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A high-reliability organization must have high-performing teams. Core teams in healthcare should include the patient and, where possible, the patient's family. Everyone on the team should understand what is expected of them in terms of expertise, leadership, communication, mutual support, and awareness of the situation. One test of the excellence of a clinical team is having high-quality handoffs of patients.

Background In the UK, Core Surgical Training (CST) marks the start of a surgical career, but previous experience and skills vary widely. Whilst Individual hospital Trusts offer local inductions, these are generally of a generic, administrative nature rather than advising trainees on how best to harness training opportunities. We designed a regional induction programme, ‘Building Excellence in Surgical Training’ (BEST) to address this, develop essential technical and non-technical skills, and engender support networks. Methods All incoming London Core Surgical Trainees (annual cohort size 90) were invited to participate, during the week prior to commencement of training. Trainees undertook 3 modules (portfolio, surgical skills and human factors-based simulation) and a research paper presentation day. We collected qualitative and quantitative data through a structured evaluation form, pre and post course Likert-scale scores and self-assessment utilising the non-technical skills for surgeons (NOTSS) framework. Results 972 CSTs have completed BEST over the past 12 years. In 2019, significant improvements were seen in: confidence for starting CST, 45% (n = 22/49)-83% (n = 33/40,p = 0.00045); feeling the core programme cared about them, 55% (n = 27/49)-98% (n = 41/42, p = Conclusion BEST equips trainees with the fundamental skills and confidence to safely embark on surgical training and provides tools to navigate the challenges training presents. The ethos of collaboration and support will aid the development of more resilient and empowered surgeons, vital in this era.

Background Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the National Heart, Lung and Blood Institute and the National Cancer Institute being 25.1% and 11.3%, respectively. The Thoracic Surgery Foundation (TSF), which is an arm of The Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer-reviewed funding. The aim of this study was to assess the impact of these awards. Methods Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed by using Scopus , MEDLINE, and Google Scholar for publications, citations, and h-index. The National Institutes of Health (NIH) RePorter and the Federal RePorter were used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a 4-year window from the time of the research award was used. Results Fifty-two research awards were given to early career faculty during this study period, and 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty members were awarded 27 (52%) awards, and general thoracic faculty members were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period after the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range [IQR], 12 to 36), with a median citation count of 147 (IQR, 32 to 327). The current median h-index was 26 (IQR, 15 to 36), with 2323 (IQR, 1173 to 4568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant; 40.4% of these awardees received grants from the NIH, and 25% had 2 or more NIH grants. Comparing academic position at the time of the award with current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors. Conclusions Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.

At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing-and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission.

The enrollment of students from African Region has increased in India in the last decade. It has expanded to 22 African countries and across the climatic zones of Africa. This study, delineates climatic adaptations of African students in Indian conditions. Studies have significantly indicated about the role of climatic conditions and adaptations on educational outcomes at higher education level. Besides the social and academic challenges of studying in countries other than home countries climatic adaptations have been one of several struggles students face while studying professional courses with long study hours, group projects and site visits for practical understandings. With the help of focus group discussion and qualitative interviews of selected group of students studying in universities of National Capital Region of India, and feedbacks from the faculty and peer group a comprehensive framework of the study has been developed to assess the challenges in climatic adaptation for international students. This study also demonstrate some of the implications of climatic adaptation in terms of increase in frequency of visiting health care centers, additional financial burden and pursuit of academic excellence through study abroad. With the help of persons responsible for management of international student affairs, this study acknowledges and makes suggestion on some of the institutional preparedness for supporting international students joining respective organizations to pursue their dream courses in higher education institutions.

Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. Research to improve diagnosis in critical care medicine has accelerated in past years. However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.

