Participatory logic modeling in a multi-site initiative to advance implementation science

BACKGROUND: Logic models map the short-term and long-term outcomes that are expected to occur with a program, and thus are an essential tool for evaluation. Funding agencies, especially in the United States (US), have encouraged the use of logic models among their grantees. They also use logic models to clarify expectations for their own funding initiatives. It is increasingly recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not engaged grantees in developing the logic model associated with their own initiatives. This article describes an instance where a US funder of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC METHODS: The reflective case study was collectively constructed by representatives of the seven centers funded under ISC RESULTS: The initial logic model for ISC CONCLUSIONS: The IS

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Spatial patterns and trends of daily rainfall regime in Peninsular Malaysia during the southwest and northeast monsoons : 1975-2004

This study focuses on describing the patterns and trends of five selected rainfall indices in Peninsular Malaysia, based on daily rainfall data from 1975 to 2004. Five rainfall indices based on two main seasons, the northeast and southwest monsoons, were analyzed: total rainfall, frequency of wet days, rainfall intensity, frequency of wet days (extreme frequency), and rainfall intensity (extreme intensity) exceeding the long-term mean 95th percentile. The findings indicated that the eastern areas of the Peninsula were strongly influenced by the northeast monsoon, while the southwest monsoon had the greatest impact on the western part of the Peninsula, particularly the northwest. In studying the trends of these rainfall indices, the non-parametric Mann-Kendall test was used. The serial correlation and cross-correlation structure of the data were accounted for in determining the significance of the Mann-Kendall test results. It was found that there were differences in trend patterns over the Peninsula during both seasons, with a decrease in total rainfall and a significant decrease in frequency of wet days leading to a significant increase in rainfall intensity over the Peninsula, except in eastern areas, during the southwest monsoon. In contrast, a trend of significantly increasing total rainfall and an increase in frequencies of extreme rainfall events during the northeast monsoon caused a significantly increasing trend in rainfall intensity over the Peninsula to be observed. However, no significant trend was observed with respect to extreme intensity during both monsoons over the Peninsula. The findings of this study suggest that rainfall patterns in Peninsular Malaysia are very much affected by the northeast monsoon, based on the larger magnitude of changes observed in the rainfall indices

Observed Climate Variability and Change

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