GL, Fix GM, White BS, Cutrona SL, Reardon CM, Damschroder LJ, Burns M, DeLaughter K, Opra Widerquist MA, Arasim M, Lindquist J, Gifford AL, King HA, Kaitz J, Jasuja GK, Hogan TP, Lopez JCF, Henderson B, Fitzgerald BA, Goetschius A, Hagan D, McCoy C, Seelig A, Nevedal A. Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration. Front Health Serv 2024; 3:1223277. [PMID: 38420338 PMCID: PMC10900518 DOI: 10.3389/frhs.2023.1223277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024]
Abstract
Introduction The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA. Methods Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators. Results In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank. Conclusion DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J. Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | | | - Maria Arasim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Heather A. King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Division of General Internal Medicine, Duke University, Durham, NC, United States
| | - Jenesse Kaitz
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Guneet K. Jasuja
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Timothy P. Hogan
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Jaifred Christian F. Lopez
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Blake Henderson
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Blaine A. Fitzgerald
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Amber Goetschius
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Danielle Hagan
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Carl McCoy
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Alex Seelig
- Agile Six Applications, Inc., San Diego, CA, United States
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Cutrona SL, White L, Miano D, Damschroder LJ, Hogan TP, Gifford AL, White B, King HA, Opra Widerquist MA, Orvek E, DeLaughter K, Nevedal AL, Reardon CM, Henderson B, Vega R, Jackson GL. Supporting Veteran's Administration Medical Center Directors' Decisions When Adopting Innovative Practices: Development and Implementation of the "QuickView" and "WishList" Tools. Perm J 2023; 27:79-91. [PMID: 37545198 PMCID: PMC10502382 DOI: 10.7812/tpp/23.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Since 2015, the Veterans Health Administration (VHA) Diffusion of Excellence Program has supported spread of practices developed by frontline employees. Shark Tank-style competitions encourage "Sharks" nationwide (VHA medical center/regional directors) to bid for the opportunity to implement practices at their institutions. Methods The authors evaluated bidding strategies (2016-2020), developing the "QuickView" practice comparator to promote informed bidding. Program leaders distributed QuickView and revised versions in subsequent competitions. Our team utilized in-person observation, online chats after the competition, bidder interviews, and bid analysis to evaluate QuickView use. Bids were ranked based on demonstrated understanding of resources required for practice implementation. Results Sharks stated that QuickView supported preparation before the competition and suggested improvements. Our revised tool reported necessary staff time and incorporated a "WishList" from practice finalists detailing minimum requirements for successful implementation. Bids from later years reflected increased review of facilities' current states before the competition and increased understanding of the resources needed for implementation. Percentage of bids describing local need for the practice rose from 2016 to 2020: 4.7% (6/127); 62.1% (54/87); 78.3% (36/46); 80.6% (29/36); 89.7% (26/29). Percentage of bids committing specific resources rose following QuickView introduction: 81.1% (103/127) in 2016, 69.0% (60/87) in 2017, then 73.9% (34/46) in 2018, 88.9% (32/36) in 2019, and 89.7% (26/29) in 2020. Discussion In the years following QuickView/WishList implementation, bids reflected increased assessment before the competition of both local needs and available resources. Conclusion Selection of a new practice for implementation requires an understanding of local need, necessary resources, and fit. QuickView and WishList appear to support these determinations.
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Affiliation(s)
- Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Danielle Miano
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Timothy P Hogan
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Section of General Internal Medicine, Department of Health Law, Policy & Management, Boston University, Boston, MA, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Andrea L Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Diffusion of Excellence, Office of Discovery, Education and Affiliate Networks, VHA, Washington, DC, USA
| | - Ryan Vega
- Office of Discovery, Education and Affiliate Networks, VHA, Bedford, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
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Kaitz J, DeLaughter K, Deeney C, Cutrona SL, Hogan TP, Gifford AL, Jackson GL, White B, King H, Reardon C, Nevedal A, Henderson B, Fix GM. Leveraging Organizational Conditions for Innovation: A Typology of Facility Engagement in the Veterans Health Administration Shark Tank-Style Competition. Perm J 2023:1-8. [PMID: 36946078 DOI: 10.7812/tpp/22.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Introduction The development and spread of innovation are known challenges in health care. The US Veterans Health Administration (VHA) created a "Shark Tank"-style competition directed at frontline employees. In this annual, systemwide competition, employees submit innovations to the competition, and winning innovations receive support for implementation in other facilities. Method A multiple case study design was used to understand facility engagement in the competition, and the relationship between engagement and organizational conditions. The authors created a typology to describe the relationship between facility engagement in the competition and organizational conditions for innovation. Results Overall, there was high participation in the VHA's competition across all 130 facilities. The authors identified 7 mutually exclusive types of facility engagement. Discussion As expected, facilities with the most established conditions for innovation were the most engaged in the competition. Additionally, other facilities had various ways to be involved. Consequently, there may be benefit to the VHA tailoring how they work with facilities, based on organizational conditions. Larger facilities with ongoing research and more resources may be more suited to develop innovations, whereas smaller facilities could benefit from a focus on adoption. Conclusion These insights are valuable to the VHA and can be used by other health care systems to tailor innovation programs and allocate resources based on diverse needs across a vast health care system.
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Affiliation(s)
- Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Christine Deeney
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Heather King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caitlin Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Department of Veterans Affairs, VHA Innovation Ecosystem/Diffusion of Excellence, Washington, DC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Portillo E, Lehmann M, Hagen T, Maurer M, Kettner J, Bhardwaj S, Goodrich D, McFarland MS, Virrueta N, Henderson B, Birstler J, Chui MA. Evaluation of an implementation package to deliver the COPD CARE service. BMJ Open Qual 2023; 12:bmjoq-2022-002074. [PMID: 36849192 PMCID: PMC9972453 DOI: 10.1136/bmjoq-2022-002074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is estimated to be the leading cause of death in the next 15 years. Patients with COPD suffer from persistent chronic cough, sputum production and exacerbations leading to deteriorating lung function, worsening quality of life and loss of independence. While evidence-based interventions exist to improve the well-being of patients with COPD, incorporation of these interventions into routine clinical care is challenging. Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE) is a team-based, coordinated care transitions service integrating evidence-based interventions for COPD management within the patient care delivery model to reduce readmissions. This evaluation considers the process of scaling the COPD CARE service across medical facilities using an implementation package designed for service expansion. The implementation package was developed at the United States Veterans Health Administration and implemented at two medical centres. Core dissemination and implementation science methods were applied to guide design and delivery of the implementation package.The aims of this evaluation were to (1) evaluate the impact of the implementation package on use of evidence-based interventions for COPD management and (2) explore clinician perceptions of the implementation package. This prospective mixed-methods quality improvement project included two Plan Do Check Act (PDCA) cycles conducted over a 24-month period. Electronic health record data demonstrated significant improvements in the count of evidence-based interventions incorporated into routine clinical care after training completion (p<0.001), offering preliminary effectiveness of the package to improve uptake of best practices for COPD management. Clinician perceptions of the implementation package, measured by questionnaire at multiple time points, demonstrated significant improvements for all scales at the end of the final PDCA cycle. Clinicians described the implementation package as positively impacting clinician confidence, interprofessional collaboration and patient care delivery.
