Improving Hospital Efficiency: A Process Model of Organizational Change Commitments

Improving hospital efficiency is a critical goal for managers and policy makers. We draw on participant observation of the perioperative coaching program in seven Ontario hospitals to develop knowledge of the process by which the content of change initiatives to increase hospital efficiency is defined. The coaching program was a change initiative involving the use of external facilitators with the goal of increasing perioperative efficiency. Focusing on the role of subjective understandings in shaping initiatives to improve efficiency, we show that physicians, nurses, administrators, and external facilitators all have differing frames of the problems that limit efficiency, and propose different changes that could enhance efficiency. Dynamics of strategic and contested framing ultimately shaped hospital change commitments. We build on work identifying factors that enhance the success of change efforts to improve hospital efficiency, highlighting the importance of subjective understandings and the politics of meaning-making in defining what hospitals change

Physical Acoustics

Contains reports on two research projects.U. S. Navy (Office of Naval Research) under Contract Nonr-1841(42)National Aeronautics and Space Administratio

An algebraic Haag's theorem

Under natural conditions (such as split property and geometric modular action of wedge algebras) it is shown that the unitary equivalence class of the net of local (von Neumann) algebras in the vacuum sector associated to double cones with bases on a fixed space-like hyperplane completely determines an algebraic QFT model. More precisely, if for two models there is unitary connecting all of these algebras, then --- without assuming that this unitary also connects their respective vacuum states or spacetime symmetry representations --- it follows that the two models are equivalent. This result might be viewed as an algebraic version of the celebrated theorem of Rudolf Haag about problems regarding the so-called "interaction-picture" in QFT. Original motivation of the author for finding such an algebraic version came from conformal chiral QFT. Both the chiral case as well as a related conjecture about standard half-sided modular inclusions will be also discussed

What's the point of knowing how?

Why is it useful to talk and think about knowledge-how? Using Edward Craig’s discussion of the function of the concepts of knowledge and knowledge-how as a jumping off point, this paper argues that considering this question can offer us new angles on the debate about knowledge-how. We consider two candidate functions for the concept of knowledge-how: pooling capacities, and mutual reliance. Craig makes the case for pooling capacities, which connects knowledge-how to our need to pool practical capacities. I argue that the evidence is much more equivocal. My suggested diagnosis is that the concept of knowledge-how plays both functions, meaning that the concept of knowledge-how is inconsistent, and that the debate about knowledge-how is at least partly a metalinguistic negotiation. In closing, I suggest a way to revise the philosophical concept of knowledge how

Capture Velocity for a Magneto-Optical Trap in a Broad Range of Light Intensity

In a recent paper, we have used the dark-spot Zeeman tuned slowing technique [Phys. Rev. A 62, 013404-1, (2000)] to measure the capture velocity as a function of laser intensity for a sodium magneto optical trap. Due to technical limitation we explored only the low light intensity regime, from 0 to 27 mW/cm^2. Now we complement that work measuring the capture velocity in a broader range of light intensities (from 0 to 400 mW/cm^2). New features, observed in this range, are important to understant the escape velocity behavior, which has been intensively used in the interpretation of cold collisions. In particular, we show in this brief report that the capture velocity has a maximum as function of the trap laser intensity, which would imply a minimum in the trap loss rates.Comment: 2 pages, 2 figure

Biomarkers of Tuberculosis Severity and Treatment Effect: A Directed Screen of 70 Host Markers in a Randomized Clinical Trial.

More efficacious treatment regimens are needed for tuberculosis, however, drug development is impeded by a lack of reliable biomarkers of disease severity and of treatment effect. We conducted a directed screen of host biomarkers in participants enrolled in a tuberculosis clinical trial to address this need. Serum samples from 319 protocol-correct, culture-confirmed pulmonary tuberculosis patients treated under direct observation as part of an international, phase 2 trial were screened for 70 markers of infection, inflammation, and metabolism. Biomarker assays were specifically developed for this study and quantified using a novel, multiplexed electrochemiluminescence assay. We evaluated the association of biomarkers with baseline characteristics, as well as with detailed microbiologic data, using Bonferroni-adjusted, linear regression models. Across numerous analyses, seven proteins, SAA1, PCT, IL-1β, IL-6, CRP, PTX-3 and MMP-8, showed recurring strong associations with markers of baseline disease severity, smear grade and cavitation; were strongly modulated by tuberculosis treatment; and had responses that were greater for patients who culture-converted at 8weeks. With treatment, all proteins decreased, except for osteocalcin, MCP-1 and MCP-4, which significantly increased. Several previously reported putative tuberculosis-associated biomarkers (HOMX1, neopterin, and cathelicidin) were not significantly associated with treatment response. In conclusion, across a geographically diverse and large population of tuberculosis patients enrolled in a clinical trial, several previously reported putative biomarkers were not significantly associated with treatment response, however, seven proteins had recurring strong associations with baseline radiographic and microbiologic measures of disease severity, as well as with early treatment response, deserving additional study

