Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

On Kaon production in e+e- and Semi-inclusive DIS reactions

We consider semi-inclusive unpolarized DIS for the production of charged kaons and the different possibilities to test the conventionally used assumptions s-\bar=0 and D_d^{K^+-K^-}=0. The considered tests have the advantage that they do not require any knowledge of the fragmentation functions. We also show that measurements of both charged and neutral kaons would allow the determination of the kaon FFs D_q^{K^++K^-} solely from SIDIS measurements, and discuss the comparison of (D_u-D_d)^{K^+-K^-} obtained independently in SIDIS and e+e- reactions. All analysis are performed in LO and NLO in QCD. The feasibility of the tests to HERMES SIDIS data is considered.Comment: 7 pages, NLO analysis for all presented tests and feasibility to HERMES data adde

Right eigenvalue equation in quaternionic quantum mechanics

We study the right eigenvalue equation for quaternionic and complex linear matrix operators defined in n-dimensional quaternionic vector spaces. For quaternionic linear operators the eigenvalue spectrum consists of n complex values. For these operators we give a necessary and sufficient condition for the diagonalization of their quaternionic matrix representations. Our discussion is also extended to complex linear operators, whose spectrum is characterized by 2n complex eigenvalues. We show that a consistent analysis of the eigenvalue problem for complex linear operators requires the choice of a complex geometry in defining inner products. Finally, we introduce some examples of the left eigenvalue equations and highlight the main difficulties in their solution.Comment: 24 pages, AMS-Te

The issues of enterprise growth in transition and post-transition period: the case of Polish 'Elektrim'

Case study of Polish company Elektrim illustrates the changing basis of growth of enterprises between the transition and post-transition periods. Elektrim grew primarily through conglomeration in the transition period. After the exhaustion of this mode of growth Elektrim has started to focus on a few core areas (telecoms, cables, energy). The strategic shift to telecommunications has been based on partnerships with foreign firms and it is likely that this will be the pattern in other areas. In this respect, the case of Elektrim shows the importance of internationalisation for the growth of enterprises in CEE. Based on the case study the paper draws several analytical issues: First, Elektrim's shift from conglomeration to focusing suggests that the institutional context, which drives firm strategy in post-socialist economies like Poland, is, perhaps, also changing. Second, in order to grow Elektrim is forced to enter into equity relationships and partnerships like with French Vivendi. This suggests that the possibilities for firm growth in post-socialist economies, like Poland, through generic expansion are still fewer when compared to growth based on mergers & acquisitions or different forms of alliances. Third, Elektrim's relationship with government is complex and refutes the simplified dichotomy of markets vs. governments. This raises the issue of to what extent post-socialist governments operate as a 'compensatory mechanism' on which firms like Elektrim can rely to grow. Fourth, the opening of the CEECs has led to relocations of EU and other MNCs into this region with the result that they are also transferring the oligopolistic competition from EU into new markets. The case of Elektrim shows how CEE companies and goverment regulations become factors in the oligopolistic competition between big EU companies. CEE companies and governments may use this competition to their advantage but also their limited bargaining powers may lead to outcomes unfavourable to them

Classifying and avoiding singularities in the alternative gravity dark energy models

The future finite-time singularities emerging in alternative gravity dark energy models are classified and studied in Jordan and Einstein frames. It is shown that such singularity may occur even in flat spacetime for the specific choice of the effective potential. The conditions for the avoidance of finite-time singularities are presented and discussed. The problem is reduced to the study of a scalar field evolving on an effective potential by using the conformal transformations. Some viable modified gravity models are analyzed in detail and the way to cure singularity is considered by introducing the higher-order curvature corrections. These results maybe relevant for the resolution of the conjectured problem in the relativistic star formation in such modified gravity where finite-time singularity is also manifested.Comment: 21 pages, 12 figures, published version in PR

Quaternionic potentials in non-relativistic quantum mechanics

We discuss the Schrodinger equation in presence of quaternionic potentials. The study is performed analytically as long as it proves possible, when not, we resort to numerical calculations. The results obtained could be useful to investigate an underlying quaternionic quantum dynamics in particle physics. Experimental tests and proposals to observe quaternionic quantum effects by neutron interferometry are briefly reviewed.Comment: 21 pages, 16 figures (ps), AMS-Te

Universality of non-leading logarithmic contributions in transverse-momentum distributions

We consider the resummation of the logarithmic contributions to the region of small transverse momenta in the distributions of high-mass systems (lepton pairs, vector bosons, Higgs particles, ....) produced in hadron collisions. We point out that the resummation formulae that are usually used to compute the distributions in perturbative QCD involve process-dependent form factors and coefficient functions. We present a new universal form of the resummed distribution, in which the dependence on the process is embodied in a single perturbative factor. The new form simplifies the calculation of non-leading logarithms at higher perturbative orders. It can also be useful to systematically implement process-independent non-perturbative effects in transverse-momentum distributions. We also comment on the dependence of these distributions on the factorization and renormalization scales.Comment: misprints corrected in Eqs. (6), (7) and (12), results unchange