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Affiliation(s)
- Edward Portillo
- University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin, USA
| | - Molly Lehmann
- Department of Veterans Affairs, William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | - Timothy Hagen
- Department of Veterans Affairs, Healthcare System of the Ozarks, Fayetteville, Arkansas, USA
| | - Martha Maurer
- University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin, USA
| | - Jordyn Kettner
- Department of Veterans Affairs, William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | - Sonia Bhardwaj
- Department of Veterans Affairs, William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | - David Goodrich
- Department of Veterans Affairs, Center for Health Equity and Promotion (CHERP), Pittsburgh, Pennsylvania, USA
| | - M Shawn McFarland
- Department of Veterans Affairs, Clinical Pharmacy Practice Office, Washington, DC, USA
| | - Natasha Virrueta
- Department of Veterans Affairs, William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | - Blake Henderson
- Department of Veterans Affairs, Diffusion of Excellence, Washington, DC, USA
| | - Jen Birstler
- University of Wisconsin-Madison, Institute for Clinical and Translational Research (ICTR), Madison, Wisconsin, USA
| | - Michelle A Chui
- University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin, USA
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Reardon CM, Damschroder L, Opra Widerquist MA, Arasim M, Jackson GL, White B, Cutrona SL, Fix GM, Gifford AL, DeLaughter K, King HA, Henderson B, Vega R, Nevedal AL. Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool. Implement Sci Commun 2023; 4:6. [PMID: 36647162 PMCID: PMC9842210 DOI: 10.1186/s43058-022-00386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/18/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed. The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors "Shark Tank" competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices. METHODS In June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses. RESULTS A representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1-4. CONCLUSIONS The initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.
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Affiliation(s)
- Caitlin M. Reardon
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Laura Damschroder
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Marilla A. Opra Widerquist
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Maria Arasim
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - George L. Jackson
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Family Medicine & Community Health, Duke University, Durham, USA
| | - Brandolyn White
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA ,grid.168645.80000 0001 0742 0364Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA ,grid.189504.10000 0004 1936 7558Department of Health Law, Policy & Management, Boston University, Boston, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA
| | - Heather A. King
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA
| | - Blake Henderson
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Ryan Vega
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Andrea L. Nevedal
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
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Musey P, Kelker H, Yoder K, Henderson B, Johnson O, Sarmiento E, Harris M, Vyas P, Welch J. 221 Impact of the COVID Pandemic on Emergency Physician Well-Being and Burnout: A 2-Year Longitudinal Study. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pattwell M, Eldridge L, Milton M, Jethwa J, Murphy J, Slavova-Boneva V, Kiely G, Cowan-Dickie S, Pessoa Silva M, Tomlins E, Crimmin J, McWhirter A, Roe J, Ashforth K, Grayer J, Henderson B, Stanley P, Mann L, Halsted A, Kano Y, McGinn M, Droney J, Mooney J, Bateman E, Wood J, Kipps E, Johnston S, Ashurst I, Ring A, Battisti N. Nutritional needs in older adults receiving systemic treatment for breast cancer: The Royal Marsden Senior Adult Oncology Programme experience. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jackson GL, Damschroder LJ, White BS, Henderson B, Vega RJ, Kilbourne AM, Cutrona SL. Balancing reality in embedded research and evaluation: Low vs high embeddedness. Learn Health Syst 2021; 6:e10294. [PMID: 35434356 PMCID: PMC9006533 DOI: 10.1002/lrh2.10294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
Embedding research and evaluation into organizations is one way to generate “practice‐based” evidence needed to accelerate implementation of evidence‐based innovations within learning health systems. Organizations and researchers/evaluators vary greatly in how they structure and operationalize these collaborations. One key aspect is the degree of embeddedness: from low embeddedness where researchers/evaluators are located outside organizations (eg, outside evaluation consultants) to high embeddedness where researchers/evaluators are employed by organizations and thus more deeply involved in program evolution and operations. Pros and cons related to the degree of embeddedness (low vs high) must be balanced when developing these relationships. We reflect on this process within the context of an embedded, mixed‐methods evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program. Considerations that must be balanced include: (a) low vs high alignment of goals; (b) low vs high involvement in strategic planning; (c) observing what is happening vs being integrally involved with programmatic activities; (d) reporting findings at the project's end vs providing iterative findings and recommendations that contribute to program evolution; and (e) adhering to predetermined aims vs adapting aims in response to evolving partner needs.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Durham North Carolina USA
- Division of General Internal Medicine, Department of Medicine Duke University Durham North Carolina USA
- Department of Family Medicine and Community Health Duke University Durham North Carolina USA
| | - Laura J. Damschroder
- Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan USA
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Blake Henderson
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Ryan J. Vega
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Amy M. Kilbourne
- Quality Enhancement Research Initiative (QUERI) United States Veterans Health Administration Washington District of Columbia USA
- Department of Learning Health Sciences University of Michigan Ann Arbor Michigan USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research Bedford & Boston VA Medical Centers Bedford Massachusetts USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester Massachusetts USA
- Division of General Internal Medicine, Department of Medicine University of Massachusetts Medical School Worcester Massachusetts USA
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Kelker H, Cushman E, Munson C, Yoder K, Musey P, Reed K, Henderson B, Vynas P, Johnson O, Welch J. 99 Identifying Factors that Contribute to Joy and Gratitude for Emergency Medicine Health Care Providers Amidst the COVID-19 Pandemic. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Jackson GL, Cutrona SL, White BS, Reardon CM, Orvek E, Nevedal AL, Lindquist J, Gifford AL, White L, King HA, DeLaughter K, Houston TK, Henderson B, Vega R, Kilbourne AM, Damschroder LJ. Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program. Jt Comm J Qual Patient Saf 2020; 47:217-227. [PMID: 33549485 DOI: 10.1016/j.jcjq.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program developed and manages a framework for identification, replication, and diffusion of promising practices throughout the nation's largest integrated health care system. DoE identifies promising practices through a "Shark Tank" competition with winning bidders receiving external implementation facilitation. DoE further supports diffusion of successful practices across the VHA. METHODS This article presents results of a mixed methods implementation evaluation of DoE, focusing on program reach, program participation and decisions to adopt innovative practices, implementation processes, and practice sustainment. Data sources include practice adoption metrics, focus groups with bidders (two focus groups), observations of DoE events (seven events), surveys of stakeholders (five separate surveys), and semistructured interviews of facility directors, practice developers, implementation teams, and facilitators (133 participants). RESULTS In the first four Shark Tank cohorts (2016-2018), 1,676 practices were submitted; 47 were designated Gold Status Practices (practices with facilitated implementation). Motivation for participation varied. Generally, staff led projects targeting problems they felt passionate about, facility directors focused on big-picture quality metrics and getting middle manager support, and frontline staff displayed variable motivation to implement new projects. Approximately half of facilitated implementation efforts were successful; barriers included insufficient infrastructure, staff, and resources. At the facility level, 73.3% of facilities originating or receiving facilitated implementation support have maintained the practice. VHA-wide, 834 decisions to adopt these practices were made. CONCLUSION DoE has resulted in the identification of many candidate practices, promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across the VHA.
