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PubMed1985

The rate of adoption of new procedures among physicians. The impact of specialty and practice characteristics.

Four hundred eighty-four physicians were surveyed on the number of new procedures they adopted during a 1-year period. Clear differences were found among specialties. A simultaneous statistical analysis of factors affecting the adoption of new procedures yielded a number of additional significant relationships. Up to an age of approximately 50 years, age has an increasing impact on the number of new procedures adopted by physicians. Beyond that age, it has a decreasing effect. Board certified physicians tend to adopt more new procedures than physicians who are not board certified. Among those physicians in nonurban locations, those in solo practice adopt significantly fewer procedures than those in other practice modes. The implications of these findings for such issues as the rising costs of health care and physician reimbursement systems are discussed.

Adult↗

PubMed1995

Adoption of HIV-related services among urban US hospitals: 1988 and 1991.

Recent reports document that US hospitals vary considerably, notably by ownership, in the number of acquired immunodeficiency syndrome (AIDS) patients they treat. Still, little is known about other types of hospital response to human immunodeficiency virus (HIV) and AIDS and the relative strength of ownership as a determining factor. With annual survey data from the American Hospital Association the authors examine the formal adoption of HIV-related services among urban US hospitals at the turn of the decade. Descriptive analyses of 2 years of data (1988 and 1991) are presented. A multivariate logistic regression analysis, conducted on the 1991 data, tests for unique ownership effects on the likelihood that hospitals are heavy investors in HIV-related care. Patterns of service adoption for 1991 strongly resemble those for 1988. Nearly three fourths of urban US hospitals offer general inpatient AIDS care, and over half provide HIV testing. Few urban hospitals offer outpatient services; even fewer operate AIDS units. A substantial minority report no formal adoption of HIV-related services. For-profit hospitals stand out as least likely to formally adopt these HIV-related services. Those adopting a comprehensive set of HIV-related services typically are public or secular, not-for-profit in ownership, large, affiliated with a medical school, and high volume users of Medicaid funding. The logistic regression analysis suggests that public ownership is a key determinant of greater service investment, even after controlling for other explanatory factors. This study appears to mirror a familiar pattern of hospital response to undercompensated care in the United States.

AIDS Serodiagnosis↗

PubMedDate not supplied

Partial examination of the public health impact of the People with Arthritis Can Exercise (PACE) program: reach, adoption, and maintenance.

OBJECTIVE: To partially evaluate the public health impact (i.e., reach, adoption, maintenance) of People with Arthritis Can Exercise (PACE) programs, which were initiated as a result of two PACE instructor-training workshops. DESIGN: The study design involved a one-time only, cross-sectional assessment of reach, adoption, and maintenance, conducted 6 months after the workshops. SAMPLE: Participants were 11 adults (n(females)=10) trained to be PACE instructors at one of the workshops. MEASUREMENTS: One-on-one phone interviews, developed using the RE-AIM framework, assessed reach, adoption, and maintenance. RESULTS: Eight of the 11 individuals trained as instructors subsequently began PACE in one of 10 organizations across various communities, indicating high program adoption. However, on average, only 7 individuals with arthritis participated in each PACE program, indicating a low program reach. Within 6 months of beginning PACE, only 3 organizations continued to offer PACE, indicating low program maintenance. Two primary challenges to initiating PACE included recruiting a sufficient number of people to participate in the program and in finding a convenient time to offer it so more individuals could join. CONCLUSION: The public health impact, as assessed by reach, adoption, and maintenance, of PACE programs initiated as a result of 2 instructor-training workshops was low.

Advertising↗

PubMed1983

Suppression of adoptive antituberculosis immunity by normal recipient animals.

