Although leadership of organizations rarely is discussed in terms of the religious construct of repentance, we propose that repentance and continuous improvement are closely related ideas that profoundly impact individuals and organizations. We identify six parallels between repentance and continuous improvement and then show how these parallels apply to the fundamental principles associated with highly regarded leadership perspectives. We conclude by identifying five contributions of the article to the management literature.

This empirical study reports the implementation and assessment of service learning in management education. Principles of Management students worked in teams to support Campus Kitchens, a national program affiliated with colleges and universities, in recovering surplus food and delivering it to community members. Student perceptions regarding civic engagement and social responsibility, application of skills, and professional development were assessed. Two complete cycles of implementation and assessment are chronicled. The sample size for Cycle 1 was 123 students and for Cycle 2 (...) the sample size was 91 students. The authors describe how empirical as well as anecdotal data drove the changes made to improve the service-learning experience. (shrink)

Understanding the components of clinical care that work best is a cornerstone of improving health care. And yet, the more we improve the quality of quality improvement and move to continuous learning about clinical care more broadly, the more we find ourselves in a regulatory environment that makes evaluation more difficult, expensive, and, in some situations, impossible. In their paper on the ethical underpinnings of the distinction between research and treatment, Ruth Faden and colleagues raise important implications for (...) a wide array of situations. These points give reason to rethink the definition of routine clinical operations to include evaluation of the processes and outcomes of care and dissemination of findings. We concur with the assertion by Faden and colleagues, and with previous work from The Hastings Center, that conducting continuous improvement activities such as these is an obligation of health systems and clinicians. We believe that rigorous, systematic evaluation should be considered part of normal, expected operations, rather than exceptional behavior that requires extraordinary regulatory control. (shrink)

The essay, ‘A renewed attempt to answer the question: “Is the human race continually improving?”’ appeared as Part II of Kant’s 1798 publication, The conflict of the faculties, where it was subordinated under a second title: ‘The conflict of the philosophy faculty with the faculty of law’. How did this new situation affects the meaning of the essay? My argument considers first, the conflict of the faculty of philosophy with the faculty of law; second, the earlier philosophy of history Kant (...) had developed; and, finally, the revision of this position in ‘A renewed attempt’. The situation of his argument in the contest between the philosophical and the legal faculties points to other veins of argumentation in Kant’s political theory, particularly his appeal to a principle of publicity, but they hardly achieve the theoretical clarity or the systematic centrality they should command. They are displaced in the quest for prediction of the future history of mankind. The question of human progress exceeds the frame of the coordination of the university, and the main question must remain: what was new in Kant’s approach to the question of human progress, and was it in fact an enhancement of his philosophy of history? In those terms, ‘A renewed attempt’ must be regarded a distinct failure. Its innovations prove problematic. Its retreats and equivocations, moreover, threaten to undermine the grander vision of Kant’s philosophical history and his political theory, entangling them in an unacceptably theological recourse.Keywords: Immanuel Kant; Philosophy of history; Progress; Publicity; Providence. (shrink)

Objective: To assess whether continuous consent, a process in which information is given to research participants at different stages in a trial, and clinician training in that process were effective when used by clinicians while gaining consent to the Total Body Hypothermia (TOBY) trial. The TOBY trial is a randomised controlled trial (RCT) investigating the use of whole-body cooling for neonates with evidence of perinatal asphyxia. Obtaining valid informed consent for the TOBY trial is difficult, but is a good (...) test of the effectiveness of continuous consent. Methods: Semistructured interviews were conducted with 30 sets of parents who consented to the TOBY trial and with 10 clinicians who sought it by the continuous consent process. Analysis was focused on the validity of parental consent based on the consent components of competence, information, understanding and voluntariness. Results: No marked problems with consent validity at the point of signature were observed in 19 of 27 (70%) couples. Problems were found mainly to lie with the competence and understanding of the parents: mothers, particularly, had problems with competence in the early stages of consent. Problems in understanding were primarily to do with side effects. Problems in both competence and understanding were observed to reduce markedly, particularly for mothers, in the post-signature phase, when further discussion took place. Randomisation was generally understood but unpopular. Information was not always given by clinicians in stages during the short period available before parents gave consent. Most clinicians, however, were able to give follow-up information. Discussion: Consent validity was found to compare favourably with similar trials examined in the Euricon study. Conclusion: Adopting the elements of the continuous consent process and clinician training in RCTs should be considered by researchers, particularly when they have concerns about the quality of consent they are likely to obtain by using a conventional process. (shrink)