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Hogrefe C, Henderson B, Tonnesen G, Mathur R, Matichuk R. Multiscale Modeling of Background Ozone: Research Needs to Inform and Improve Air Quality Management. EM (Pittsburgh Pa) 2020; N/A:1-6. [PMID: 33281437 PMCID: PMC7709794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- C Hogrefe
- Center for Environmental Measurement and Modeling, Office of Research and Development, Environmental Protection Agency, Research Triangle Park, NC 27711
| | - B Henderson
- Office of Air Quality Planning and Standards, Office of Air and Radiation, Environmental Protection Agency, Research Triangle Park, NC 27711
| | - G Tonnesen
- Air and Radiation Division, Region 8, Environmental Protection Agency, Denver, CO 80202
| | - R Mathur
- Center for Environmental Measurement and Modeling, Office of Research and Development, Environmental Protection Agency, Research Triangle Park, NC 27711
| | - R Matichuk
- Air and Radiation Division, Region 8, Environmental Protection Agency, Denver, CO 80202
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Smigelsky MA, Nieuwsma JA, Meador K, Vega RJ, Henderson B, Jackson GL. Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model. Healthc (Amst) 2020; 8:100440. [PMID: 32919579 PMCID: PMC7405892 DOI: 10.1016/j.hjdsi.2020.100440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
Healthcare providers across a wide variety of settings face a common challenge: the need to provide real time care for complex problems that are not adequately addressed by existing protocols. In response to these intervention gaps, frontline providers may utilize existing evidence to develop new approaches that are tailored to specific problems. It is imperative that such approaches undergo some form of evaluation, ensuring quality control while permitting ongoing adaptation and refinement. “Dynamic diffusion” is an innovative approach to intervention improvement and dissemination whereby care practices are delivered and continuously evaluated under real-world conditions as part of a structured network experience. This “dynamic diffusion network” (DDN) promotes cross-pollination of ideas and shared learning to generate relatively rapid improvements in care. The pilot Mental Health and Chaplaincy DDN was developed to advance suicide prevention efforts and moral injury care practices being conducted by 13 chaplain-mental health professional teams across the Veterans Health Administration. Lessons learned from the pilot DDN include the importance of the following: geographic and cultural diversity among innovation collaborators to ensure the broadest possible relevance of solutions; leadership support to facilitate engagement of frontline providers in quality improvement efforts; and participation in a community of practice to motivate providers and offer opportunities for direct collaboration and cross-pollination of ideas.
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Affiliation(s)
- Melissa A Smigelsky
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Keith Meador
- Mental Health and Chaplaincy, Department of Veterans Affairs, Durham, NC, USA; Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, Vanderbilt Divinity School, Vanderbilt University, Nashville, TN, USA
| | - Ryan J Vega
- VHA Innovation Ecosystem/Diffusion of Excellence, Department of Veterans Affairs, Washington, DC, USA
| | - Blake Henderson
- VHA Innovation Ecosystem/Diffusion of Excellence, Department of Veterans Affairs, Washington, DC, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Jackson G, Cutrona S, White B, Reardon C, Orvek E, Nevedal A, Lindquist J, Gifford A, King H, DeLaughter K, Henderson B, Vega R, Damschroder L. Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- G. Jackson
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - S. Cutrona
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System Durham NC United States
| | - C. Reardon
- VA Ann Arbor Healthcare System Ann Arbor MI United States
| | - E. Orvek
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - A. Nevedal
- VA Palo Alto Health Care System Menlo Park CA United States
| | - J. Lindquist
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - A. Gifford
- VA Boston Healthcare System Boston MA United States
- Boston University Boston MA United States
| | - H. King
- Duke University Durham NC United States
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - K. DeLaughter
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. Henderson
- United States Veterans Health Administration Innovation Ecosystem Washington DC United States
| | - R. Vega
- Veterans Health Administration (VHA) Innovation Ecosystem Washington DC United States
| | - L. Damschroder
- VA Ann Arbor Healthcare System Ann Arbor MI United States
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Nevedal AL, Reardon CM, Jackson GL, Cutrona SL, White B, Gifford AL, Orvek E, DeLaughter K, White L, King HA, Henderson B, Vega R, Damschroder L. Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study. Implement Sci Commun 2020; 1:61. [PMID: 32885216 PMCID: PMC7427879 DOI: 10.1186/s43058-020-00053-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual "Shark Tank" competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. METHODS Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. RESULTS Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. CONCLUSIONS Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA's DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.
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Affiliation(s)
- Andrea L. Nevedal
- Center for Innovation to Implementation, VHA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025 USA
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
| | - George L. Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Brandolyn White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Section of General Internal Medicine & Department of Health Law, Policy & Management, Boston University, 715 Albany St., Talbot Building, T2W, Boston, MA 02118 USA
| | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
| | - Heather A. King
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Blake Henderson
- Diffusion of Excellence, VHA Innovation Ecosystem, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Ryan Vega
- VHA Office of Discovery, Education and Affiliate Networks, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Laura Damschroder
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
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Vega R, Jackson GL, Henderson B, Clancy C, McPhail J, Cutrona SL, Damschroder LJ, Bhatnagar S. Diffusion of Excellence: Accelerating the Spread of Clinical Innovation and Best Practices across the Nation's Largest Health System. Perm J 2019; 23:18.309. [PMID: 31634112 DOI: 10.7812/tpp/18.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The time it takes for clinical innovation and evidence-based practices to reach patients remains a major challenge for the health care sector. In 2015, the Veterans Health Administration (VHA) launched the Diffusion of Excellence Initiative aimed at aligning organizational resources with early-stage to midstage promising practices and innovations to replicate, scale, and eventually spread those with greatest potential for impact and positive outcomes. Using a 5-step systematic approach refined over time, frontline VHA staff have submitted more than 1676 practices since the initiative's inception, 47 of which have been selected as high-impact, Gold Status practices. These Gold Status practices have been replicated more than 412 times in Veterans Affairs hospitals across the country, improving care for more than 100,000 veterans and approximately $22.6 million in cost avoidance for the VHA. More importantly, practices such as Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to complete oral care) and rapid availability of intranasal naloxone have saved veterans' lives. Several practices are now being implemented across the country, and the Diffusion of Excellence Initiative is playing a pivotal role as the VHA works to modernize its health care system. This initiative serves as a promising model for other health care systems seeking to accelerate the spread and adoption of clinical innovation and evidence-based practices.
