The impact of Cochrane Systematic Reviews : a mixed method evaluation of outputs from Cochrane Review Groups supported by the UK National Institute for Health Research

© 2014 Bunn et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: There has been a growing emphasis on evidence-informed decision making in health care. Systematic reviews, such as those produced by the Cochrane Collaboration, have been a key component of this movement. The UK National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs). The aim of this study was to identify the impacts of Cochrane reviews published by NIHR funded CRGs during the years 2007-11. Methods: We sent questionnaires to CRGs and review authors, interviewed guideline developers and used bibliometrics and documentary review to get an overview of CRG impact and to evaluate the impact of a sample of 60 Cochrane reviews. We used a framework with four categories (knowledge production, research targeting, informing policy development, and impact on practice/services). Results: A total of 1502 new and updated reviews were produced by the 20 NIHR funded CRGs between 2007-11. The clearest impacts were on policy with a total of 483 systematic reviews cited in 247 sets of guidance; 62 were international, 175 national (87 from the UK) and 10 local. Review authors and CRGs provided some examples of impact on practice or services, for example safer use of medication, the identification of new effective drugs or treatments and potential economic benefits through the reduction in the use of unproven or unnecessary procedures. However, such impacts are difficult to objectively document and the majority of reviewers were unsure if their review had produced specific impacts. Qualitative data suggested that Cochrane reviews often play an instrumental role in informing guidance although a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and guideline developers were barriers to their use. Conclusions: Health and economic impacts of research are generally difficult to measure. We found that to be the case with this evaluation. Impacts on knowledge production and clinical guidance were easier to identify and substantiate than those on clinical practice. Questions remain about how we define and measure impact and more work is needed to develop suitable methods for impact analysis.Peer reviewe

The disruption of proteostasis in neurodegenerative diseases

Cells count on surveillance systems to monitor and protect the cellular proteome which, besides being highly heterogeneous, is constantly being challenged by intrinsic and environmental factors. In this context, the proteostasis network (PN) is essential to achieve a stable and functional proteome. Disruption of the PN is associated with aging and can lead to and/or potentiate the occurrence of many neurodegenerative diseases (ND). This not only emphasizes the importance of the PN in health span and aging but also how its modulation can be a potential target for intervention and treatment of human diseases.info:eu-repo/semantics/publishedVersio

Electrodeposition and Capacitive Behavior of Films for Electrodes of Electrochemical Supercapacitors

Polypyrrole films were deposited by anodic electropolymerization on stainless steel substrates from aqueous pyrrole solutions containing sodium salicylate and tiron additives. The deposition yield was studied under galvanostatic conditions. The amount of the deposited material was varied by the variation of deposition time at a constant current density. SEM studies showed the formation of porous films with thicknesses in the range of 0–3 μm. Cyclic voltammetry data for the films tested in 0.5 M Na2SO4 solutions showed capacitive behavior and high specific capacitance (SC) in a voltage window of 0.9 V. The films prepared from pyrrole solutions containing tiron showed better capacitive behavior compared to the films prepared from the solutions containing sodium salicylate. A highest SC of 254 F g−1 was observed for the sample with a specific mass of 89 μg cm−2 at a scan rate of 2 mV s−1. The SC decreased with an increasing film thickness and scan rate. The results indicated that the polypyrrole films deposited on the stainless steel substrates by anodic electropolymerization can be used as electrodes for electrochemical supercapacitors (ES)

The Volatile Anesthetic Isoflurane Increases Endothelial Adenosine Generation via Microparticle Ecto-5′-Nucleotidase (CD73) Release

Endothelial dysfunction is common in acute and chronic organ injury. Isoflurane is a widely used halogenated volatile anesthetic during the perioperative period and protects against endothelial cell death and inflammation. In this study, we tested whether isoflurane induces endothelial ecto-5′-nucleotidase (CD73) and cytoprotective adenosine generation to protect against endothelial cell injury. Clinically relevant concentrations of isoflurane induced CD73 activity and increased adenosine generation in cultured human umbilical vein or mouse glomerular endothelial cells. Surprisingly, isoflurane-mediated induction of endothelial CD73 activity occurred within 1 hr and without synthesizing new CD73. We determined that isoflurane rapidly increased CD73 containing endothelial microparticles into the cell culture media. Indeed, microparticles isolated from isoflurane-treated endothelial cells had significantly higher CD73 activity as well as increased CD73 protein. In vivo, plasma from mice anesthetized with isoflurane had significantly higher endothelial cell-derived CD144+ CD73+ microparticles and had increased microparticle CD73 activity compared to plasma from pentobarbital-anesthetized mice. Supporting a critical role of CD73 in isoflurane-mediated endothelial protection, a selective CD73 inhibitor (APCP) prevented isoflurane-induced protection against human endothelial cell inflammation and apoptosis. In addition, isoflurane activated endothelial cells Rho kinase evidenced by myosin phosphatase target subunit-1 and myosin light chain phosphorylation. Furthermore, isoflurane-induced release of CD73 containing microparticles was significantly attenuated by a selective Rho kinase inhibitor (Y27632). Taken together, we conclude that the volatile anesthetic isoflurane causes Rho kinase-mediated release of endothelial microparticles containing preformed CD73 and increase adenosine generation to protect against endothelial apoptosis and inflammation