Resumen. La presente investigación ofrece la oportunidad de pensar y dialogar sobre la estrategia, los objetivos, las personas y el futuro de la gestión municipal del H. Ayuntamiento de Navolato desde una perspectiva del conocimiento. Se trata pues de averiguar qué características deben cumplir esos recursos para adquirir un carácter estratégico. La información se obtuvo mediante una encuesta semiestructurada, aplicada a 181 individuos. Los datos recabados fueron objeto, en un principio, de dos tipos de tabulaciones. En algunos casos sólo se (...) efectúo una tabulación simple, que consistió en el conteo de una sola variable; en otros casos la tabulación fue cruzada contando dos o más variables de forma simultánea. Para el análisis de los datos se utilizó el programa de tratamiento de datos estadísticos SPSS versión 12 para Windows, que facilitó el tratamiento inferencial de los datos extraídos de la muestra seleccionada. El análisis de los resultados muestra que el Ayuntamiento presenta perfiles favorables para una gestión del conocimiento, óptima y eficaz, al alcanzar una puntuación total de 115, contando con una fortaleza estructural interna. Se concluye que las administraciones públicas no son ajenas a la sociedad del conocimiento, se están acomodando a estas nuevas exigencias, mejorando sus procesos para satisfacer las nuevas necesidades de los ciudadanos. Redefiniendo la función pública y el servicio público, a través de la búsqueda de mecanismos para conocer y medir el valor de la gestión del conocimiento, y así poder llevar a cabo una gestión eficiente y eficaz de estos recursos.Palabras Claves. Administración pública municipal, Gestión del conocimiento, Nueva Gestión Pública, Economía aplicada.. This research provides an opportunity to think and discuss the strategy, goals, people and future of municipal management of Navolato City knowledge perspective. It is about finding out what characteristics should meet those resources to acquire a strategic nature. The information was obtained through a semistructured survey applied to 181 individuals. The data collected were subjected, in principle, two types of tabs. In some cases only made a simple tabulation, which consisted of a single variable count, in other cases the cross tabulation was counting two or more variables simultaneously. For data analysis software was used for statistical data processing SPSS version 12 for Windows, which facilitated inferential treatment of the extracted data from the selected sample. The analysis of the results shows that the City has profiles favorable for knowledge management, optimal and efficient, to achieve a total score of 115, relying on internal structural strength. We conclude that public administrations are not foreign to the knowledge society, are arranging to these new demands by improving their processes to satisfy the new needs of citizens. Redefining the civil and public service, through the search for mechanisms to analyze and measure the value of knowledge management, and therefore be able to carry out a efficient and effective management of these resources.Keywords. Municipal public administration, knowledge management, new public management, applied economic. (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

Background Adherence to ethical guidelines and regulations and protecting and respecting the dignity and autonomy of participants by obtaining a valid informed consent form (ICF) prior to participation in research are crucial; The subjects did not add signatures next to the corrections made to signatures or dates on the ICF, Multiple signatures in other fields, ICF missing/missing signature, Incorrect ICF version Signed after modification, Correction tape used to correct signature, Impersonated signature, Non-research-member signature, however, ICFs are often not properly completed, (...) which must be addressed. This study analyzed ICF signing errors and implemented measures to reduce or prevent these errors. Methods We used the plan–do–check–act (PDCA) cycle to help improve the correctness and validity of ICF signing. Results Interim and final reports from January 2016 to February 2020 including 363 ICFs were studied. The total proportion of correct ICF signatures (200, 83.3%) following the PDCA intervention was significantly higher than that before the intervention (P < 0.05). Analysis of the types of signing error demonstrated that signature errors were significantly reduced after the intervention, particularly for subjects did not add signatures next to the corrections made to signatures or dates on the ICF (16, 6.7%) and impersonated signature (0; P < 0.05). Conclusions The proportions of other error types—multiple signatures in other fields, missing or unsigned ICF, incorrect signature order, incorrect ICF version, use of correction tape to correct signature, and non-medical profession members signing the ICF—did not differ significantly. (shrink)