Adoptive immunity is poorly expressed in normal syngeneic mice. This phenomenon was studied by using experimental antituberculosis immunity as a model system representing pure cell-mediated immunity. Expression of adoptive immunity was facilitated by pretreating recipients with sublethal ionizing radiation (500 rads) or high doses (200 mg/kg) of cyclophosphamide or by using adult thymectomized, lethally irradiated, bone-marrow-reconstituted (TXB) mice. Adult thymectomy was less effective, and a low dose of cyclophosphamide (20 mg/kg) was completely ineffective. The beneficial effect of sublethal irradiation was reduced over time; it persisted for 4 weeks and was absent after 8 weeks. Attempts to restore the suppressed state of normal mice to sublethally irradiated mice by using normal spleen or thymus cells did not succeed. Even in rats, which express adoptive antituberculosis immunity without immunosuppressive treatment, the use of sublethally irradiated or TXB recipients potentiated adoptive immunity. It was concluded that suppression of adoptive immunization in normal recipient mice is mediated predominantly, if not exclusively, by T lymphocytes that are sensitive to a number of immunosuppressive agents. The suppressor cells are long-lived and can be regenerated from precursors that are resistant to 500 but not to 900 rads of ionizing radiation.

Animals↗

PubMed1992

Policies and practices related to information system adoption in hospitals owned by Ministries of Health in the Arab Gulf.

This is a discussion paper based on the findings from a study of the factors affecting the adoption of computer-based hospital information systems (CBHIS) in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as visits to ministries of health in these countries. The focus of this paper is on the adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of the main role that ministries of health play as providers of health care in the Region. Prior to describing CBHIS adoption practices, an overview of the Region in terms of its economic development and its health care delivery systems is presented. Next, the research setting along with the major findings are briefly described followed by a discussion of the advantages and disadvantages of centralized CBHIS adoptions. Finally, management guidelines related to the adoption of CBHIS by multi-hospital institutions are proposed.

Decision Making, Organizational↗

PubMed2007

Mapping early conformational changes in alphaIIb and beta3 during biogenesis reveals a potential mechanism for alphaIIbbeta3 adopting its bent conformation.

Current evidence supports a model in which the low-affinity state of the platelet integrin alphaIIbbeta3 results from alphaIIbbeta3 adopting a bent conformation. To assess alphaIIbbeta3 biogenesis and how alphaIIbbeta3 initially adopts the bent conformation, we mapped the conformational states occupied by alphaIIb and beta3 during biogenesis using conformation-specific monoclonal antibodies (mAbs). We found that alphaIIbbeta3 complex formation was not limited by the availability of either free pro-alphaIIb or free beta3, suggesting that other molecules, perhaps chaperones, control complex formation. Five beta3-specific, ligand-induced binding site (LIBS) mAbs reacted with much or all free beta3 but not with beta3 when in complex with mature alphaIIb, suggesting that beta3 adopts its mature conformation only after complex formation. Conversely, 2 alphaIIb-specific LIBS mAbs directed against the alphaIIb Calf-2 region adjacent to the membrane reacted with only minor fractions of free pro-alphaIIb, raising the possibility that pro-alphaIIb adopts a bent conformation early in biogenesis. Our data suggest a working model in which pro-alphaIIb adopts a bent conformation soon after synthesis, and then beta3 assumes its bent conformation by virtue of its interaction with the bent pro-alphaIIb.

Cell Line↗

PubMed2006

Closing the research-practice gap: factors affecting adoption and implementation of a children's mental health program.

Despite the availability of effective interventions, they are not widely used in community mental health centers. This study examined the adoption and implementation of The Arson Prevention Program for Children (TAPP-C), a program for juvenile firesetters developed at a teaching hospital and disseminated to community settings. Questionnaire data from mental health professionals were used to evaluate the roles of adopter, innovation, and dissemination characteristics in TAPP-C adoption and implementation. Results indicate that different factors are important at different diffusion stages. Moreover, they suggest that innovation characteristics may be particularly important to adoption, whereas adopter and dissemination characteristics may be more influential in implementation.

Adolescent↗

PubMed2003

Evaluation of the effect of a long-term trap-neuter-return and adoption program on a free-roaming cat population.