Sine-Gordon Soliton on a Cnoidal Wave Background

The method of Darboux transformation, which is applied on cnoidal wave solutions of the sine-Gordon equation, gives solitons moving on a cnoidal wave background. Interesting characteristics of the solution, i.e., the velocity of solitons and the shift of crests of cnoidal waves along a soliton, are calculated. Solutions are classified into three types (Type-1A, Type-1B, Type-2) according to their apparent distinct properties.Comment: 11 pages, 5 figures, Contents change

Characterization of potential biomarkers of reactogenicity of licensed antiviral vaccines: randomized controlled clinical trials conducted by the BIOVACSAFE consortium

Funding text The authors are grateful for the vital contributions of the participating study volunteers, clinicians, nurses, and laboratory technicians at the Surrey study site. The work by Roberto Leone, laboratory technician at Humanitas Clinical and Research Center, is gratefully acknowledged. Finally, they thank Ellen Oe (GSK) for scientific writing assistance. The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n°115308, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and EFPIA companies’ in-kind contribution. The contribution of the European Commission to the Advanced Immunization Technologies (ADITEC) project (grant agreement n° 280873) is also gratefully acknowledged. Publisher Copyright: © 2019, The Author(s).Biomarkers predictive of inflammatory events post-vaccination could accelerate vaccine development. Within the BIOVACSAFE framework, we conducted three identically designed, placebo-controlled inpatient/outpatient clinical studies (NCT01765413/NCT01771354/NCT01771367). Six antiviral vaccination strategies were evaluated to generate training data-sets of pre-/post-vaccination vital signs, blood changes and whole-blood gene transcripts, and to identify putative biomarkers of early inflammation/reactogenicity that could guide the design of subsequent focused confirmatory studies. Healthy adults (N = 123; 20–21/group) received one immunization at Day (D)0. Alum-adjuvanted hepatitis B vaccine elicited vital signs and inflammatory (CRP/innate cells) responses that were similar between primed/naive vaccinees, and low-level gene responses. MF59-adjuvanted trivalent influenza vaccine (ATIV) induced distinct physiological (temperature/heart rate/reactogenicity) response-patterns not seen with non-adjuvanted TIV or with the other vaccines. ATIV also elicited robust early (D1) activation of IFN-related genes (associated with serum IP-10 levels) and innate-cell-related genes, and changes in monocyte/neutrophil/lymphocyte counts, while TIV elicited similar but lower responses. Due to viral replication kinetics, innate gene activation by live yellow-fever or varicella-zoster virus (YFV/VZV) vaccines was more suspended, with early IFN-associated responses in naïve YFV-vaccine recipients but not in primed VZV-vaccine recipients. Inflammatory responses (physiological/serum markers, innate-signaling transcripts) are therefore a function of the vaccine type/composition and presence/absence of immune memory. The data reported here have guided the design of confirmatory Phase IV trials using ATIV to provide tools to identify inflammatory or reactogenicity biomarkers.Peer reviewe

Who is to blame? The relationship between ingroup identification and relative deprivation is moderated by ingroup attributions

Contradictory evidence can be found in the literature about whether ingroup identification and perceived relative deprivation are positively or negatively related. Indeed, theoretical arguments can be made for both effects. It was proposed that the contradictory findings can be explained by considering a hitherto unstudied moderator: The extent to which deprivation is attributed to the ingroup. It was hypothesised that identification would only have a negative impact on deprivation, and that deprivation would only have a negative impact on identification, if ingroup attributions are high. To test this, attributions to the ingroup were experimentally manipulated among British student participants (N = 189) who were asked about their perceived deprivation vis-à-vis German students, yield ing support for the hypotheses