In the chemical production process, the temperature of the continuous reactor has nonlinear characteristics such as large inertia. An improved autodisturbance control method is proposed. By improving the tracking differentiator with adjustable parameters, the expanded state observer and the control structure obtained an improved automatic disturbance rejection control model and realized the optimal control of the nonlinear and large-delay systems. On the process control training system, the experiment of the continuous system process flow is compared with the anti-interference (...) of the Smith predictive compensation system, which uses an optimal set of data. The reactor temperature fluctuates, but the self-resistance is improved. The optimal overshoot of the disturbance is close to 0. Compared with the original antidisturbance controller, the antidisturbance time is not affected by the number of iterations, which reduces the high requirements on the accuracy of the parameters. Therefore, the improved automatic disturbance rejection control improves the operation and enhances the ability to resist external disturbance that changes the controlled object. (shrink)

ObjectiveThis study aims to evaluate the effectiveness of the MotivAir program—a phone-based intervention based on Motivational Interviewing principles and techniques—in enhancing adherence to Continuous Positive Airway Pressure therapy among patients with Obstructive Sleep Apnea Syndrome.MethodsA multicenter randomized controlled trial design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A minimum (...) sample of 80 participants will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary and secondary outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation.DiscussionParticipants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition. (shrink)

Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide realtime feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. (...) The primary purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. (shrink)

One of the great achievements of Pierre Hadot has been to chart how philosophy's self‐conception has shifted over time, first as the culture of the classical world gave way to that of medieval Christianity, and then again through the long and gradual emergence of the modern age. Hadot himself suggests that the crucial shift came in the middle ages, as a result of the growing dominance of Christianity. The chapter argues that philosophy in both its classical and medieval incarnations has (...) consistently involved systematic logical inquiry of an abstract. Descartes’ philosophy is Janus‐faced, affording us frequent glances back to the tradition he grew out of, but also allowing glimpses forward to the modern age that his ideas helped to launch. (shrink)

The introduction of the ‘National Strategies’ for primary education in 1998, positioned ‘strategy’ as a powerful instrument for mobilising the school ‘workforce’ in England in the cause of continuous improvement. Government approaches to strategy formulation and enactment appear to reflect an instrumentalist orientation found in many mainstream strategic management publications. This paper reflects on how the strategic pursuit of quick, ‘spectacular’ gains may lead to the loss of ethics of care. Phenomenological insights into modes of being-in-the-world are drawn (...) upon to suggest that a preoccupation with strategy and its accompanying ‘toolkit’ of targets, standards and inspections diminishes a deeper engagement with the meaning and purpose of education. Based on Heidegger’s premise that understanding is at the core of being human, it is posited that the concern with ‘spectacular’ outputs is both superficial and potentially de-humanising. At the root of strategic thinking and the resulting forgetfulness of being is the Cartesian dogma and its dualistic (mis)understandings. (shrink)

Evaluators who are interested in developing or improving a program or policy frequently look to formative evaluation as a guiding framework.This book shows why those hoping to use evaluation to drive change in complex systems, rather than develop or improve one program, policy, or product, need to shift from the oversimplified idea of formative evaluation to a more specified continuous improvement model grounded in improvement science. In doing so, author Kristen L. Rohanna provides guidance to both evaluators (...) and others, such as K-12 educators or hospital administrators, who lead improvement initiatives in their organizations and seek to solve persistent problems of practice. The book includes an extended case study: a networked improvement community of five public middle and high schools. (shrink)

The principal goal of the brain-computer interface is to translate brain signals into meaningful commands to control external devices or neuroprostheses to restore lost functions of patients with severe motor disabilities. The invasive recording of brain signals involves numerous health issues. Therefore, BCIs based on non-invasive recording modalities such as electroencephalography are safer and more comfortable for the patients. The BCI requires reconstructing continuous movement parameters such as position or velocity for practical application of neuroprostheses. The BCI studies in (...) continuous decoding have extensively relied on extracting features from the amplitude of brain signals, whereas the brain connectivity features have rarely been explored. This study aims to investigate the feasibility of using phase-based connectivity features in decoding continuous hand movements from EEG signals. To this end, the EEG data were collected from seven healthy subjects performing a 2D center-out hand movement task in four orthogonal directions. The phase-locking value and magnitude-squared coherence are exploited as connectivity features along with multiple linear regression for decoding hand positions. A brute-force search approach is employed to find the best channel pairs for extracting features related to hand movements. The results reveal that the regression models based on PLV and MSC features achieve the average Pearson correlations of 0.43 ± 0.03 and 0.42 ± 0.06, respectively, between predicted and actual trajectories over all subjects. The delta and alpha band features have the most contribution in regression analysis. The results also demonstrate that both PLV and MSC decoding models lead to superior results on our data compared to two recently proposed feature extraction methods solely based on the amplitude or phase of recording signals. This study verifies the ability of PLV and MSC features in the continuous decoding of hand movements with linear regression. Thus, our findings suggest that extracting features based on brain connectivity can improve the accuracy of trajectory decoder BCIs. (shrink)