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Affiliation(s)
- Ryan Vega
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Richmond, VA
| | - George L Jackson
- Durham Veterans Administration Medical Center, Veterans Health Administration, NC
| | - Blake Henderson
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Washington, DC
| | - Carolyn Clancy
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Washington, DC
| | - Jennifer McPhail
- Diffusion of Excellence Team, Atlas Research, LLC, Washington, DC
| | - Sarah L Cutrona
- Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA
| | - Laura J Damschroder
- Ann Arbor Veterans Administration Medical Center, Veterans Health Administration, MI
| | - Saurabha Bhatnagar
- Office of Quality, Safety, and Value, Veterans Health Administration, Washington, DC
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Herrero M, Addison J, Bedelian C, Carabine E, Havlík P, Henderson B, Van De Steeg J, Thornton PK. Climate change and pastoralism: impacts, consequences and adaptation. REV SCI TECH OIE 2017; 35:417-433. [PMID: 27917982 DOI: 10.20506/rst.35.2.2533] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors discuss the main climate change impacts on pastoralist societies, including those on rangelands, livestock and other natural resources, and their extended repercussions on food security, incomes and vulnerability. The impacts of climate change on the rangelands of the globe and on the vulnerability of the people who inhabit them will be severe and diverse, and will require multiple, simultaneous responses. In higher latitudes, the removal of temperature constraints might increase pasture production and livestock productivity, but in tropical arid lands, the impacts are highly location specific, but mostly negative. The authors outline several adaptation options, ranging from implementing new technical practices and diversifying income sources to finding institutional support and introducing new market mechanisms, all of which are pivotal for enhancing the capacity of pastoralists to adapt to climate variability and change. Due to the dynamism of all the changes affecting pastoral societies, strategies that lock pastoral societies into specified development pathways could be maladaptive. Flexible and evolving combinations of practices and policies are the key to successful pastoral adaptation.
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Affiliation(s)
- A F Merry
- Clinical Associate Professor, Department of Anaesthesia, Green Lane Hospital, Department of Pharmacology, School of Medicine, University of Auckland, Auckland, New Zealand
| | - B Henderson
- Captain, A320 Training Manager, Air New Zealand
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Herrero M, Addison J, Bedelian C, Carabine E, Havlík P, Henderson B, Van De Steeg J, Thornton PK. Climate change and pastoralism: impacts, consequences and adaptation. REV SCI TECH OIE 2016; 35:417-433. [PMID: 27917982 DOI: 10.20506/rst/35.2.2533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors discuss the main climate change impacts on pastoralist societies, including those on rangelands, livestock and other natural resources, and their extended repercussions on food security, incomes and vulnerability. The impacts of climate change on the rangelands of the globe and on the vulnerability of the people who inhabit them will be severe and diverse, and will require multiple, simultaneous responses. In higher latitudes, the removal of temperature constraints might increase pasture production and livestock productivity, but in tropical arid lands, the impacts are highly location specific, but mostly negative. The authors outline several adaptation options, ranging from implementing new technical practices and diversifying income sources to finding institutional support and introducing new market mechanisms, all of which are pivotal for enhancing the capacity of pastoralists to adapt to climate variability and change. Due to the dynamism of all the changes affecting pastoral societies, strategies that lock pastoral societies into specified development pathways could be maladaptive. Flexible and evolving combinations of practices and policies are the key to successful pastoral adaptation.
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Nibali L, Novoa L, Donos N, Henderson B, Blanco J, Tomas I. Leukocyte receptor expression in chronic periodontitis. Clin Oral Investig 2016; 20:2559-2564. [PMID: 26961374 DOI: 10.1007/s00784-016-1774-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/29/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Microbial recognition in the periodontium through specific leukocyte receptors gives rise to the response which in susceptible individuals can lead to periodontal diseases. The aim of this study was to explore the expression of leukocyte receptors in the gingival tissues of chronic periodontitis patients and to analyse differences between diseased and control sites (sites with probing pocket depth <4 mm). MATERIAL AND METHODS Thirty-seven chronic periodontitis patients were included in the study. Gingival biopsies were harvested from diseased and control sites and processed by flow cytometry for the determination of the expression of 16 leukocyte receptors (CD4, CD8, CD11b, CD14, CD16, CD19, CD25, CD28, CD49d, CD49e, CD62, CD71, CD80, CCR7, Ly6G and HLA-DR). RESULTS Expression of all studied receptors was higher in test compared with control sites (p < 0.005). Sampled sites with less bleeding on probing exhibited higher expression of CD16 and CD14 receptors (p = 0.020 and 0.011, respectively). CONCLUSIONS This study points towards considerable differences in the expression of leukocyte receptors between diseased and control sites in the same periodontal patients.
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Affiliation(s)
- L Nibali
- Clinical Oral Research Centre, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
| | - L Novoa
- Oral Sciences Research Group, Periodontology and Special Needs Units, School of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - N Donos
- Clinical Oral Research Centre, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
| | - B Henderson
- Division of Microbial Diseases, UCL Eastman Dental Institute, London, UK
| | - J Blanco
- Oral Sciences Research Group, Periodontology and Special Needs Units, School of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - I Tomas
- Oral Sciences Research Group, Periodontology and Special Needs Units, School of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
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Henderson B, Godde C, Medina-Hidalgo D, van Wijk M, Silvestri S, Douxchamps S, Stephenson E, Power B, Rigolot C, Cacho O, Herrero M. Closing system-wide yield gaps to increase food production and mitigate GHGs among mixed crop-livestock smallholders in Sub-Saharan Africa. Agric Syst 2016; 143:106-113. [PMID: 26941474 PMCID: PMC4767044 DOI: 10.1016/j.agsy.2015.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 05/04/2023]
Abstract
In this study we estimate yield gaps for mixed crop-livestock smallholder farmers in seven Sub-Saharan African sites covering six countries (Kenya, Tanzania, Uganda, Ethiopia, Senegal and Burkina Faso). We also assess their potential to increase food production and reduce the GHG emission intensity of their products, as a result of closing these yield gaps. We use stochastic frontier analysis to construct separate production frontiers for each site, based on 2012 survey data prepared by the International Livestock Research Institute for the Climate Change, Agriculture and Food Security program. Instead of relying on theoretically optimal yields-a common approach in yield gap assessments-our yield gaps are based on observed differences in technical efficiency among farms within each site. Sizeable yield gaps were estimated to be present in all of the sites. Expressed as potential percentage increases in outputs, the average site-based yield gaps ranged from 28 to 167% for livestock products and from 16 to 209% for crop products. The emission intensities of both livestock and crop products registered substantial falls as a consequence of closing yield gaps. The relationships between farm attributes and technical efficiency were also assessed to help inform policy makers about where best to target capacity building efforts. We found a strong and statistically significant relationship between market participation and performance across most sites. We also identified an efficiency dividend associated with the closer integration of crop and livestock enterprises. Overall, this study reveals that there are large yield gaps and that substantial benefits for food production and environmental performance are possible through closing these gaps, without the need for new technology.