OBJECTIVE: To evaluate the effect of a long-term trap-neuter-return program, with adoption whenever possible, on the dynamics of a free-roaming cat population. DESIGN: Observational epidemiologic study. ANIMALS: 155 unowned free-roaming cats. PROCEDURES: Free-roaming cats residing on a university campus were trapped, neutered, and returned to the environment or adopted over an 11-year period. RESULTS: During the observation period (January 1991 to April 2002), 75% of the cats were feral, and 25% were socialized. Kittens comprised 56% of the original population. Male cats were slightly more numerous (55%) than females. At the conclusion of the observation period, 47% of the cats had been removed for adoption, 15% remained on site, 15% had disappeared, 11% were euthanatized, 6% had died, and 6% had moved to the surrounding wooded environment. Trapping began in 1991; however, a complete census of cats was not completed until 1996, at which time 68 cats resided on site. At completion of the study in 2002, the population had decreased by 66%, from 68 to 23 cats (of which 22 were feral). No kittens were observed on site after 1995, but additional stray or abandoned cats continued to become resident. New arrivals were neutered or adopted before they could reproduce. CONCLUSIONS AND CLINICAL RELEVANCE: A comprehensive long-term program of neutering followed by adoption or return to the resident colony can result in reduction of free-roaming cat populations in urban areas.

Animal Welfare↗

PubMed1993

Adoption and abandonment of matrix management programs: effects of organizational characteristics and interorganizational networks.

Organizational design theorists argue that organizations adopt matrix (departmentalized) structures for technical reasons, to solve problems of internal coordination and information processing. Research on interorganizational networks suggests that organizations adopt new structures because of mimetic forces and normative pressures. We examined the effects of both sets of factors on the adoption of matrix management in a group of hospitals. Multivariate analyses revealed that matrix adoption is influenced not only by task diversity, but also by sociometric location, the dissemination of information, and the cumulative force of adoption in interorganizational networks. Such variables exert little influence on decisions to abandon matrix programs, however.

Decision Making, Organizational↗

PubMed1975

Antigen-initiated B-lymphocyte differentiation. VII. Quantification of AFC progenitor levels in adoptive and culture responses to NIP-POL antigen.

Quantitative studies on B cells require a direct assay for antibody-forming cell (AFC) progenitor function, in which the number of AFC produced bears a simple, linear arithmetic relationship to the number of progenitors present. This might be expected under conditions where helper T-cell and accessory cell requirements are by-passed, or provided in excess. This possibility has been tested using as antigen the hapten NIP (4-hydroxy-3-iodo-5-nitrophenylacetic acid) on the carrier POL (polymerized bacterial flagellin), in adoptive transfer of normal and nude mouse spleen cells to irradiated recipients, and in cell culture. Primary and secondary IgM responses to this antigen are "T cell-independent'. The secondard IgG response is T cell-dependent but this function can be provided by 'carrier-primed' irradiated recipients. However in no case did the cell dose response curve show a linear, arithmetic relationship between cells transferred or cultured, and AFC produced. If less than 10 X 10(6) cells were adoptively transferred or cultured, a sigmoid curve was obtained, approximately linear with a slope of around 1-6 on a log-log scale. In adoptive transfer, a plateau was then seen above 10 X 10(6) cells, followed by a second sharp rise beginning around 15 X 10(6) cells. Addition of irradiated spleen cells as 'fillers' to maintain cell numbers constant produced a linear (arithmetic scale) dose response curve for the primary IgM responses, both adoptive and in culture. Lipopolysaccharide injection of recipients also produced linear regions in the adoptive transfer system. These techniques provide more direct, quantitative assay systems for the primary IgM responses to this antigen. However, arithmetic linear cell dose response curves were still not obtained for the secondary IgG responses, using irradiated filler cells.

Animals↗

PubMed2001

Organizational adoption of preemployment drug testing.

