Unpacking the black box of improvement

During the Salzburg Global Seminar Session 565-Better Health Care: How do we learn about improvement, participants discussed the need to unpack the black box of improvement. The black box refers to the fact that when quality improvement interventions are described or evaluated, there is a tendency to assume a simple, linear path between the intervention and the outcomes it yields. It is also assumed that it is enough to evaluate the results without understanding the process of by which the improvement took place. However, quality improvement interventions are complex, nonlinear and evolve in response to local settings. To accurately assess the effectiveness of quality improvement and disseminate the learning, there must be a greater understanding of the complexity of quality improvement work. To remain consistent with the language used in Salzburg, we refer to this as unpacking the black box of improvement. To illustrate the complexity of improvement, this article introduces four quality improvement case studies. In unpacking the black box, we present and demonstrate how Cynefin framework from complexity theory can be used to categorize and evaluate quality improvement interventions. Many quality improvement projects are implemented in complex contexts, necessitating an approach defined as probesense- respond. In this approach, teams experiment, learn and adapt their changes to their local setting. Quality improvement professionals intuitively use the probe-sense-respond approach in their work but document and evaluate their projects using language for simple or complicated' contexts, rather than the complex contexts in which they work. As a result, evaluations tend to ask 'How can we attribute outcomes to the intervention, rather than 'What were the adaptations that took place. By unpacking the black box of improvement, improvers can more accurately document and describe their interventions, allowing evaluators to ask the right questions and more adequately evaluate quality improvement interventions.Fil: Ramaswamy, Rohit. University of North Carolina; Estados UnidosFil: Reed, Julie. Nihr Clarch Northwest London; Estados UnidosFil: Livesley, Nigel. Institute for Healthcare Improvement; Estados UnidosFil: Boguslavsky, Victor. University Research Co; Estados UnidosFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Sax, Sylvia. University of Heidelberg; AlemaniaFil: Houleymata, Diarra. Applying Science to Strengthen and Improve Systems Project,; MalíFil: Kimble, Leighann. University Research Co; Estados UnidosFil: Parry, Gareth. Institute of Healthcare Improvement; Estados Unido

Single-grain TT-OSL bleaching characteristics: Insights from modern analogues and OSL dating comparisons

Previous assessments of thermally transferred optically stimulated luminescence (TT-OSL) signal resetting in natural sedimentary settings have been based on relatively limited numbers of observations, and have been conducted primarily at the multi-grain scale of equivalent dose (De) analysis. In this study, we undertake a series of single-grain TT-OSL bleaching assessments on nineteen modern and geological dating samples from different sedimentary environments. Daylight bleaching experiments performed over several weeks confirm that single-grain TT-OSL signals are optically reset at relatively slow, and potentially variable, rates. Single-grain TT-OSL residual doses range between 0 and 24 Gy for thirteen modern samples, with >50% of these samples yielding weighted mean De values of 0 Gy at 2σ. Single-grain OSL and TT-OSL dating comparisons performed on well-bleached and heterogeneously bleached late Pleistocene samples from Kangaroo Island, South Australia, yield consistent replicate age estimates. Our results reveal that (i) single-grain TT-OSL residuals can potentially be reduced down to insignificant levels when compared with the natural dose range of interest for most TT-OSL dating applications; (ii) the slow bleaching properties of TT-OSL signals may not necessarily limit their dating applicability to certain depositional environments; and (iii) non-trivial differences may be observed between single-grain and multi-grain TT-OSL bleaching residuals in some modern samples. Collectively, these findings suggest that single-grain TT-OSL dating may offer advantages over multi-grain TT-OSL dating in certain complex depositional environments

Prospects for Electron Imaging with Ultrafast Time Resolution

Many pivotal aspects of material science, biomechanics, and chemistry would benefit from nanometer imaging with ultrafast time resolution. Here we demonstrate the feasibility of short-pulse electron imaging with t10 nanometer/10 picosecond spatio-temporal resolution, sufficient to characterize phenomena that propagate at the speed of sound in materials (1-10 kilometer/second) without smearing. We outline resolution-degrading effects that occur at high current density followed by strategies to mitigate these effects. Finally, we present a model electron imaging system that achieves 10 nanometer/10 picosecond spatio-temporal resolution

Shared values and deliberative valuation:Future directions

Valuation that focuses only on individual values evades the substantial collective and intersubjective meanings, significance and value from ecosystems. Shared, plural and cultural values of ecosystems constitute a diffuse and interdisciplinary field of research, covering an area that links questions around value ontology, elicitation and aggregation with questions of participation, ethics, and social justice. Synthesising understanding from various contributions to this Special Issue of Ecosystem Services, and with a particular focus on deliberation and deliberative valuation, we discuss key findings and present 35 future research questions in eight topic areas: 1) the ontology of shared values; 2) the role of catalyst and conflict points; 3) shared values and cultural ecosystem services; 4) transcendental values; 5) the process and outcomes of deliberation; 6) deliberative monetary valuation; 7) value aggregation, meta-values and ‘rules of the game’; and 8) integrating valuation methods. The results of this Special Issue and these key questions can help develop a more extensive evidence base to mature the area and develop environmental valuation into a more pluralistic, comprehensive, robust, legitimate and effective way of safeguarding ecosystems and their services for the future

3D-DIP-Chip: a microarray-based method to measure genomic DNA damage

Genotoxins cause DNA damage, which can result in genomic instability. The genetic changes induced have far-reaching consequences, often leading to diseases such as cancer. A wide range of genotoxins exists, including radiations and chemicals found naturally in the environment, and in man-made forms created by human activity across a variety of industries. Genomic technologies offer the possibility of unravelling the mechanisms of genotoxicity, including the repair of genetic damage, enhancing our ability to develop, test and safely use existing and novel materials. We have developed 3D-DIP-Chip, a microarray-based method to measure the prevalence of genomic genotoxin-induced DNA damage. We demonstrate the measurement of both physical and chemical induced DNA damage spectra, integrating the analysis of these with the associated changes in histone acetylation induced in the epigenome. We discuss the application of the method in the context of basic and translational sciences

Peatland core domain sets: building consensus on what should be measured in research and monitoring

It is often difficult to compile and synthesise evidence across multiple studies to inform policy and practice because different outcomes have been measured in different ways or datasets and models have not been fully or consistently reported. In the case of peatlands, a critical terrestrial carbon store, this lack of consistency hampers the evidence-based decisions in policy and practice that are needed to support effective restoration and conservation. This study adapted methods pioneered in the medical community to reach consensus over peatland outcomes that could be consistently measured and reported to improve the synthesis of data and reduce research waste. Here we report on a methodological framework for identifying, evaluating and prioritising the outcomes that should be measured. We discuss the subsequent steps to standardise methods for measuring and reporting outcomes in peatland research and monitoring. The framework was used to identify and prioritise sets of key variables (known as core domain sets) for UK blanket and raised bogs, and for tropical peat swamps. Peatland experts took part in a structured elicitation and prioritisation process, comprising two workshops and questionnaires, that focused on climate (32 and 18 unique outcomes for UK and tropical peats, respectively), hydrology (26 UK and 16 tropical outcomes), biodiversity (8 UK and 22 tropical outcomes) and fire-related outcomes (13, for tropical peatlands only). Future research is needed to tackle the challenges of standardising methods for data collection, management, analysis, reporting and re-use, and to extend the approach to other types of peatland. The process reported here is a first step towards creating datasets that can be synthesised to inform evidence-based policy and practice, and contribute towards the conservation, restoration and sustainable management of this globally significant carbon store. evidence-based policy and practice, evidence synthesis, outcomes, standardisationpublishedVersio