{"id":40376,"date":"2017-10-13T17:40:57","date_gmt":"2017-10-13T16:40:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40376"},"modified":"2017-10-17T11:17:13","modified_gmt":"2017-10-17T10:17:13","slug":"jeffrey-aronson-when-i-use-a-word-implementation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/10\/13\/jeffrey-aronson-when-i-use-a-word-implementation\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Implementation"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>In various blogs that I have been writing in the last few months about <\/span>translational research<\/span><\/a>, <\/span>algorithms<\/span><\/a>, <\/span>knowledge<\/span><\/a> and its <\/span>diffusion<\/span><\/a> and <\/span>dissemination<\/span><\/a>, <\/span>skills<\/span><\/a>, <\/span>performance<\/span><\/a>, and <\/span>competence<\/span><\/a>, implementation has been ever present in the background and is an important part of my <\/span>operational model<\/span><\/a> of translational research.<\/span><\/p>\n

The IndoEuropean root PEL\u018e meant to fill, with the implication of abundance and multitude. Following consonantal change, fill and full are derivatives, as is <\/span>fulsome<\/span><\/a>, which has changed its meaning twice over the years. The earliest meaning listed in the <\/span>OED<\/span><\/i> (first recorded in 1325) was complimentary: \u201ccharacterized by being full of some commodity or material; abundant, plentiful; providing a copious supply, rich.\u201d It then (1390) turned around to mean \u201coffending against accepted standards of morality or taste; morally reprehensible, obnoxious, deplorable\u201d and went on to develop increasingly pejorative meanings, such as \u201cwearisome\u201d (1430); \u201cfull and plump; fleshy, corpulent; oversized, overfed, \u00a0full-figured; voluptuous\u201d (1447); \u201cphysically disgusting; filthy, dirty, foul, loathsome\u201d (1510); \u201cof food: coarse, heavy, filling; difficult to digest, cloying\u201d (1555); “sexually unrestrained, unchaste, lascivious; bawdy, lewd\u201d (1600); and \u201csickening, nauseating (in taste); sickly-sweet\u201d (1694). Then after a long delay it became complimentary again: \u201cunrestrained, exuberant; effusive; lavish; wholehearted\u201d, as in \u201cfulsome praise\u201d (1936). Take your pick.<\/span><\/p>\n

From a Greek derivative of PEL\u018e, \u03c0\u03bf\u03bb\u03cd\u03c2, we get hoi polloi and many words beginning with poly-, a prefix meaning many or too many; polymyalgia means simply pain in many muscles, while polycythaemia means too many erythrocytes and polydactyly too many fingers; but polypharmacy can imply both: many (<\/span>appropriate<\/span><\/a>) drugs or too many (<\/span>inappropriate<\/span><\/a>) ones.<\/span><\/p>\n

Make PEL\u018e into PL\u018e and you get another Greek derivative, \u03c0\u03bb\u03ae\u03b8\u03b5\u03b9\u03bd, to be full, and a Latin one, pl\u0113re, to fill, giving us plethora, plethoric, plethysmography (measuring changes in volume), pleonasm, and pleiotropic. The Pliocene epoch was so called because of the abundance of fossils of species, still extant, that it generated, and the Pleistocene (Greek \u03c0\u03bb\u03b5\u1fd6\u03c3\u03c4\u03bf\u03c2<\/span>,<\/span><\/i> the most) was the last part of the Pliocene; the suffix in each case is from the Greek<\/span>, <\/span><\/i>\u03ba\u03b1\u03b9\u03bd\u03cc\u03c2<\/span>,<\/span><\/i> new. <\/span><\/p>\n

\"\"\u00a0\"\"<\/p>\n

Figure 1. <\/b>The lexicographer Henry Watson Fowler, with his dog Raven, and an extract from the first edition of <\/span>Modern English Usage<\/span><\/i> (1926). Fowler wrote that \u201cBarbarism means uncivilized condition, grossly uncultivated taste, or an illiterate expression.\u201d He took exception to Pleistocene, Pliocene, and Miocene (Greek \u03bc\u03b5\u03af\u03c9\u03bd, lesser) because he thought that they were not formed by proper methods of word formation\u2014even though the two elements in each word are Greek, and not hybrid barbarisms, the Greeks would not have combined two adjectives in this way. Pliocene and Miocene were terms introduced by <\/span>William Whewell<\/span><\/a>.<\/span><\/p>\n

From Latin plus, more, we get plural, pluperfect, and pluripotent, plus surplus. The Latin word for a marsh, palus, which teems with wildlife, is another conceivable derivative, giving us paludial, palustrine, and Paludrine, which contains proguanil hydrochloride, a treatment for malaria. From Latin plenum, full, we get plebeians (the hoi polloi in their multitude), plebiscite, plenary, plenitude, plenty, plenipotentiary, and replenish, as well as accomplish, complement and compliment, complete, comply, deplete, expletive, replete, supply, and of course, implement.<\/span><\/p>\n

In Latin impl\u0113re meant to fill up. The noun implementum meant something that added to your stocks of anything, and therefore fulfilled a purpose or completed something, and, by confusion with employment, something that was used or useful. Implementation therefore means simply the act of implementing or fulfilling a task.<\/span><\/p>\n

The rate at which an innovation is implemented was first characterised in 1962, by Everett Rogers in his book <\/span>Diffusion of Innovations<\/span><\/a><\/em>, in which he described four phases in the promulgation, and with it the implementation, of the outcomes of research: introduction, early adoption, late adoption, and never adoption. Rogers called those who fill these categories, innovators, early adopters, the early majority, the late majority, and laggards.<\/span><\/p>\n

The term \u201cimplementation research\u201d had few early adopters and although, with a few sporadic exceptions, it only started to appear in 1995, it did not begin to be widely used until a decade later, when it was <\/span>defined<\/span><\/a> as \u201cscientific investigations that support movement of evidence based, effective health care approaches . . . from the clinical knowledge base into routine use.\u201d At the same time, after a 2004 conference on implementation research, the term \u201cimplementation science\u201d started to be used. It was defined as \u201ca body of knowledge on methods to promote the systematic uptake of new or underused scientific findings into the usual activities of regional and national health care and community organizations, including individual practice sites.\u201d<\/span><\/p>\n

The frequencies with which the two terms appear in publications indexed in PubMed have increased in parallel since then (Figure 2).<\/span><\/p>\n

\"\"<\/a><\/p>\n

Figure 2. <\/b>Numbers of publications indexed in PubMed as containing the terms \u201cimplementation research\u201d or \u201cimplementation science\u201d<\/span><\/p>\n

Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

In various blogs that I have been writing in the last few months about translational research, algorithms, knowledge and its diffusion and dissemination, skills, performance, and competence, implementation has been […]<\/p>\n

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