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Affiliation(s)
- B. Henderson
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - C. Godde
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - D. Medina-Hidalgo
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - M. van Wijk
- ILRI, International Livestock Research Institute, Nairobi, Kenya
| | - S. Silvestri
- ILRI, International Livestock Research Institute, Nairobi, Kenya
| | - S. Douxchamps
- ILRI, International Livestock Research Institute, Nairobi, Kenya
| | - E. Stephenson
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - B. Power
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - C. Rigolot
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
| | - O. Cacho
- University of New England, Armidale, NSW 2351, Australia
| | - M. Herrero
- Commonwealth Scientific and Industrial Research Organization, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, QLD 4067, Australia
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Scalici J, Henderson B, Wang B, Finan M, Rocconi R. Correlation of positron emission tomography (PET) with CA-125 levels in predicting recurrence in ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hristov AN, Oh J, Firkins JL, Dijkstra J, Kebreab E, Waghorn G, Makkar HPS, Adesogan AT, Yang W, Lee C, Gerber PJ, Henderson B, Tricarico JM. Special topics--Mitigation of methane and nitrous oxide emissions from animal operations: I. A review of enteric methane mitigation options. J Anim Sci 2013; 91:5045-5069. [PMID: 24045497 DOI: 10.2527/jas2013-6583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The goal of this review was to analyze published data related to mitigation of enteric methane (CH4) emissions from ruminant animals to document the most effective and sustainable strategies. Increasing forage digestibility and digestible forage intake was one of the major recommended CH4 mitigation practices. Although responses vary, CH4 emissions can be reduced when corn silage replaces grass silage in the diet. Feeding legume silages could also lower CH4 emissions compared to grass silage due to their lower fiber concentration. Dietary lipids can be effective in reducing CH4 emissions, but their applicability will depend on effects on feed intake, fiber digestibility, production, and milk composition. Inclusion of concentrate feeds in the diet of ruminants will likely decrease CH4 emission intensity (Ei; CH4 per unit animal product), particularly when inclusion is above 40% of dietary dry matter and rumen function is not impaired. Supplementation of diets containing medium to poor quality forages with small amounts of concentrate feed will typically decrease CH4 Ei. Nitrates show promise as CH4 mitigation agents, but more studies are needed to fully understand their impact on whole-farm greenhouse gas emissions, animal productivity, and animal health. Through their effect on feed efficiency and rumen stoichiometry, ionophores are likely to have a moderate CH4 mitigating effect in ruminants fed high-grain or mixed grain-forage diets. Tannins may also reduce CH4 emissions although in some situations intake and milk production may be compromised. Some direct-fed microbials, such as yeast-based products, might have a moderate CH4-mitigating effect through increasing animal productivity and feed efficiency, but the effect is likely to be inconsistent. Vaccines against rumen archaea may offer mitigation opportunities in the future although the extent of CH4 reduction is likely to be small and adaptation by ruminal microbes and persistence of the effect is unknown. Overall, improving forage quality and the overall efficiency of dietary nutrient use is an effective way of decreasing CH4 Ei. Several feed supplements have a potential to reduce CH4 emission from ruminants although their long-term effect has not been well established and some are toxic or may not be economically feasible.
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Affiliation(s)
- A N Hristov
- Department of Animal Science, The Pennsylvania State University, University Park 16802
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Montes F, Meinen R, Dell C, Rotz A, Hristov AN, Oh J, Waghorn G, Gerber PJ, Henderson B, Makkar HPS, Dijkstra J. SPECIAL TOPICS — Mitigation of methane and nitrous oxide emissions from animal operations: II. A review of manure management mitigation options1. J Anim Sci 2013; 91:5070-94. [DOI: 10.2527/jas.2013-6584] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Montes
- Plant Science Department, Pennsylvania State University, University Park 16802
| | - R. Meinen
- Animal Science Department, Pennsylvania State University, University Park 16802
| | - C. Dell
- USDA-Agricultural Research Service, Pasture Systems and Watershed Management Research Unit, University Park, PA 16802
| | - A. Rotz
- USDA-Agricultural Research Service, Pasture Systems and Watershed Management Research Unit, University Park, PA 16802
| | - A. N. Hristov
- Department of Animal Science, Pennsylvania State University, University Park 16802
| | - J. Oh
- Department of Animal Science, Pennsylvania State University, University Park 16802
| | | | - P. J. Gerber
- Agriculture and Consumer protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - B. Henderson
- Agriculture and Consumer protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - H. P. S. Makkar
- Agriculture and Consumer protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - J. Dijkstra
- Wageningen University, 6700 AH Wageningen, The Netherlands
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Hristov AN, Ott T, Tricarico J, Rotz A, Waghorn G, Adesogan A, Dijkstra J, Montes F, Oh J, Kebreab E, Oosting SJ, Gerber PJ, Henderson B, Makkar HPS, Firkins JL. SPECIAL TOPICS — Mitigation of methane and nitrous oxide emissions from animal operations: III. A review of animal management mitigation options1. J Anim Sci 2013; 91:5095-113. [DOI: 10.2527/jas.2013-6585] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- A. N. Hristov
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - T. Ott
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - J. Tricarico
- Innovation Center for U.S. Dairy, Rosemont, IL 60018
| | - A. Rotz
- USDA-Agricultural Research Service, Pasture Systems and Watershed Management Research Unit, University Park, PA 16802
| | | | | | - J. Dijkstra
- Wageningen University, 6700 AH Wageningen, The Netherlands
| | - F. Montes
- Plant Science Department, Pennsylvania State University, University Park 16802
| | - J. Oh
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - E. Kebreab
- University of California–Davis, Davis 95616
| | - S. J. Oosting
- Wageningen University, 6700 AH Wageningen, The Netherlands
| | - P. J. Gerber
- Agriculture and Consumer Protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - B. Henderson
- Agriculture and Consumer Protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - H. P. S. Makkar
- Agriculture and Consumer Protection Department, Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
