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Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned.
Approach and development:
This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.
Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.
Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.
Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme.
Conclusion:
Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.
Christoph Wittich, or Wittichius, was a strong critic of Spinoza, who attacked both his TTP and his Ethics. He dedicated an entire work to refuting the latter: Anti-Spinoza sive examen Ethices Benedicti de Spinoza, et commentaries de Deo et ejus attributis (Wittich 1690).
Wittich was a professor of theology, mathematics, and Hebrew at the universities of Herborn (1651–53), Duisburg (1653–55), Nijmegen (1655–71), and Leiden (1671–87). He was an explicit proponent of Descartes’s philosophy. His appointment at Herborn prompted the Count of Nassau to raise questions about the acceptability of teaching Cartesianism in the universities. This led to a controversy that was only resolved by an edict issued by the States of Holland in 1656.
Quatenus is an adverb usually translated into English as “insofar as.” Spinoza uses the term at least 444 times in the Ethics (Lærke 2012, 261). Traditionally, it has been regarded as Spinoza’s contrivance for trying to wriggle out of metaphysical paradoxes generated by his system (Caird 1888, 166; W. James 1909, 47).
The Dutch Cartesians form part of the historical context that is crucial for understanding Spinoza’s philosophy (Bunge 2001; Verbeek 2003; James 2012; Douglas 2015b). The Dutch Republic, where Descartes spent the years 1628–49 and produced his greatest philosophical work, was naturally the first country to embrace his teaching, which entered the universities in a storm of controversy (Verbeek 1992, chap. 2 ; Bunge 2001, chap. 2; Douglas 2015b, §1.3; Schmaltz 2017, §1.3.1; Strazzoni 2018, chap. 2).
Solid particles trapped in an acoustic standing wave have been observed to undergo propulsion. This phenomenon has been attributed to the generation of a steady streaming flow, with a reversal in the propulsion direction at a distinct frequency. We explain the mechanism underlying this reversal by considering the canonical problem of a sphere executing oscillatory rotation in an unbounded fluid that undergoes rectilinear oscillation; these two oscillations occur at identical frequency but with an arbitrary phase difference. Two distinct bifurcations in the flow field occur: (1) a stagnation point first forms with increasing frequency, which (2) splits into a saddle node and a vortex centre. Reversal in the propulsion direction is driven by reversal in the flow far from the sphere, which coincides with the second bifurcation. This flow is identified with that of a Stokeslet whose strength is the net force exerted on the particle, which has implications for studying the flow field around particles of non-spherical geometries and for modelling suspensions of particles in acoustic fields.
Recent studies indicate that a template method for creating Al-pillared clays, in which surfactant micelles foster the creation of a homogeneous mesoporous network within the pillar, effectively enhance catalyst performance and adsorbent properties. No studies, however, have described the relative effects of the surfactant concentration and Al content on the textural and acidic properties and on the catalytic activity of the Al-pillared clays. The purpose of the present study was to fill this gap, using the isomerization of 1-butene as the test process for catalytic activity. Modified pillared clays (MPC) were prepared from a synthetic clay, TS-1, using different amounts of a non-ionic surfactant (Igepal CO-720) and a fixed concentration of a solution containing the Al polycation [Al13O4-(OH)24]7+. MPC with a fixed amount of surfactant and different amounts of Al were also prepared. The catalysts were characterized by X-ray diffraction (XRD), X-ray fluorescence (XRF), temperature-programmed desorption of ammonia, 27Al magic-angle spinning nuclear magnetic resonance (27Al MAS NMR), and N2 adsorption/desorption isotherms. Isomerization of 1-butene at 250°C was used to test the catalytic activity. Analyses by XRD and XRF showed that the synthesized solids were amorphous and that the amount of pillaring by Al increased with the amount of Al complex used. Interestingly, the surface area and pore volume were directly proportional to the amount of surfactant employed and decreased with increasing amounts of Al pillaring. All solids showed activity for 1-butene isomerization, with a maximum conversion of ∼75%. Only cis- and trans-2-butene were observed. The absence of isobutene suggested that acid sites of moderate strength were formed, in agreement with the results obtained from the desorption of ammonia.
Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address this, there is a strong movement towards integrating male reproductive and sexual healthcare involving clinicians such as andrologists, urologists, endocrinologists and counselors. This book will emphasize this integrated approach to male reproductive and sexual health throughout the lifespan. Practical advice on how to perform both clinical and laboratory evaluations of infertile men is given, as well as a variety of methods for medically and surgically managing common issues. This text ties together the three major pillars of clinical andrology: clinical care, the andrology laboratory, and translational research.
Background: The FIRST Trial is a 5-year study funded by the Agency for Healthcare Research and Quality. Our investigation is situated within a more extensive study to restrict fluoroquinolone antibiotics by requiring providers to obtain authorization from an infectious disease physician before prescribing fluoroquinolones. Our research team is performing a systematic evaluation to identify organizational characteristics and influencers of the fluoroquinolone preprescription authorization implementation process to understand variables that may facilitate or hinder implementation success. Methods: To address this critical gap, we present a qualitative analysis from our ongoing, multisite research project aimed at systematically assessing the adoption of an antimicrobial stewardship intervention in the form of an EHR-integrated best-practice alert (BPA) at each site to identify work system factors that impact uptake and variability in the implementation of the BPA at each location. The evaluation provides a detailed explanation of activities through the implementation process (eg, before implementation, during implementation, and after implementation) to assess how an organization effectively negotiates the phases and transitions, ultimately influencing the impact of the intervention. We have used a contextual determinant framework (CFIR) that has enabled us to perform a systematic and comprehensive exploration and identification of potential explanatory themes or variables to shed light on the complex social phenomenon of implementation. Results: Participants who will be a part of our poster presentation will learn about implementing a BPA, the potential barriers to implementation, and strategies for overcoming these barriers. Stakeholders within our study include site coordinators, medical doctors, nurses, pharmacists, and clinical informaticists. Our analysis synthesizes their experiences implementing and sustaining this evidence-based antimicrobial stewardship intervention. It includes (1) a detailed description of the process of change, (2) work-system factors (eg, inner setting and outer setting) that they believe influenced the success of the intervention, (3) barriers and facilitators (eg, CFIR constructs) within the implementation process; and (4) description of how these could have influenced the outcomes of interest (eg, implementation and intervention effectiveness). Conclusions: Our research is expected to advance patient safety research and initiatives by providing a more robust approach to performing systematic intervention evaluations. By outlining stakeholders’ experiences within our study, implementation leaders within healthcare systems will utilize our findings to aid them in their design and implementation process when designing and implementing similar types of healthcare interventions.
The Bolivar Archaeological Project exemplifies the possibilities of archaeology as service, incorporating descendant communities and local stakeholders into the fabric of the research design and planning for a state infrastructure project. This collaborative, multidisciplinary project attends to marginalized histories to offer a model for how publicly funded cultural resources management archaeology can serve multiple goals. The Bolivar Archaeological Project was conceived as a public archaeology project, with dual goals of being community driven and yielding scholarly contributions. In the shifting rural–urban landscape of Denton County, a Texas Department of Transportation road improvement project has supported archaeological investigations of two nineteenth-century sites—a blacksmith shop and hotel—associated with the historic Chisholm Trail. The blacksmith shop belonged to Tom Cook, an African American freedman, whose descendants reside nearby and became active participants in the investigations, including as collaborative authors in this article. The project illustrates the importance of representation and praxis to realize inclusive community engagement, with this article outlining the development of the project and ongoing research. Informed by Black feminist archaeologies, the project works at the intersections of local communities and state infrastructure while navigating landscapes of fraught histories and presents to forge an archaeology for the twenty-first century.
This Element presents several frameworks of strategy-making that serve to analyze organizational evolution processes within and beyond the firm. These frameworks form an integrated evolutionary ecological lens to examine the dynamics of strategy-making in organizational evolution. They highlight the role of the internal selection environment for analyzing processes and practices at various managerial levels (top, middle, and operational) within the organization. The Element also explains the role of the CEO in maintaining and updating the internal selection environment and contributing to organizational evolution, as well as making. fundamental decisions about organizational splits of the firm's business models as an ecosystem evolves.