Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Deepening Understanding of Certification Adoption and Non-Adoption of International-Supplier Ethical Standards

This study presents a theory of causally complex configurations of antecedent conditions influencing the adoption versus non-adoption of international supplier ethical certification-standards. Using objective measures of antecedents and outcomes, a large-scale study of exporting firms in the cut-flower industry in two South American countries (Colombia and Ecuador) supports the theory. The theory includes the following and additional propositions. No single (simple)-antecedent condition is sufficient for accurately predicting a high membership score in outcome conditions; the outcome conditions include a firm’s adoption or rejection of a product certification. No single (simple)-antecedent condition is necessary for accurately predicting high scores in the outcome condition. A few complex antecedent conditions (configurations) are sufficient but the occurrence of each is not necessary for accurately predicting high scores (e.g., adoption) in an outcome condition. Causal asymmetry of antecedent conditions indicating adoption versus non-adoption of specific ethical standards occurs—that is, causal conditions leading to rejection are not the mirror opposites of causal conditions leading to adoption

Golden Rule of Forecasting: Be Conservative

This article proposes a unifying theory, or the Golden Rule, or forecasting. The Golden Rule of Forecasting is to be conservative. A conservative forecast is consistent with cumulative knowledge about the present and the past. To be conservative, forecasters must seek out and use all knowledge relevant to the problem, including knowledge of methods validated for the situation. Twenty-eight guidelines are logically deduced from the Golden Rule. A review of evidence identified 105 papers with experimental comparisons; 102 support the guidelines. Ignoring a single guideline increased forecast error by more than two-fifths on average. Ignoring the Golden Rule is likely to harm accuracy most when the situation is uncertain and complex, and when bias is likely. Non-experts who use the Golden Rule can identify dubious forecasts quickly and inexpensively. To date, ignorance of research findings, bias, sophisticated statistical procedures, and the proliferation of big data, have led forecasters to violate the Golden Rule. As a result, despite major advances in evidence-based forecasting methods, forecasting practice in many fields has failed to improve over the past half-century

Engineering of cyclodextrin glucanotransferases and the impact for biotechnological applications

Cyclodextrin glucanotransferases (CGTases) are industrially important enzymes that produce cyclic α-(1,4)-linked oligosaccharides (cyclodextrins) from starch. Cyclodextrin glucanotransferases are also applied as catalysts in the synthesis of glycosylated molecules and can act as antistaling agents in the baking industry. To improve the performance of CGTases in these various applications, protein engineers are screening for CGTase variants with higher product yields, improved CD size specificity, etc. In this review, we focus on the strategies employed in obtaining CGTases with new or enhanced enzymatic capabilities by searching for new enzymes and improving existing enzymatic activities via protein engineering