Exposure to environmental contextual changes, such as those occurring after an earthquake, requires individuals to learn novel routes around their environment, landmarks and spatial layout. In this study, we aimed to uncover whether contextual changes that occurred after the 2009 L’Aquila earthquake affected topographic memory in exposed survivors. We hypothesized that individuals exposed to environmental changes—individuals living in L’Aquila before, during and after the earthquake (hereafter called exposed participants, EPs)—improved their topographic memory skills compared with non-exposed participants (NEPs) who moved (...) to L’Aquila after the earthquake, as only EPs had to modify their previous cognitive map of L’Aquila. We also hypothesized that memory improvement was selective for the navigational space and did not generalize across other spatial and verbal domains. To test these hypotheses, we compared the topographic and spatial memory skills of 56 EPs without post-traumatic stress disorder (PTSD) symptoms to the skills of 47 NEPs using the Walking Corsi Test (WalCT; memory test in the navigational space) and the Corsi Block-Tapping Test (CBT; visuospatial memory test in the reaching space); EPs and NEPs were matched for gender, education and general navigational skills. A sub-group of participants also underwent the Rey-Auditory Verbal Learning Test (RAVLT; verbal memory test). The results showed that only EPs had better performances on topographic learning (TL) assessed using the WalCT rather than spatial learning assessed by the CBT. This outcome suggests the possibility that EPs specifically improved topographic memory. This effect may be due to continuous exposure to environmental changes that have required individuals to learn novel paths within the city and integrate novel information, such as “new towns,” into their pre-existing mental representation of the city. Implications and limitations of the study are discussed. (shrink)

The interocular suppression technique termed continuous flash suppression (CFS) has become an immensely popular tool for investigating visual processing outside of awareness. The emerging picture from studies using CFS is that extensive processing of a visual stimulus, including its semantic and affective content, occurs despite suppression from awareness of that stimulus by CFS. However, the current implementation of CFS in many studies examining processing outside of awareness has several drawbacks that may be improved upon for future studies using CFS. (...) In this paper, we address some of those shortcomings, particularly ones that affect the assessment of unawareness during CFS, and ones to do with the use of ‘visible’ conditions that are often included as a comparison to a CFS condition. We also discuss potential biases in stimulus processing as a result of spatial attention and feature-selective suppression. We suggest practical guidelines that minimize the effects of those limitations in using CFS to study visual processing outside of awareness. (shrink)

Some laws cannot yet be entirely abrogated in a current political situation, though permitting grave injustices against some individuals; for example, unborn and/or disabled individuals. In supporting the passing of new ‘imperfect’ laws that protect only some of those who now lack protection, do we ourselves discriminate unjustly against those remaining unprotected? Or does that depend on factors such as our intentions – including what we intend that others intend? How may we collaborate with colleagues who intend, and perhaps explicitly (...) defend, the continuation of remaining, closely-related injustices, although they are willing to join us in trying to improve some aspects of the status quo? This paper explores the moral constraints on our attempts to extend the law’s protection to some, but not to all, of those individuals currently deprived of such ­protection and at risk of serious harm. (shrink)

__Improvement in Action_, Anthony S. Bryk’s sequel to _Learning to Improve_, illustrates how educators have effectively applied the six core principles of continuous improvement in practice._ The book highlights relevant examples of rigorous, high-quality improvement work in districts, schools, and professional development networks across the country. The organizations featured in the book have addressed, with remarkable results, long-standing inequitable educational outcomes in high school graduation rates, college readiness, and absenteeism. The cases emphasize the measures the educators took (...) and the thinking that motivated their actions. Bryk describes how improvers, working in different contexts and confronting different problems, used select principles, tools, and methods to make improvement come to life. Brief analytic reflections are embedded throughout the narratives, and each chapter concludes with an analysis of a set of larger lessons illuminated by the organization’s story. Taken as a set, these examples offer readers valuable insights about the actual dynamics of doing improvement work. _Improvement in Action_, paired with _Learning to Improve_, provides readers with a comprehensive understanding of the practice, method, and theory of large-scale continuous improvement in education. (shrink)