The mining industry spends a lot of blasting, explosives, and the safe implementation of blasting practices. Surface mines account for about 90% of the country’s overall production. The blasting process is necessary for the occurrence of disintegration and the displacement of the fragmented rock. The explosive energy helps in moving the rock mass, whereas a great part of it is consumed in the generation of flyrock, ground vibrations, noise and air blasts, which are highly undesirable. Flyrock contributes about 68% of total injuries worldwide. Flyrock, also known as rock throw is the uncontrolled driving of rock wastes produced in blasting and founds one of the key causes of material damage and harm to people. Since flyrock is considered a critical issue of mining, it becomes necessary to study the parameters for flyrock generation and its mitigation measures. The present work emphasizes various causes of flyrock, precautions in dealing with flyrock, and various models used for the prediction of throws. The three models used in this report include Lundborg Prediction Model, General Trajectory Throw, and Workman and Scaled Burden Approach. Further, the Python program compares the accuracy of these various prediction models by taking the inputs, which include different blast specifications. Those predictions compared with the pre-existing Mine Excellence flyrock Predictor software.

This study aims to investigate and deliberates the relationship between Organizational Learning Mechanisms, strategic agility, and organizational excellence in Employees of Kafrelsheikh University. Moreover, it examined the effect of strategic agility as a moderator of this relationship between Organizational Learning Mechanisms and organizational excellence. A total of 325 questionnaires were collected from respondents who were chosen from a stratified random sampling. The findings indicate that Organizational Learning Mechanisms and its dimensions, Knowledge recognition mechanisms, Knowledge assimilation mechanisms, and Knowledge exploitation mechanisms have a significant impact on strategic agility as well as organizational excellence. Moreover, the results indicate that strategic agility partial mediates the relationship between Organizational Learning Mechanisms and organizational excellence. The findings of this study can have significant implications for Employees of Kafrelsheikh University. The study observes that there is a critical shortage of Strategic Agility, Organizational Learning Mechanisms and that a greater understanding of the factors that influence the Organizational Excellence is needed, Therefore, Organizational Learning Mechanisms can lead to Organizational Excellence and Strategic Agility.

The features of a holistic view in an organization create the data value of the Business Intelligence (BI) and Knowledge Management (KM) in viewing the big picture of organizational performance diagnostics framework. This research focuses on the specific features of railway supply chain performance in viewing the decision-making process and creating better knowledge formation. The intention of the study is to structure supplier performance using BI-KM framework development to determine holistic perspective factors. The outcomes indicate that BI and KM significantly increased the railway supply chain and significantly increased the information system. This BI-KM framework relates the current analytic characteristics in designing the railway supply chain towards information system in determining the strategic theme of the decision-making process of the decision support system together with system features, characteristics of data, the content of the themes, and the effect of the decision-making process and for executive strategic performance diagnostics tool that provides effective strategic decision making in supply chain performance. The quantitative research method uses SmartPLS software version 3.2.8 for empirical analysis through distributing survey questionnaires to 320 railway suppliers in Malaysia. Using a model-driven development framework, to measure the implementation success of the decision support system, the study is conducted in the railway supplier focusing on strategic management that helps to make the decision and facilitate the organizational success.