This study explored the adoption of preemployment drug testing by 360 organizations. Survival models were developed that included internal organizational and labor market factors hypothesized to affect the likelihood of adoption of drug testing. Also considered was another set of variables that included social and political variables based on institutional theory. An event history analysis using Cox regressions indicated that both internal organizational and environmental variables predicted adoption of drug testing. Results indicate that the higher the proportion of drug testers in the worksite's industry, the more likely it would be to adopt drug testing. Also, the extent to which an organization uses an internal labor market, voluntary turnover rate, and the extent to which management perceives drugs to be a problem were related to likelihood of adoption of drug testing.

Adult↗

PubMedDate not supplied

Social and demographic characteristics influencing adoption of female sterilisation.

This paper analyzes the relationship between the adoption of female sterilization and 3 social and modernization variables (education, income, and family type) and 2 demographic variables (number of living children and years of marriage) for a sample of 200. The influence of each of these 5 variables on female sterilization is studied by the percentage distribution method and the variance test. The data are analyzed by using the urban-rural and adopter-nonadopter classification. Results show that the social and modernization variables do not seem to influence the adoption of female sterilization among urban or rural households, but the demographic variables--number of living children and years of marriage--do seem to have a clear influence. Among rural households there are differences in these variables between adopters and nonadopters of female sterilization. There is a policy implication here: the government has to advocate the 2 child norm to all eligible couples in the early years of marriage and advise them to adopt sterilization after the birth of the 2nd child. This will go a long way in achieving the national target of the replacement level of reproduction by the year 2000.

Asia↗

PubMed2005

Instructional technology adoption of medical faculty in teaching.

Despite large investment by higher education institutions in technology for faculty and student use, instructional technology is not being integrated into instructions in the higher education institutions, including medical education institutions. While diffusion of instructional technologies has been reached a saturation point with early adopters of technology, it has remained limited among mainstream faculty. This study explored technology adoption patterns and perceptions of medical faculty about barriers and incentives to technology adoption in teaching.Complete data was obtained from 155 participants by using survey methodology and analyzed on the basis of theories of diffusion of innovation.Findings provided evidence for limited adoption of relatively new tools associated with instruction into mainstream faculty. Inadequate hardware for students and faculty, lack of reward structure, insufficient traing oppurtunites were identified as major barriers to faculty technology adoption.

Education, Medical↗

PubMed2006

District-level religious composition and adoption of sterilization in India.

This paper examined the influence of religion on the adoption of female sterilization, using data from the 1992/93 Indian National Family Health Survey. The influence of religion at both individual and district levels was examined, and a multi-level modelling methodology was used for assessing community variations in the influence of religion on the adoption of sterilization. Individual religion was a strong predictor of the decision to adopt sterilization, and residence in a district in which more than 20% of the people were Muslims significantly lowered the odds of adoption of sterilization. There was more variation in the adoption of sterilization between districts for Muslim women and women from minority religious groups. The results demonstrate the influence of community conservatism on the choice of contraceptive methods and point to the mediating effects that community characteristics can have on access to sterilization services for women from religious minority sub-groups.

Adolescent↗

PubMedDate not supplied

Organizational integrative mechanisms and adoption of innovations by nurses.

The relationship between organizational activities and structures that increase information flow (integrative mechanisms) and nurse adoption of innovations (research results) was studied using Rogers' theory of innovation diffusion. Analysis of variance demonstrated a significant interaction effect between level of integrative mechanism use, institution size, and nurse adoption of innovations. In small hospitals a higher level of integrative mechanism use was related to increased nurse innovation adoption; however, in large hospitals the opposite was found. Of the five categories of integrative mechanisms identified, only Research Conduct and Publication were significantly related to innovation adoption, and then only in small hospitals. In large hospitals, Conference and Presentation, Position and Committee, and Publication categories were demonstrated to be significantly, but negatively, related to innovation adoption among nurses.

Communication↗

PubMed1985

Adoptive immunotherapy of newly induced murine sarcomas.