The leading assumption of this paper is that we can improve the methodology of conceptual engineering if we differentiate between the different functions of our concepts. There is a growing body of research that emphasizes the revisionist virtues of conceptual engineering against the descriptive task of conceptual analysis. Yet, it also has faced severe critiques. Among the difficulties raised are the problems of conceptual identification and continuity. That is why several philosophers are trying to resolve these problems and improve the (...) methodology by calling attention, for example, to the functions that concepts can play. I follow this line of argument and argue that we can increase the chances of success if we also clarify and differentiate them. Identifying and assessing the relationship between functions will help us avoid confusion, inconsistencies, and possible verbal disputes. Doing this not only serves our theoretical and practical purposes but helps us reconsider the potentialities and limits of the conceptual engineering program. (shrink)

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 124.3 (2003) 493-496 [Access article in PDF] Piero Boitani. The Genius to Improve an Invention: Literary Transitions. Notre Dame: University of Notre Dame Press, 2002. xiv + 151 pp. Cloth, $35; paper, $18. This is an English-language revision of Boitani's Il genio di migliorare un'invenzione (Bologna 1999), which was itself originally composed in English; as Boitani engagingly puts it, "I do not quite know in (...) what language I am writing" (xiv). The book's "linguistic vicissitudes" are intriguingly appropriate to its topic, which is the (mostly) translingual commerce between literary texts in which the difference evident in imitation can be understood as an inspired "improvement." That terminology comes from Dryden's somewhat hangdog comment on the relative unoriginality of English writers: "the Genius of our Countrymen in general," he writes in the preface to his Fables, is "rather to improve an Invention, than to invent themselves" (cited by Boitani, 74). Boitani is more celebratory about the process in question, which he takes to be an important motor of both literary creation and literary history; "improvement" for him suggests "that species of literary transmission which comes somewhere between T. S. Eliot's notion of tradition and the individual talent and Harold Bloom's 'anxiety of influence.' 'Improving' means kicking against ancestorly traces... but it also means accepting our predecessors, taking them on in a nonbelligerent sense—indeed, positively loving them with filial devotion: a relationship which will inevitably be (as Bloom argues) Oedipal-Freudian but also a special one of affection and 'moving beyond'" (ix). This is not so much a theory as an enlightened disposition to give both piety and competitiveness their due in assessing authorial relations across gaps of time and language; most of the book's trim length is taken up with a series of handsomely mounted case studies.The central three chapters, all dealing with English engagements with classic Italian poetry, are, I think, the most rewarding. Boitani's inwardness with the Italian material gives the discussions a confidence and specificity—at times a passion—not often met with in anglophone scholarship on the subjects he takes up. Chaucer's recasting of Boccaccio's Filostrato as Troilus and Criseyde is in effect a stilnovist recasting, making the story truer to the spirit of Boccaccio's own Italian predecessors. In a passage of otherwise close translation from Filostrato, Chaucer substitutes his version of the incipit of a famous canzone of Guido Guinizelli's on the nature of love ("Al cor gentile rempaira sempre amore"; "In gentil hertes ay redy to repaire"). Boitani offers a brief but compelling reading of Guinizelli's poem itself, which seems to him "the fascinating dramatization of a whole culture" (53), and then traces Dante's involvement with it, most significantly in his portrait of Francesca in Inferno 5, where illicit love is treated with a compassion that readers continue to find surprising. The English Criseyde is, as it were, an extension of the same line of thought: "Chaucer seems to understand the analogies of Guinizelli's canzone and to interpret them as a sequence that sketches in a double—downward and upward—movement in a Dantean perspective. Francesca may yet lead to Beatrice" (68). Along the way [End Page 493] Dante is imagined saluting the work of his successor: "Well done, Dante would say, enough is kept, enough is changed. The invention is properly improved" (64). The result is a welcome if mostly implicit rebuke to the sterner, less romantic understandings of Chaucer's poem that have tended to dominate in the last several decades.In the chapter that gives its title to the book as a whole, a more linear sequence of revision is traced from Boccaccio's Teseida through Chaucer's Knight's Tale to Shakespeare's and Fletcher's Two Noble Kinsmen and Dryden's Palamon and Arcite. Within this succession, Shakespeare and Fletcher strain the outlines of Boitani's own model; they "have... not just 'improved' an 'invention.' They have radically revolutionized the story, and perhaps their 'anxiety of influence' toward Chaucer [in their... (shrink)

Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...) using the discourse and methodology of healthcare quality improvement. -/- Discussion: Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. -/- Conclusions: We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared (...) with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

On March 23rd, 2020, elite soccer academies in the UK closed in compliance with the government enforced lockdown intended to contain the COVID-19 pandemic. This forced parents, players, and coaches to reconsider how they interacted with, and supported, one another. The aims of the present study were to explore the perceptions of players, parents, and coaches regarding how they interacted and collaborated with one another during the COVID-19 pandemic to support wellbeing and performance, and; to identify opportunities to enhance workings (...) of those within the athletic triangle resulting from adaptions made following enforced lockdown. Using an interpretive description methodology, semi-structured interviews were conducted with five coaches, six players, and six parents from an English elite academy soccer club. Interviews were analyzed using thematic analysis. Findings highlighted the importance of support and the different means of communication used between members of the athletic triangle to facilitate such support; the increased understanding of each member of the athletic triangle, leading to enhanced relationships, and; how members of the athletic triangle adapted practice to facilitate relationship development during the pandemic and beyond. The identification of these considerations has implications for coach and parent education initiatives to allow for optimal functioning of the athletic triangle as elite academy soccer clubs return from lockdown. These include the importance of continued communication between coach, athlete and parent; increasing understanding of each individual within the athletic triangle; and utilizing key interpersonal and technological skills learnt during the lockdown to further facilitate engagement within the athletic triangle. (shrink)

The target and background will change continuously in the long-term tracking process, which brings great challenges to the accurate prediction of targets. The correlation filter algorithm based on manual features is difficult to meet the actual needs due to its limited feature representation ability. Thus, to improve the tracking performance and robustness, an improved hierarchical convolutional features model is proposed into a correlation filter framework for visual object tracking. First, the objective function is designed by lasso regression modeling, and a (...) sparse, time-series low-rank filter is learned to increase the interpretability of the model. Second, the features of the last layer and the second pool layer of the convolutional neural network are extracted to realize the target position prediction from coarse to fine. In addition, using the filters learned from the first frame and the current frame to calculate the response maps, respectively, the target position is obtained by finding the maximum response value in the response map. The filter model is updated only when these two maximum responses meet the threshold condition. The proposed tracker is evaluated by simulation analysis on TC-128/OTB2015 benchmarks including more than 100 video sequences. Extensive experiments demonstrate that the proposed tracker achieves competitive performance against state-of-the-art trackers. The distance precision rate and overlap success rate of the proposed algorithm on OTB2015 are 0.829 and 0.695, respectively. The proposed algorithm effectively solves the long-term object tracking problem in complex scenes. (shrink)

This paper addresses a question concerning psycho­logical continuity, i.e., which features preserve the same psychological subject over time; this is not the same question as the one concerning the necessary and sufficient conditions for personal identity. Marc Slors defends an account of psychological continuity that adds two features to Derek Parfit’s Relation R, namely narrativity and embodiment. Slors’s account is a significant improvement on Parfit’s, but still lacks an explicit acknowledgment of a third feature that I call relationality. Because (...) they are usually regarded as cases of radical discontinuity, I start my discussion from the experiences of psychological disruption undergone by victims of severe violence and trauma. As it turns out, the challenges we encounter in granting continuity to the experiences of violence and trauma victims are germane to those we encounter in granting continuity to the experiences of subjects in non-traumatic contexts. What is missing in the most popular accounts of psychological continuity is an explicit acknowledgment of the links that tie our psychological lives to other subjects. A more persuasive notion of psychological continuity is not only embodied and narrative, as is Slors’s notion, but also explicitly relational. (shrink)

Studying via the Internet using information tools is a common activity for students in higher education. With students accessing their subject material via the Internet, studies have shown that students have difficulty understanding the complete purpose of an assessment which leads to poor information search practices. The selection of relevant information for particular learning assessments is the topic of this paper as it describes a case study that focuses on the information tool use of a small group of participants and (...) is a continuation of similar research studies. The study and discussed research findings point to the benefit of students use of a visualisation tool to provide relevant learning cues and to transition to improved engagement with online assessment. (shrink)

The rule of Continuous Improvement is one of the pillars of the concept of Total Quality Management. It states that one should continuously seek the sources of arising problems and eliminate or minimize them. The article presents a method of implementing the concept of Corporate Social Responsibility based on the above rule and afterwards it identifies the most important advantages of using the rule. The article also stresses its usefulness in the area of Small and Medium-sized Companies.