Evaluation of the Oscillatory Interference Model of Grid Cell Firing through Analysis and Measured Period Variance of Some Biological Oscillators

Models of the hexagonally arrayed spatial activity pattern of grid cell firing in the literature generally fall into two main categories: continuous attractor models or oscillatory interference models. Burak and Fiete (2009, PLoS Comput Biol) recently examined noise in two continuous attractor models, but did not consider oscillatory interference models in detail. Here we analyze an oscillatory interference model to examine the effects of noise on its stability and spatial firing properties. We show analytically that the square of the drift in encoded position due to noise is proportional to time and inversely proportional to the number of oscillators. We also show there is a relatively fixed breakdown point, independent of many parameters of the model, past which noise overwhelms the spatial signal. Based on this result, we show that a pair of oscillators are expected to maintain a stable grid for approximately t = 5µ3/(4πσ)2 seconds where µ is the mean period of an oscillator in seconds and σ2 its variance in seconds2. We apply this criterion to recordings of individual persistent spiking neurons in postsubiculum (dorsal presubiculum) and layers III and V of entorhinal cortex, to subthreshold membrane potential oscillation recordings in layer II stellate cells of medial entorhinal cortex and to values from the literature regarding medial septum theta bursting cells. All oscillators examined have expected stability times far below those seen in experimental recordings of grid cells, suggesting the examined biological oscillators are unfit as a substrate for current implementations of oscillatory interference models. However, oscillatory interference models can tolerate small amounts of noise, suggesting the utility of circuit level effects which might reduce oscillator variability. Further implications for grid cell models are discussed

Thermodynamic principles and implementations of quantum machines

The efficiency of cyclic heat engines is limited by the Carnot bound. This bound follows from the second law of thermodynamics and is attained by engines that operate between two thermal baths under the reversibility condition whereby the total entropy does not increase. By contrast, the efficiency of engines powered by quantum non-thermal baths has been claimed to surpass the thermodynamic Carnot bound. The key to understanding the performance of such engines is a proper division of the energy supplied by the bath to the system into heat and work, depending on the associated change in the system entropy and ergotropy. Due to their hybrid character, the efficiency bound for quantum engines powered by a non-thermal bath does not solely follow from the laws of thermodynamics. Hence, the thermodynamic Carnot bound is inapplicable to such hybrid engines. Yet, they do not violate the principles of thermodynamics. An alternative means of boosting machine performance is the concept of heat-to-work conversion catalysis by quantum non-linear (squeezed) pumping of the piston mode. This enhancement is due to the increased ability of the squeezed piston to store ergotropy. Since the catalyzed machine is fueled by thermal baths, it adheres to the Carnot bound. We conclude by arguing that it is not quantumness per se that improves the machine performance, but rather the properties of the baths, the working fluid and the piston that boost the ergotropy and minimize the wasted heat in both the input and the output.Comment: As a chapter of: F. Binder, L. A. Correa, C. Gogolin, J. Anders, and G. Adesso (eds.), "Thermodynamics in the quantum regime - Recent Progress and Outlook", (Springer International Publishing

Patients-people-place : developing a framework for researching organizational culture during health service redesign and change

BACKGROUND: Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory. METHODS: As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model. RESULTS: In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas (‘domains’) and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization’s culture in each domain. CONCLUSIONS: This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization’s culture are addressed in future health service research

Characteristics of polyvinylpyrrolidone-layered silicate nanocomposites prepared by attrition ball milling

Polyvinylpyrrolidone (PVP)/sodium montmorillonite (MMT) nanocomposites prepared via the solution intercalation method were investigated by UV/vis, SEM, X-ray diffraction, TEM, FT-IR and PLM (polarized light microscopy). PVP/MMT nanocomposites show exfoliation below 20 wt% MMT and intercalation above this concentration. Nanocomposites retain good optical clarity and increased thermal resistance with MMT content. The compatibility between PVP and MMT and their enhanced properties may be explained by hydrogen bonding interactions. In addition, the nanocomposites prepared under more rigorous mixing conditions show better transparency because the smaller particle sizes are induced. In addition, the study on optically clear PVP/MMT suspensions helps one to understand how optical anisotropy of MMT is affected by the existence of polymer in. aqueous solution. (C) 2002 Elsevier Science Ltd. All rights reserved.This work was supported in part by Brain Korea 21 program and in part by the Center for Advanced Functional Polymers. We thank Samsung General Chemicals for allowing the use of the cryogenic ultra-microtome