Two newly induced methylcholanthrene sarcomas of C57BL/6 mouse origin were selected for studies of the adoptive immunotherapy of established tumors. The MCA 105 and MCA 106 tumors, used during their first five transplant generations, possessed weakly immunogenic tumor-associated transplantation antigens as revealed by failure to elicit immunity to reject 10(6) tumor cells by tumor growth and excision. Specific immunity to reject a 10(6) tumor cell challenge could be elicited in less than 50% of mice by immunization with a mixture of viable tumor cells and Corynebacterium parvum. Adoptive transfer of spleen cells from properly immunized mice consistently mediated the regression of established MCA 105 and MCA 106 tumors. Following systemic administration of 10(8) immune cells into mice bearing palpable tumor, the tumor grew for at least 1 week and then completely regressed. The adoptive immunotherapy was immunologically specific for each of these tumors and was mediated by sensitized T-lymphocytes. Irradiation (1000 R) of the transferred cells abrogated their in vivo activity. With both tumors, successful therapy required prior immune suppression of the host. This latter finding suggested the existence of suppression mechanisms mediated by tumor-bearing mice although we have been unable to reconstitute this suppression by giving T-cell-depleted mice syngeneic spleen cells. The two new animal tumor models characterized in this study not only demonstrate the feasibility of adoptive immunotherapy to weakly immunogenic tumors but also provide unique opportunities for mechanistic studies of the specificity of adoptive immunotherapy.

Animals↗

PubMed1982

Suppressor cells in transplantation tolerance. I. Analysis of the suppressor status of neonatally and adoptively tolerized rats.

The lymphocytes from neonatally tolerant rats which adoptively transfer tolerance to sublethally irradiated recipients do so by specifically suppressing the regeneration of alloreactivity which normally occurs after irradiation. Although tolerant cells will only partially suppress normal alloreactive cells when the two are mixed in near equivalent numbers, experiments in which the interval between injection of tolerant and normal cells into irradiated recipients was gradually extended, indicated that total suppression of normally alloreactive cells was achieved after 8 weeks of prior residence of tolerant cells in the adoptive host. Further evidence that tolerant cells would only suppress if present in excess of normal cells was obtained by reducing the tolerant cell population in tolerant donor rats by whole body irradiation. These animals then lost their ability to suppress normal alloreactive cells administered to them. The immune status of adoptively tolerized animals did not mimic that of the donors of the tolerant cells. Even where full tolerance, as measured by skin graft survival, failure to synthesize alloantibodies, and capacity to further transfer skin graft tolerance to secondary recipients, was evident the lymphocytes of these animals showed considerable graft-versus-host (GVH) reactivity. The persistence of tolerance through repeated adoptive transfers was correlated with the persistence of donor (chimeric) cells and the indicator skin graft on adoptive recipients only amplified tolerance expression where the inocula of tolerant cells given was weakly suppressive. Finally, removal of the minor population of chimeric cells from tolerant inocula using cytotoxic alloantisera abolished the capacity to transfer tolerance. These results imply an active role for chimeric cells which is best understood as an immune response involving proliferation driven by the idiotypes of the alloreceptors on host cells.

Animals↗

PubMed1980

Comparison of neonatally and adoptively induced transplantation tolerance in mice.

Transplantation tolerance induced by the semiallogeneic cells in newborn mice or by the adoptive transfer of syngeneic spleen cells from neonatally tolerant donors in adult mice was studied in the strain combination with the H-2D region disparity (B10.A recipients--B10.A(2R) donors). Tolerance could be transfered adoptively already from 3-week-old mice that had been rendered tolerant at birth and the ability for the transfer of tolerance persisted for long periods even when neonatally tolerant animals were not skin grafted. Both neonatally and adoptively induced tolerance could not be abolished by the adoptive transfer of 100 x 10(6) immunocompetent cells from normal syngeneic donors. It was observed in the in vitro experiments that cells from tolerant mice in the two types of tolerance reacted to the tolerated antigens in the mixed lymphocyte culture, did not react to the tolerated antigens in the microcytotoxicity test (only some mice with adoptively induced tolerance showed a certain degree of reactivity), but cells from both types of tolerant mice inhibited the in vitro sensitization of cells from normal syngeneic animals. This suppression was stronger with cells from neonatally tolerant mice.

Animals↗