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Hristov AN, Oh J, Firkins JL, Dijkstra J, Kebreab E, Waghorn G, Makkar HPS, Adesogan AT, Yang W, Lee C, Gerber PJ, Henderson B, Tricarico JM. Special topics--Mitigation of methane and nitrous oxide emissions from animal operations: I. A review of enteric methane mitigation options. J Anim Sci 2013; 91:5045-69. [PMID: 24045497 DOI: 10.2527/jas.2013-6583] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of this review was to analyze published data related to mitigation of enteric methane (CH4) emissions from ruminant animals to document the most effective and sustainable strategies. Increasing forage digestibility and digestible forage intake was one of the major recommended CH4 mitigation practices. Although responses vary, CH4 emissions can be reduced when corn silage replaces grass silage in the diet. Feeding legume silages could also lower CH4 emissions compared to grass silage due to their lower fiber concentration. Dietary lipids can be effective in reducing CH4 emissions, but their applicability will depend on effects on feed intake, fiber digestibility, production, and milk composition. Inclusion of concentrate feeds in the diet of ruminants will likely decrease CH4 emission intensity (Ei; CH4 per unit animal product), particularly when inclusion is above 40% of dietary dry matter and rumen function is not impaired. Supplementation of diets containing medium to poor quality forages with small amounts of concentrate feed will typically decrease CH4 Ei. Nitrates show promise as CH4 mitigation agents, but more studies are needed to fully understand their impact on whole-farm greenhouse gas emissions, animal productivity, and animal health. Through their effect on feed efficiency and rumen stoichiometry, ionophores are likely to have a moderate CH4 mitigating effect in ruminants fed high-grain or mixed grain-forage diets. Tannins may also reduce CH4 emissions although in some situations intake and milk production may be compromised. Some direct-fed microbials, such as yeast-based products, might have a moderate CH4-mitigating effect through increasing animal productivity and feed efficiency, but the effect is likely to be inconsistent. Vaccines against rumen archaea may offer mitigation opportunities in the future although the extent of CH4 reduction is likely to be small and adaptation by ruminal microbes and persistence of the effect is unknown. Overall, improving forage quality and the overall efficiency of dietary nutrient use is an effective way of decreasing CH4 Ei. Several feed supplements have a potential to reduce CH4 emission from ruminants although their long-term effect has not been well established and some are toxic or may not be economically feasible.
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Affiliation(s)
- A N Hristov
- Department of Animal Science, The Pennsylvania State University, University Park 16802
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Israeli E, Ying S, Henderson B, Mottola J, Strome T, Bernstein CN. The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38:513-21. [PMID: 23837741 DOI: 10.1111/apt.12410] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/05/2013] [Accepted: 06/22/2013] [Indexed: 12/08/2022]
Abstract
BACKGROUND Although exposure to diagnostic radiation may be associated with increased risk of malignancy, the use of abdominal CT (ACT) in the last decade has increased for patients in the emergency department (ED). AIM To examine the impact of ACT ordered in the ED on management of patients with inflammatory bowel diseases (IBD), as well as to quantify the cumulative effective dose (CED) of radiation received by these patients. METHODS A total of 152 patients with Crohn's disease (CD) and 130 patients with ulcerative colitis (UC) that presented to the ED in a tertiary centre between 2009 and 2011 were identified. For patients that had an ACT, chart review assessed if the ACT findings changed clinical management. CED of diagnostic radiation (DR) was calculated for all imaging studies between 1 January 2006 and 30 August 2012. RESULTS Abdominal CT use was 49% for CD and 19% for UC. ACTs with findings of penetrating/obstructive disease were 35% for CD. Urgent non-IBD-related diagnoses were found in 13% for CD and 28% for UC (P < 0.05). ACT caused a change in management in 81% of CD and 69% of UC patients. Mean CED from DR was 77.4 ± 63.0 mSv (median 53 mSv) for CD and 67.2 ± 51.0 mSv (median 56 mSv) for UC (P = 0.47). The CED for the 80-month period exceeded 75 mSv in 35% and 36% respectively (P = 0.99). CONCLUSIONS Although abdominal CT often changes management of IBD patients in the emergency department, this population carries a very high-risk of radiation exposure. Efforts should be made to decrease this risk by development of low-radiation protocols, and wider use of MRI/ultrasound.
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Affiliation(s)
- E Israeli
- IBD Unit, Department of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
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Henderson B, Guimaraes M, Wilkins L, Yamada R, Selby B, Anderson M, Hannegan C, Schonholz C. Radiofrequency wire for the recanalization of chronic arterial occlusions that have failed conventional endovascular techniques. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Carty CL, Spencer KL, Setiawan VW, Fernandez-Rhodes L, Malinowski J, Buyske S, Young A, Jorgensen NW, Cheng I, Carlson CS, Brown-Gentry K, Goodloe R, Park A, Parikh NI, Henderson B, Le Marchand L, Wactawski-Wende J, Fornage M, Matise TC, Hindorff LA, Arnold AM, Haiman CA, Franceschini N, Peters U, Crawford DC. Replication of genetic loci for ages at menarche and menopause in the multi-ethnic Population Architecture using Genomics and Epidemiology (PAGE) study. Hum Reprod 2013; 28:1695-706. [PMID: 23508249 DOI: 10.1093/humrep/det071] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION Do genetic associations identified in genome-wide association studies (GWAS) of age at menarche (AM) and age at natural menopause (ANM) replicate in women of diverse race/ancestry from the Population Architecture using Genomics and Epidemiology (PAGE) Study? SUMMARY ANSWER We replicated GWAS reproductive trait single nucleotide polymorphisms (SNPs) in our European descent population and found that many SNPs were also associated with AM and ANM in populations of diverse ancestry. WHAT IS KNOWN ALREADY Menarche and menopause mark the reproductive lifespan in women and are important risk factors for chronic diseases including obesity, cardiovascular disease and cancer. Both events are believed to be influenced by environmental and genetic factors, and vary in populations differing by genetic ancestry and geography. Most genetic variants associated with these traits have been identified in GWAS of European-descent populations. STUDY DESIGN, SIZE, DURATION A total of 42 251 women of diverse ancestry from PAGE were included in cross-sectional analyses of AM and ANM. MATERIALS, SETTING, METHODS SNPs previously associated with ANM (n = 5 SNPs) and AM (n = 3 SNPs) in GWAS were genotyped in American Indians, African Americans, Asians, European Americans, Hispanics and Native Hawaiians. To test SNP associations with ANM or AM, we used linear regression models stratified by race/ethnicity and PAGE sub-study. Results were then combined in race-specific fixed effect meta-analyses for each outcome. For replication and generalization analyses, significance was defined at P < 0.01 for ANM analyses and P < 0.017 for AM analyses. MAIN RESULTS AND THE ROLE OF CHANCE We replicated findings for AM SNPs in the LIN28B locus and an intergenic region on 9q31 in European Americans. The LIN28B SNPs (rs314277 and rs314280) were also significantly associated with AM in Asians, but not in other race/ethnicity groups. Linkage disequilibrium (LD) patterns at this locus varied widely among the ancestral groups. With the exception of an intergenic SNP at 13q34, all ANM SNPs replicated in European Americans. Three were significantly associated with ANM in other race/ethnicity populations: rs2153157 (6p24.2/SYCP2L), rs365132 (5q35/UIMC1) and rs16991615 (20p12.3/MCM8). While rs1172822 (19q13/BRSK1) was not significant in the populations of non-European descent, effect sizes showed similar trends. LIMITATIONS, REASONS FOR CAUTION Lack of association for the GWAS SNPs in the non-European American groups may be due to differences in locus LD patterns between these groups and the European-descent populations included in the GWAS discovery studies; and in some cases, lower power may also contribute to non-significant findings. WIDER IMPLICATIONS OF THE FINDINGS The discovery of genetic variants associated with the reproductive traits provides an important opportunity to elucidate the biological mechanisms involved with normal variation and disorders of menarche and menopause. In this study we replicated most, but not all reported SNPs in European descent populations and examined the epidemiologic architecture of these early reported variants, describing their generalizability and effect size across differing ancestral populations. Such data will be increasingly important for prioritizing GWAS SNPs for follow-up in fine-mapping and resequencing studies, as well as in translational research.
