Project description:Background:While stakeholder mapping is common in public policy, social sciences, and business management, this tool has not often been used in healthcare settings. We developed a new method of healthcare stakeholder mapping, which we call Contextual and Organizational Support Mapping of Stakeholders (COSMOS), to identify and assess key stakeholders in an implementation project. Stakeholder mapping allows the implementation team to assess and visually display all relevant stakeholders, their support for the project, and their ability to facilitate-or hinder-project implementation. Methods:The COSMOS model was developed to visualize the stakeholders involved in a hospital-based study conducted from 2013-2016. In this study, a new screen prompt and order set were embedded in the electronic health record to facilitate the identification and treatment of adult smokers admitted to the hospital. Physicians were the unit of randomization; physician behavior and tobacco quit rates among patients were followed for 1 year. Qualitative interviews with hospital administration, physicians, and information technology (IT) personnel (n=24) were conducted to identify the components and characteristics of the COSMOS. Results:The COSMOS consists of an organizational chart identifying all key stakeholders, with manipulation of colors and borders of the component boxes to indicate stakeholder support for the implementation project, and degree of criticality to its success. The COSMOS visualization informed the team's subsequent work by identifying potential impediments that might require additional attention to garner and maintain support throughout the project. In addition, the approach has proved to be a useful tool to explain these concepts to trainees in implementation science. Conclusion:The COSMOS schematic provides a visually rich means of identifying stakeholders, understanding their relationships to each other, displaying their level of support for the proposed implementation, and noting their criticality to the effort. The COSMOS can support researchers, project teams, administrators, and others engaged with implementation science-related work in healthcare, as well as other fields such as education, government, and industry.

Project description:Rationale: Auger electrons bear a low energy (0-10 keV) which is deposited in a very small volume (a few nm3) around the site of emission. From a radio-toxicological point of view, the effects of Auger electrons on normal tissues are largely unknown, understudied and generally assumed negligible. In this context, the discovery that the Auger electron emitter 99mTc can induce stunning on primary thyrocytes in vitro, at low doses, is intriguing. Extrapolated in vivo, this observation suggests that, a radioisotope as commonly used in nuclear medicine as 99mTc may significantly influence thyroid biology. The aim of the present study was to evaluate the absorbed dose of 99mTc pertechnetate (99mTcO4−) required to induce thyroid stunning in vivo and to analyse the biological events associated/concomitant with this effect. Methods: SPECT/CT imaging of thyroid uptake of 99mTcO4− was used to demonstrate stunning effect in mice and quantitative analysis of the images was used for dosimetric calculations. The biological effects associated with this phenomenon were evaluated by Western blotting, quantitative RT-PCR, histology, immuno-histochmistry and global gene expression pattern analysis. Results: Auger electrons-mediated thyroid stunning can be observed in vivo, in mouse thyroid. The threshold of the absorbed dose to the thyroid required to obtain a significant stunning effect is in the range of 20 Gy. This effect is associated with a reduction in the levels of functional Na/I symporter (NIS) protein without any significant cell death. It is reversible within days. At the cellular level, a decrease in NIS mRNA, the activation of the p53 pathway and the generation of double-strand DNA breaks can be observed. Conclusion: Auger electrons emitted by 99mTc can induce thyroid stunning in vivo, in mice but the thyroid needs to be exposed to a dose of at least 20 Gy, a dose unlikely to be encountered in the clinical practice. Nevertheless, this report represents, to our knowledge, the first example of a significant action of Auger electrons on a normal tissue, in vivo and provides a unique experimental set-up to understand the fine molecular mechanisms involved in the biological effects of Auger electrons.

Project description:Rationale: Auger electrons bear a low energy (0-10 keV) which is deposited in a very small volume (a few nm3) around the site of emission. From a radio-toxicological point of view, the effects of Auger electrons on normal tissues are largely unknown, understudied and generally assumed negligible. In this context, the discovery that the Auger electron emitter 99mTc can induce stunning on primary thyrocytes in vitro, at low doses, is intriguing. Extrapolated in vivo, this observation suggests that, a radioisotope as commonly used in nuclear medicine as 99mTc may significantly influence thyroid biology. The aim of the present study was to evaluate the absorbed dose of 99mTc pertechnetate (99mTcO4−) required to induce thyroid stunning in vivo and to analyse the biological events associated/concomitant with this effect. Methods: SPECT/CT imaging of thyroid uptake of 99mTcO4− was used to demonstrate stunning effect in mice and quantitative analysis of the images was used for dosimetric calculations. The biological effects associated with this phenomenon were evaluated by Western blotting, quantitative RT-PCR, histology, immuno-histochmistry and global gene expression pattern analysis. Results: Auger electrons-mediated thyroid stunning can be observed in vivo, in mouse thyroid. The threshold of the absorbed dose to the thyroid required to obtain a significant stunning effect is in the range of 20 Gy. This effect is associated with a reduction in the levels of functional Na/I symporter (NIS) protein without any significant cell death. It is reversible within days. At the cellular level, a decrease in NIS mRNA, the activation of the p53 pathway and the generation of double-strand DNA breaks can be observed. Conclusion: Auger electrons emitted by 99mTc can induce thyroid stunning in vivo, in mice but the thyroid needs to be exposed to a dose of at least 20 Gy, a dose unlikely to be encountered in the clinical practice. Nevertheless, this report represents, to our knowledge, the first example of a significant action of Auger electrons on a normal tissue, in vivo and provides a unique experimental set-up to understand the fine molecular mechanisms involved in the biological effects of Auger electrons. One color design, corresponding to 2 conditions performed on 4 mice: TcO4- (Tc)-treated versus Control (Ct) mice for a total of 8 samples.

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Mapping stakeholders and policies in response to deliberate biological events.

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Mapping stakeholders and policies in response to deliberate biological events.

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