Strategies for Providing Quality Patient Care in the Healthcare Industry

In the United States, there is a lack of quality healthcare, which can negatively impact patient care, so it is important for healthcare leaders to effectively utilize their resources to enhance quality patient care. Grounded in the resource advantage and total quality management theories, the purpose of this qualitative single case study was to explore strategies healthcare leaders at a large healthcare organization used to deliver quality patient care. The participants included 3 senior executive leaders at a healthcare organization in the Eastern United States. Data were collected through semistructured interviews, an analysis of organizational documents, and the client’s Baldrige Excellence Framework application. Through thematic analysis, the following three themes emerged: patient-centeredness, employee focus, and innovation. A key recommendation includes putting more emphasis on data analysis to help leaders determine which data is impactful for patients’ wellbeing. The potential for social change includes leaders of health organizations implementing strategies that ensure quality patient care, resulting in patients living longer and better lives

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

The GenTree Platform: growth traits and tree-level environmental data in 12 European forest tree species

Background: Progress in the field of evolutionary forest ecology has been hampered by the huge challenge of phenotyping trees across their ranges in their natural environments, and the limitation in high-resolution environmental information. Findings: The GenTree Platform contains phenotypic and environmental data from 4,959 trees from 12 ecologically and economically important European forest tree species: Abies alba Mill. (silver fir), Betula pendula Roth. (silver birch), Fagus sylvatica L. (European beech), Picea abies (L.) H. Karst (Norway spruce), Pinus cembra L. (Swiss stone pine), Pinus halepensis Mill. (Aleppo pine), Pinus nigra Arnold (European black pine), Pinus pinaster Aiton (maritime pine), Pinus sylvestris L. (Scots pine), Populus nigra L. (European black poplar), Taxus baccata L. (English yew), and Quercus petraea (Matt.) Liebl. (sessile oak). Phenotypic (height, diameter at breast height, crown size, bark thickness, biomass, straightness, forking, branch angle, fructification), regeneration, environmental in situ measurements (soil depth, vegetation cover, competition indices), and environmental modeling data extracted by using bilinear interpolation accounting for surrounding conditions of each tree (precipitation, temperature, insolation, drought indices) were obtained from trees in 194 sites covering the species’ geographic ranges and reflecting local environmental gradients. Conclusion: The GenTree Platform is a new resource for investigating ecological and evolutionary processes in forest trees. The coherent phenotyping and environmental characterization across 12 species in their European ranges allow for a wide range of analyses from forest ecologists, conservationists, and macro-ecologists. Also, the data here presented can be linked to the GenTree Dendroecological collection, the GenTree Leaf Trait collection, and the GenTree Genomic collection presented elsewhere, which together build the largest evolutionary forest ecology data collection available

Between but not within species variation in the distribution of fitness effects

New mutations provide the raw material for evolution and adaptation. The distribution of fitness effects (DFE) describes the spectrum of effects of new mutations that can occur along a genome, and is therefore of vital interest in evolutionary biology. Recent work has uncovered striking similarities in the DFE between closely related species, prompting us to ask whether there is variation in the DFE among populations of the same species, or among species with different degrees of divergence, i.e., whether there is variation in the DFE at different levels of evolution. Using exome capture data from six tree species sampled across Europe we characterised the DFE for multiple species, and for each species, multiple populations, and investigated the factors potentially influencing the DFE, such as demography, population divergence and genetic background. We find statistical support for there being variation in the DFE at the species level, even among relatively closely related species. However, we find very little difference at the population level, suggesting that differences in the DFE are primarily driven by deep features of species biology, and that evolutionarily recent events, such as demographic changes and local adaptation, have little impact

Mechanical Performance of the First Two Prototype 4.5 m Long Nb3_3Sn Low-ββ Quadrupole Magnets for the Hi-Lumi LHC Upgrade