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Affiliation(s)
- C L Carty
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Felix AS, Cook LS, Gaudet MM, Rohan TE, Schouten LJ, Setiawan VW, Wise LA, Anderson KE, Bernstein L, De Vivo I, Friedenreich CM, Gapstur SM, Goldbohm RA, Henderson B, Horn-Ross PL, Kolonel L, Lacey JV, Liang X, Lissowska J, Magliocco A, McCullough ML, Miller AB, Olson SH, Palmer JR, Park Y, Patel AV, Prescott J, Rastogi R, Robien K, Rosenberg L, Schairer C, Ou Shu X, van den Brandt PA, Virkus RA, Wentzensen N, Xiang YB, Xu WH, Yang HP, Brinton LA. The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer 2013; 108:727-34. [PMID: 23348519 PMCID: PMC3593566 DOI: 10.1038/bjc.2013.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine sarcomas are characterised by early age at diagnosis, poor prognosis, and higher incidence among Black compared with White women, but their aetiology is poorly understood. Therefore, we performed a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We also examined risk factor associations for malignant mixed mullerian tumours (MMMTs) and endometrioid endometrial carcinomas (EECs) for comparison purposes. METHODS We pooled data on 229 uterine sarcomas, 244 MMMTs, 7623 EEC cases, and 28,829 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with uterine sarcoma, MMMT, and EEC were estimated with polytomous logistic regression. We also examined associations between epidemiological factors and histological subtypes of uterine sarcoma. RESULTS Significant risk factors for uterine sarcoma included obesity (body mass index (BMI)≥30 vs BMI<25 kg m(-2) (OR: 1.73, 95% CI: 1.22-2.46), P-trend=0.008) and history of diabetes (OR: 2.33, 95% CI: 1.41-3.83). Older age at menarche was inversely associated with uterine sarcoma risk (≥15 years vs <11 years (OR: 0.70, 95% CI: 0.34-1.44), P-trend: 0.04). BMI was significantly, but less strongly related to uterine sarcomas compared with EECs (OR: 3.03, 95% CI: 2.82-3.26) or MMMTs (OR: 2.25, 95% CI: 1.60-3.15, P-heterogeneity=0.01). CONCLUSION In the largest aetiological study of uterine sarcomas, associations between menstrual, hormonal, and anthropometric risk factors and uterine sarcoma were similar to those identified for EEC. Further exploration of factors that might explain patterns of age- and race-specific incidence rates for uterine sarcoma are needed.
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Affiliation(s)
- A S Felix
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
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Goh CL, Schumacher FR, Easton D, Muir K, Henderson B, Kote-Jarai Z, Eeles RA. Genetic variants associated with predisposition to prostate cancer and potential clinical implications. J Intern Med 2012; 271:353-65. [PMID: 22308973 DOI: 10.1111/j.1365-2796.2012.02511.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Prostate cancer is the commonest cancer in the developed world. There is an inherited component to this disease as shown in familial and twin studies. However, the discovery of these variants has been difficult. The emergence of genome-wide association studies has led to the identification of over 46 susceptibility loci. Their clinical utility to predict risk, response to treatment, or treatment toxicity, remains undefined. Large consortia are needed to achieve adequate statistical power to answer these genetic-clinical and genetic-epidemiological questions. International collaborations are currently underway to link genetic with clinical/epidemiological data to develop risk prediction models, which could direct screening and treatment programs.
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Affiliation(s)
- C L Goh
- Oncogenetics Team, The Institute of Cancer Research, Sutton, Surrey, UK
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Bowen J, Meecham J, Hamlin M, Henderson B, Kim M, Mirjankar N, Lavine B. Development of field-deployable instrumentation based on “antigen–antibody” reactions for detection of hemorrhagic disease in ruminants. Microchem J 2011. [DOI: 10.1016/j.microc.2011.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Henderson B, Steven A. Trains boats and planes. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Whitty J, Henderson B, Francis J, Lloyd N. Optimized thick-wall cylinders by virtue of Poisson's ratio selection. Nuclear Engineering and Design 2011. [DOI: 10.1016/j.nucengdes.2010.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rigual N, Sullivan M, Cooper M, Henderson B. Experience with 2-1 [hexyloxyethyl]-2-devinylpyropheophorbide-a] (HPPH) photodynamic therapy in head and neck dysplasia and squamous carcinoma (SCC). Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Abstract
This review outlines livestock's major emission pathways and production trends, and explores the challenges and options for livestock in addressing and coping with climate change. Ruminant production is, and will continue to be, the chief source of the livestock sector's greenhouse gas (GHG) emissions, mainly as a result of deforestation, land degradation and enteric fermentation. Livestock productivity improvement is fundamental to mitigation and where it is achieved through the transfer of improved production practices and technologies, it can also deliver important rural livelihood and food security co-benefits in developing countries. Mitigation is also possible by shifting production resources, particularly concentrate feeds, from ruminant to monogastric enterprises, given their higher feed conversion efficiencies and lower emission intensities. However, standard prescriptions for productivity improvements, which are often accompanied by higher concentrations of animals on land, need safeguards to ensure that they do not lead to localized pollution problems and increase disease risks. Further, measures that simultaneously improve productivity and capacity for adaptation to climate change, such as more efficient crop-livestock integration and water management, should be exploited wherever possible. Policy options for unlocking livestock's large mitigation potential are widely known, but their implementation is currently hampered by technical and institutional capacity constraints, and by a lack of political support and global agreement on mitigation. There is a particular need for practicable methods for measurement, reporting and verification of emissions, to improve access to carbon markets, and to facilitate the sector's transition to a low-emission future.