Introduction:: The transformation happening globally, though referred by different names and nomenclatures, the overall objective to inspire digitalization and smart practices by reducing human intervention and enhancing machines intelligent to take on the global manufacturing and production to another level of excellence is a proven fact now. However, earlier research has been found, lacking in the strategic approach to evaluate and analyze the I4.0 adoption related risks for its implementation. This ultimately deprived organizations of multitude of the benefits of I4.0 adoption. Objective:: This research proposes a systematic methodology for understanding and evaluating the most evident risks in the context of I4.0 implementation. Method:: The research is mainly based on the inputs from experts/consultants along with robust literature review and researcher’s experience in the area of risks handling. The MCDM methods used for investigation and assessment are Fuzzy AHP and Fuzzy TOPSIS. The outcomes of the study are further validated through sensitivity analysis and real world scenario. Results:: Technical and Information Technology (IT) risks are found to be on the top of the priority list, which needs urgent attention while embarking on I4.0 adoption in the industry and the most important criteria, which needed urgent attention was, Information Security. The paper has also developed the ‘Industry 4.0 Risks Iceberg model’ and systematicaly categoried the challenges into 5 dimensions for easy assessment and analysis. Discussion:: The transformation happening globally, though referred by different names and nomenclatures, the overall objective to inspire digitalization and smart practices by reducing human intervention and enhancing machines intelligent to take on the global manufacturing and production to another level of excellence is a proven fact now. However, earlier research has been found, lacking in the strategic approach to evaluate and analyze the I4.0 adoption related risks for its implementation. This ultimately deprived organizations of multitude of the benefits of I4.0 adoption. Conclusions:: This systematic and holistic study of the I4.0 associated risks can be used to find the most critical and crucial risks based on which the strategies and policies may be modified to harness the best of I4.0. This will not only ensure the returns on investment but also will build the trust in the system. The research would be very beneficial to managers, academicians, researchers and technocrats who would be involved in I4.0 implementation.

The COVID-19 pandemic has prompted educators to rethink educational practices, especially with regard to technology. The COVID-19 pandemic is a huge challenge to education systems around the world. This Viewpoint offers guidance to teachers, institutional heads, and officials on addressing the crisis. This study investigated technology use in teaching during the COVID-19 lockdown in Malaysia, focusing on technology-based teaching methods, modifications necessitated by this new teaching style, and challenges teachers faced when using technology. Using purposive sampling, a qualitative study was undertaken with a sample of 10 English language teachers from Arabic schools in Malaysia. The results indicated that a digital leap occurred in education during the COVID-19 lockdown because teachers had to quickly adapt to a more technology-based teaching style. The challenges teachers faced included managing virtual classes, ensuring reliable Internet connections, overcoming a lack of preparedness and low digital competence, and dealing with students' mental health. Such changes in teaching methods have created new roles for teachers while also increasing their acceptance of e-learning and remote learning. The contribution of this research is to provide a holistic picture of remote education activities during the pandemic period to establish a linkage between the online teaching-learning process during the COVID-19 outbreak as to ensure the resumption of teaching-learning education as a normal course of procedure in the education system. Despite the human suffering brought by the pandemic, the new norms of education during COVID-19 generally have some pockets of excellence to drive the education into the Fourth Industrial Revolution. © 2021 Tech Science Press. All rights reserved.

To succeed in the conduct of clinical trials in reproductive medicine, teams must be trained and cultivated to collaborate and achieve a common goal. Here I share my personal experiences and lessons learned in teaming in the research setting by covering topics in time management, resource allocation, collaboration, publishing, and communication.

Team service innovation contributes to team service excellence and customer satisfaction in the hospitality industry. Nevertheless, mechanisms behind team service innovation have been rarely explored. This study aims to develop a team-level model of mediating and moderating mechanisms behind the relationship between team-focused transformational leadership (TFL) and team service innovation. Data were collected from 683 team members and their 114 team leaders of 67 hospitality organisations located in China. Multilevel structural equation modelling (MSEM) and latent moderated structural equation modelling (LMS) were utilised to validate the research model. Results revealed that team-focused TFL fostered team service innovation via the mediating role of developmental culture. Group extraversion diversity strengthened the relationship between team-focused TFL and team service innovation, such that the relationship was strengthened only under higher but not lower levels of group extraversion diversity. In light of research findings, theoretical and practical implications are drawn.