The U.S. High-Luminosity LHC Accelerator Upgrade Project (HL-LHC AUP) team is collaborating with CERN in the design and fabrication of the first 4.5 m long MQXFA magnets, a 150 mm aperture high-field Nb$_3$Sn quadrupole magnet that uses the aluminum shell-based bladder-and-key technology. The first two prototype magnets, MQXFAP1 and MQXFAP2, were assem-bled and tested while the first pre-series structure (MQXFA03) was in fabrication. This paper summarizes the mechanical perfor-mance of these prototype structures based on the comparison of measured strain gauge data with finite element model analyses from all load steps to powering. The MQXFAP1 magnet almost reached ultimate current before a short to ground was detected and the test was stopped. The MQXFAP2 magnet experienced a low training performance due to a fractured aluminum shell. MQXFAP1b was rebuilt with a new replacement coil, but an old coil limited the magnet from achieving the ultimate current. The mitigations and analyses of these prototype magnets are discussed in the context of the transition to pre-series production.The U.S. High-Luminosity LHC Accelerator Upgrade Project (HL-LHC AUP) team is collaborating with CERN in the design and fabrication of the first 4.5 m long MQXFA magnets, a 150 mm aperture high-field Nb$_3$Sn quadrupole magnet that uses the aluminum shell-based bladder-and-key technology. The first two prototype magnets, MQXFAP1 and MQXFAP2, were assembled and tested while the first pre-series structure (MQXFA03) was in fabrication. This paper summarizes the mechanical performance of these prototype structures based on the comparison of measured strain gauge data with finite element model analyses from all load steps to powering. The MQXFAP1 magnet almost reached ultimate current before a short to ground was detected and the test was stopped. The MQXFAP2 magnet experienced a low training performance due to a fractured aluminum shell. MQXFAP1b was rebuilt with a new replacement coil, but an old coil limited the magnet from achieving the ultimate current. The mitigations and analyses of these prototype magnets are discussed in the context of the transition to pre-series production

Magnetic Field Measurements of First Pre-series Full-Length 4.2 m Quadrupole MQXFA03 Using PCB Rotating Coils for the Hi-Lumi LHC Project

The U.S. Hi-Lumi LHC Accelerator Upgrade Project (AUP) and CERN have joined efforts to develop high field quadrupoles for the Hi-Lumi LHC upgrade. The US national laboratories in the AUP project will deliver 10 magnets and each cryostat has two 4.2 m high gradient quadrupoles in it. These magnets are made of Nb3Sn conductors, with large aperture (150 mm) and integrated gradient of 556.9 T. This paper reports on magnetic measurements performed during the vertical test at Brookhaven National Laboratory (BNL) in 2019-2020. A warm measurement Z-Scan (+/−15 A) with 42 Z-positions before cool-down was performed at BNL. The results were directly compared to field data measured at LBNL during magnet assembly. Measured harmonics and magnetic center offsets (ΔX and ΔY) have provided timely and informative diagnostics on the magnet structure's shape at both warm and cold temperatures. A new centering fixture was designed and added to better center the warm bore tube which contains the rotating coil probe. After the quench training to 16.47 kA was achieved, a complete set of cold measurements (Z-Scan at 16.47 kA and I-Scan from 960 A to 16.47 kA and back to 960 A) was made. Periodic axial variation of allowed and nonallowed harmonics was observed which is related to the coil radial and/or mid-plane variations along the magnet axis. Overall, the average harmonics in the straight section are within the required field boundaries.The U.S. Hi-Lumi LHC Accelerator Upgrade Project (AUP) and CERN have joined efforts to develop high field quad-rupoles for the Hi-Lumi LHC upgrade. The US national laborato-ries in the AUP project will deliver 10 magnets and each cryostat has two 4.2 m high gradient quadrupoles in it. These magnets are made of Nb3Sn conductors, with large aperture (150 mm) and in-tegrated gradient of 556.9 T. This paper reports on magnetic measurements performed during the vertical test at Brookhaven National Laboratory (BNL) in 2019-2020. A warm measurement Z-Scan (+/- 15 A) with 42 Z-positions before cool-down was per-formed at BNL. The results were directly compared to field data measured at LBNL during magnet assembly. Measured harmonics and magnetic center offsets (ΔX and ΔY) have provided timely and informative diagnostics on the magnet structure’s shape at both warm and cold temperatures. A new centering fixture was de-signed and added to better center the warm bore tube which con-tains the rotating coil probe. After the quench training to 16.47 kA was achieved, a complete set of cold measurements (Z-Scan at 16.47 kA and I-Scan from 960 A to 16.47 kA and back to 960 A) was made. Periodic axial variation of allowed and nonallowed harmonics was observed which is related to the coil radial and/or mid-plane variations along the magnet axis. Overall, the average harmonics in the straight section are within the required field boundaries