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Prakken B, Henderson B, Kaiser F, Steptoe A, Thompson S, So A, McInnes IB, Midwood K, Sofat N, Corrigall VM, Bodman-Smith MD, Thompson SJ, Panayi GS, Thompson S, Steinman L, Panayi G. The induction and regulation of inflammation: new molecular players: IP28. Heat Shock Proteins: Darwinistic Immune Modulation on Dangerous Grounds. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alverdi V, Henderson B, Hetrick B, Simpson J, Komives E. Kinetic Enhancement of NF-KB/DNA Dissociation by Ikbalpha. Biophys J 2011. [DOI: 10.1016/j.bpj.2010.12.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Crouch S, Fitzpatrick T, Faoagali J, Henderson B, King J, Jack L, Kleinschmidt S, Tomlinson V, Aitken L. Routine methicillin-resistant Staphylococcus aureus (MRSA) swabbing of interhospital transferred patients in the intensive care unit (ICU). Aust Crit Care 2010. [DOI: 10.1016/j.aucc.2009.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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40
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DeLellis Henderson K, Bernstein L, Henderson B, Kolonel L, Pike M. The Authors Reply. Am J Epidemiol 2008. [DOI: 10.1093/aje/kwn240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Davies A, Dhillon A, Young M, Henderson B, McHugh T, Gillespie S. Resuscitation-promoting factors are expressed in Mycobacterium tuberculosis-infected human tissue. Tuberculosis (Edinb) 2008; 88:462-8. [DOI: 10.1016/j.tube.2008.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 01/05/2008] [Accepted: 01/16/2008] [Indexed: 10/22/2022]
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Clements A, Henderson B, Tyndel S, Evans G, Brain K, Watson E, Austoker J. Diagnosed with breast cancer whilst on a family history screening programme: an exploratory qualitative study. Breast Cancer Res 2008. [PMCID: PMC3300792 DOI: 10.1186/bcr1973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Clements A, Tyndel S, Henderson B, Brain K, Watson E, Austoker J. 'More positive about mammography' – reactions of women to a false positive recall: a qualitative study of women at risk of familial breast cancer. Breast Cancer Res 2008. [PMCID: PMC3300793 DOI: 10.1186/bcr1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE Socioeconomic status (SES) is inversely associated with coronary heart disease (CHD) risk. Cumulative pathogen burden may also predict future CHD. The hypothesis was tested that lower SES is associated with a greater pathogen burden, and that pathogen burden accounts in part for SES differences in cardiovascular risk factors. METHODS This was a cross-sectional observational study involving the clinical examination of 451 men and women aged 51-72 without CHD, recruited from the Whitehall II epidemiological cohort. SES was defined by grade of employment, and pathogen burden by summing positive serostatus for Chlamydia pneumoniae, cytomegalovirus and herpes simplex virus 1. Cardiovascular risk factors were also assessed. RESULTS Pathogen burden averaged 1.94 (SD) 0.93 in the lower grade group, compared with 1.64 (0.97) and 1.64 (0.93) in the intermediate and higher grade groups (p = 0.011). Pathogen burden was associated with a higher body mass index, waist/hip ratio, blood pressure and incidence of diabetes. There were SES differences in waist/hip ratio, high-density lipoprotein-cholesterol, fasting glucose, glycated haemoglobin, lung function, smoking and diabetes. The SES gradient in these cardiovascular risk factors was unchanged when pathogen burden was taken into account statistically. CONCLUSIONS Although serological signs of infection with common pathogens are more frequent in lower SES groups, their distribution across the social gradient does not match the linear increases in CHD risk present across higher, intermediate and lower SES groups. Additionally, pathogen burden does not appear to mediate SES differences in cardiovascular risk profiles.
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Affiliation(s)
- A Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Steptoe A, Shamaei-Tousi A, Gylfe A, Bailey L, Bergström S, Coates AR, Henderson B. Protective effect of human heat shock protein 60 suggested by its association with decreased seropositivity to pathogens. Clin Vaccine Immunol 2007; 14:204-7. [PMID: 17202307 PMCID: PMC1797791 DOI: 10.1128/cvi.00179-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of heat shock protein 60 (Hsp60) in human plasma has been linked with cardiovascular disease (CVD). In this study, the examination of the relationship between Hsp60 in plasma and seropositivity for three microbial agents, which are thought to be risk factors for CVD, surprisingly revealed a negative association between Hsp60 and seropositivity, suggesting a protective effect of this circulating stress protein.
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Affiliation(s)
- A Steptoe
- Department of Epidemiology and Public Health, UCL Eastman Dental Institute, University College London, London, United Kingdom
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Antony PMA, Boy J, Henderson B, Stamminger T, Rieß O, Schmidt T. Localization signals within ataxin-3 influence the formation of intranuclear aggregates in spinocerebellar ataxia type 3. Akt Neurol 2007. [DOI: 10.1055/s-2007-987448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Albright C, Steffen A, Wilkens L, Henderson B, Kolonel L. Body mass index and the prevalence of obesity in monorace and multiracial adults: Results from the Multiethnic Cohort Study. J Sci Med Sport 2006. [DOI: 10.1016/j.jsams.2006.12.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Keep NH, Ward JM, Robertson G, Cohen-Gonsaud M, Henderson B. Bacterial resuscitation factors: revival of viable but non-culturable bacteria. Cell Mol Life Sci 2006; 63:2555-9. [PMID: 17013561 DOI: 10.1007/s00018-006-6188-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- N H Keep
- School of Crystallography and Institute of Structural Molecular Biology, Birkbeck, University of London, Malet Street, London, WC1E 7HX, United Kingdom.
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Gannon PFG, Berg AS, Gayosso R, Henderson B, Sax SE, Willems HMJ. Occupational asthma prevention and management in industry--an example of a global programme. Occup Med (Lond) 2006; 55:600-5. [PMID: 16314331 DOI: 10.1093/occmed/kqi184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.
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