Every government's major objective is to provide the greatest services in order to establish efficiency and quality of performance. Syria's government has understood how critical it is to go in the direction of information technology. However, there are gaps and poor links across government sectors, which has tainted the image of Syrian e-governance. As a result, one of the main aims of this study is to figure out what factors impact Syrians' acceptance of the e-government system. A total of 600 questionnaires were delivered to Syrian individuals as part of a survey. The data was analysed using the structural equation model (SEM) using AMOS version 21.0. User intention to utilise an e-government system was shown to be influenced by performance expectations, effort expectations, system flexibility, citizens-centricity, and facilitating conditions. Assurance, responsiveness, reliability, tangibles, and empathy are five fundamental factors that have a major impact on government operation excellence. Behavioural Intention is being utilised as a mediator between the government operation excellence (GOE) initiative and the e-government platform.

Background Anxiety disorders are the most common mental disorders, for which some countries and organizations have developed guidelines. It is necessary to understand the quality of these guidelines. Methods The relevant guidelines were searched systematically by five reviewers using Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE Recommendation Excellence (AGREE-REX) instruments. The scores in each domain were descriptively analyzed, and guidelines from different countries were compared. Results Seventeen guidelines were included. The scores in the domains “rigor of development” and “applicability” were the lowest and ranged from 16% to 77% and 25% to 71%, respectively. The scores in the domains “implementability” and “values and preferences” were similar and ranged from 30% to 67% and 25% to 77%. In terms of the comparison among countries, the Canadian guidelines achieved the highest scores in many domains but only scored 43% in the domain of “values and preferences”. The Indian guidelines scored less than 50% in many domains but achieved a high score of 83% in the domain “scope and purpose”. Limitations Language restrictions may cause selection bias. Besides, insufficient reports may lead to deviation of assessment results. Conclusions There was no obvious advantage in guidelines from different countries. There was still a lot of room for improvement in some domains, especially “applicability”, “implementability”, “rigor of development” and “values and preferences”.

Global health education programs should strive continually to improve the quality of education, increase access, create communities that foster excellence in global health practices, and ensure sustainability. The COVID-19 pandemic forced the University of Minnesota’s extensive global health education programs, which includes a decade of hybrid online and in-person programing, to move completely online. We share our experience, a working framework for evaluating global health educational programming, and lessons learned. Over the decades we have moved from a predominantly passive, lecture-based, in-person course to a hybrid online (passive) course with an intensive hands-on 2-week requirement. The pandemic forced us to explore new active online learning models. We retained our on-demand, online passive didactics, which used experts’ time efficiently and was widely accessible and well received. In addition, we developed a highly effective synchronous online component that we felt replaced some of the hands-on activities effectively and led us to develop new and innovative “hands-on” experiences. This new, fully online model combining quality asynchronous and synchronous learning provided many unanticipated advantages, such as increasing access while decreasing our carbon footprint dramatically. By sharing our experience, lessons learned, and resources, we hope to inspire other programs likewise to innovate to improve quality, access, community, and sustainability in global health, especially if these innovations can help decrease negative aspects of global health education such as its environmental impact.

The purpose of this study was to identify the academic quality assurance practices that should be employed to attain teaching excellence at selected private higher education institutions in the city of Jeddah, Saudi Arabia. The study adopted a qualitative interpretive research design and utilized one-to-one, in-depth, semi-structured interviews with 12 participants. The sample was purposefully selected and comprised six faculty members, four program directors, one senior academic staff member, and one junior non-academic administrator, from three private higher education institutions in the Kingdom of Saudi Arabia. Findings revealed four categories of practices: a) Must-keep practices, b) Must-modify practices, c) Must-add practices, and d) Must-avoid practices. Some of the practices relating to quality assurance that the study identified are maintaining important evaluation-related practices while providing feedback for improvement, closing the loop, educating all employees about and increasing their reengagement in quality assurance practice, and reducing paperwork and work duplication. This study concludes by recommending that higher education institutions employ the strategies discussed in the findings to promote teaching creativity and to improve the quality of teaching and learning, to achieve teaching excellence. https://doi.org/10.26803/ijlter.20.11.13