BackgroundResearch Ethics Boards, or Institutional Review Boards, protect the safety and welfare of human research participants. These bodies are responsible for providing an independent evaluation of proposed research studies, ultimately ensuring that the research does not proceed unless standards and regulations are met.Main bodyConcurrent with the growing volume of human participant research, the workload and responsibilities of Research Ethics Boards (REBs) have continued to increase. Dissatisfaction with the review process, particularly the time interval from submission to decision, is common within (...) the research community, but there has been little systematic effort to examine REB processes that may contribute to inefficiencies. We offer a model illustrating REB workflow, stakeholders, and accountabilities.ConclusionBetter understanding of the components of the research ethics review will allow performance targets to be set, problems identified, and solutions developed, ultimately improving the process. (shrink)

With the continuous development and improvement of Internet media technologies in China, the influence of livestream e-commerce is becoming increasingly prominent, and an increasing number of people are engaging in consumption activities in this field. It is important to study consumer stickiness in livestream e-commerce to promote economic structure adjustment and innovation-driven development. Therefore, in this study, we adopted the expectation confirmation theory as the theoretical framework and analyzed the ECT and stickiness. The study considered satisfaction as the (...) previous influencing factor of user and consumer stickiness, replaced the continuance intention in the expectation confirmation model with consumer stickiness as the explanatory variable, introduced the variable of perceived playfulness as the value perception after user experience, and established a consumer stickiness factors model. A total of 262 valid questionnaires were collected in this study, and SmartPLS analysis along with interviews were used to justify the limitations of data analysis. The results of the study demonstrated a significant effect of perceived usefulness and confirmation on satisfaction, a significant effect of confirmation on perceived usefulness, a significant effect of satisfaction on stickiness, and a significant effect of confirmation on perceived playfulness. Based on findings from the data analysis and interviews, we further proposed rationalized recommendations, and aimed to provide some theoretical guidance for future research on live streaming. (shrink)

This paper proposes the modified generalization of the HSS to solve a large and sparse continuous Sylvester equation, improving the efficiency and robustness. The analysis shows that the MGHSS converges to the unique solution of AX + XB = C unconditionally. We also propose an inexact variant of the MGHSS and prove its convergence under certain conditions. Numerical experiments verify the efficiency of the proposed methods.

On average, women make up half of introductory-level philosophy courses, but only one-third of upper-division courses. We contribute to the growing literature on this problem by reporting the striking results of our study at the University of Oklahoma. We found that two attitudes are especially strong predictors of whether women are likely to continue in philosophy: feeling similar to the kinds of people who become philosophers, and enjoying philosophical puzzles and issues. In a regression analysis, they account for 63% of (...) variance. Importantly, women are significantly less likely to hold these attitudes than men. Thus, instructors who care about improving the retention of women undergraduates should find ways to improve these attitudes – for instance, by demonstrating the ways in which professional philosophers are like them. We will discuss some tentative but intuitively plausible suggestions for interventions, though further research is required to establish the effectiveness of those interventions. (shrink)

Contemporary education now appears to be dominated by the continual drive for improvement measured against the assessment of what students have learned. It is our contention that a foundational relation with assessment organises contemporary education. Here we draw on a 'way of thinking' that is deconstructive in its intent. Such thinking makes clear the vicious circularity of the argument for improvement, wherein assessment valorised in discourses of improvement provides not only a rationalisation for improvement via assessment, (...) but also the very means of achieving such possibilities via targets grounded in limited specifications of assessment. On reading Heidegger's 'question concerning technology' we sought to reconsider the vicious circle of improvement in relation to Being. We claim that the means-ends driven technology of assessment, rather than being at our disposal and under our control, only serves to reveals the Real to us in accordance with the restricting principle of reason. The principle of reason, we argue, grounds 'Enframing' that ranks and orders the very beings of education as objects to produce an objective 'world as picture', rather than opening the possibility of their identity as belongings with a movement of difference. So, 'improvement' becomes normative and binding for institutions and practices on grounds of the principle of assessment, and renders agents of education as functionaries of 'Enframing'. (shrink)

Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account (...) for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny. (shrink)

This paper implements the continuous Hindi Automatic Speech Recognition (ASR) system using the proposed integrated features vector with Recurrent Neural Network (RNN) based Language Modeling (LM). The proposed system also implements the speaker adaptation using Maximum-Likelihood Linear Regression (MLLR) and Constrained Maximum likelihood Linear Regression (C-MLLR). This system is discriminatively trained by Maximum Mutual Information (MMI) and Minimum Phone Error (MPE) techniques with 256 Gaussian mixture per Hidden Markov Model(HMM) state. The training of the baseline system has been done (...) using a phonetically rich Hindi dataset. The results show that discriminative training enhances the baseline system performance by up to 3%. Further improvement of ~7% has been recorded by applying RNN LM. The proposed Hindi ASR system shows significant performance improvement over other current state-of-the-art techniques. (shrink)

The process of continuing education of paramedics is based on gaining educational credits during five-year educational periods. One of the forms of self-improvement are Internet-based educational programs. The lack of regulations concerning the organizational and technical aspects of e-learning made the authors attempt to analyze the phenomenon. The aim of the article is to present an initial analysis of the role of online educational programs in comparison with other forms of professional training of paramedics. One in three respondents has (...) recently used one of the methods of distance learning. Despite the low awareness of the effectiveness of e-learning, almost 70% of the interviewees expressed a positive opinion about it and over 50% were willing to use such forms in the future. The respondents preferred online trainings in the asynchronous version, containing audio-visual materials and providing the possibility to obtain a certificate issued to the participant after completing the course. The demand for topics in the area of professional training included mainly the fields of Drug Therapy, electrotherapy, electrocardiogram evaluation, medical segregation, and help in delivery in pre-hospital conditions. Modern forms of distance learning do not make it possible to acquire practical skills, yet their role in professional training of paramedics is still significant. According to the authors, online educational programs constitute an effective complement to traditional training through the performance of tasks in a mixed form, known as blended-learning. (shrink)

A great need for systematic evaluation of ethics training programs exists. Those tasked with developing an ethics training program may be quick to dismiss the value of training evaluation in continuous process improvement. In the present effort, we use a case study approach to delineate how to leverage formative and summative evaluation measures to create a high-quality ethics education program. With regard to formative evaluation, information bearing on trainee reactions, qualitative data from the comments of trainees, in addition (...) to empirical findings, can ensure that the training program operates smoothly. Regarding summative evaluation, measures examining trainee cognition, behavior, and organization-level results provide information about how much trainees have changed as a result of taking the ethics training. The implications of effective training program evaluation are discussed. (shrink)

The development of action and perception, and their relation in infancy is a central research area in socio-cognitive sciences. In this Perspective Article, we focus on the developmental variability and continuity of action and perception. At group level, these skills have been shown to consistently improve with age. We would like to raise awareness for the issue that, at individual level, development might be subject to more variable changes. We present data from a longitudinal study on the perception and production (...) of contralateral reaching skills of infants aged 7, 8, 9, and 12 months. Our findings suggest that individual development does not increase linearly for action or for perception, but instead changes dynamically. These non-continuous changes substantially affect the relation between action and perception at each measuring point and the respective direction of causality. This suggests that research on the development of action and perception and their interrelations needs to take into account individual variability and continuity more progressively. (shrink)

The translational research community, in general, and the Clinical and Translational Science Awards (CTSA) community, in particular, share the vision of repurposing EHRs for research that will improve the quality of clinical practice. Many members of these communities are also aware that electronic health records (EHRs) suffer limitations of data becoming poorly structured, biased, and unusable out of original context. This creates obstacles to the continuity of care, utility, quality improvement, and translational research. Analogous limitations to sharing objective data (...) in other areas of the natural sciences have been successfully overcome by developing and using common ontologies. This White Paper presents the authors’ rationale for the use of ontologies with computable semantics for the improvement of clinical data quality and EHR usability formulated for researchers with a stake in clinical and translational science and who are advocates for the use of information technology in medicine but at the same time are concerned by current major shortfalls. This White Paper outlines pitfalls, opportunities, and solutions and recommends increased investment in research and development of ontologies with computable semantics for a new generation of EHRs. (shrink)