Introduction Physical activity is recommended for healthy pregnant women. Clinical practice guidelines vary with regard to initial time, duration, or type of physical activity that is recommended, which is confusing for health care professionals and pregnant women alike. This study aimed to appraise clinical guidelines relevant to physical activity for pregnant women and summarize consensus and discrepant recommendations. Methods The websites of organizations that develop guidelines including those of obstetricians, gynecologists, midwives, and medical sports associations were searched in addition to 9 literature databases for the period from January 2010 through November 2020. Guidelines were included if they were published in a journal or on a website in English or Chinese; were labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for pregnant women. Two authors independently extracted recommendations. Four reviewers independently assessed guideline quality using the AGREE II instrument. Results Thirteen guidelines met the inclusion criteria. The guidelines developed by the World Health Organization and the National Institute for Health and Clinical Excellence were deemed to have the highest methodological quality. The recommendations were consistent with regard to recommended exercise duration, frequency, intensity, and type of physical activity. The main discrepant recommendations included best tools for conducting pre-exercise screening and assessing intensity of exertion. Guidelines also differ on optimal heart rate during exercise, when in pregnancy to initiate an exercise regimen, and duration or frequency of strengthening exercises. Discussion Of the 13 guidelines, 2 were found to have good methodological quality. The recommendations that were consistent across the differing guidelines can support health care providers in counseling women about physical activity during pregnancy. The recommendations that are discrepant among these guidelines may contribute to confusion and a reluctance to recommend exercise during pregnancy. Research is needed to clarify discrepant recommendations.

Nowadays, the automotive industries seek to consider increasingly higher standards of competitiveness. This sector is looking for a proper management methodology to solve a given problem in its kind of organization. In this sense, continuous improvement is essential for any business environment, due to provide conditions for getting excellence levels. Based on this strategy, the Lean Six Sigma (LSS) appears as an option to be applied. Although Lean was originated in the automotive industry, systematic review about Lean Six Sigma in this industry has a lack of research, considering tools and aspects within metrics. For that, the objective of this work is to carry out a literature review on the implementation of Lean Six Sigma in the automotive industry. The databases adopted for this research were Web of Science and Google Scholar, resulting in 69 selected articles. The results indicated that the implementation of this methodology contributes to the continuous improvement process and problem-solving in the automotive branch.

Purpose The application of lean thinking in the transportation industry provides opportunities to streamline operations with a value-added orientation. Prior literature shows evidence of limited application of lean thinking in the transportation operations of the pharmaceutical industry. This study aims to close this research gap by investigating the application of lean thinking for improving pharmaceutical transportation performance. Design/methodology/approach This study conducted an action research approach at an Indonesian pharmaceutical distribution company. One cycle in one year was analyzed; empirical data were collected and analyzed through direct observations, interviews and the study of company data and documentation. Findings The application of lean thinking in waste elimination allowed the delivered project to achieve a remarkable 40% reduction in overall transportation costs, 75% reduction in total lead time, 200% improvement in truck productivity and 100% improvement in truckload capacity utilization. Practical implications This study can guide the pharmaceutical industry toward achieving excellence in transportation operations through lean thinking implementation. Originality/value There has been limited research on this topic, and this study is the first attempt to generate new and significant evidence of a real-life application of lean thinking within the field of pharmaceutical transportation.

Nurses in advanced practice roles have existed in Canada for over 100 years, yet only in the last two decades, have nurse practitioners (NPs) been recognized as advanced practice nurses (APNs). During this time, NP educational programs have increased and transitioned from post-baccalaureate level to graduate level. Legislation and national NP regulatory approval processes have contributed to existing barriers to NP role implementation and full scope of practice. While regulation is mandatory and focused on public safety, an emphasis towards quality has led to the introduction of a national voluntary NP program accreditation process. The purpose of this paper is to initiate a discussion between Canadian NP regulators and educators related to proposed regulatory approaches and accreditation processes that balance public safety while promoting quality and excellence in NP education. Having two separate and costly processes has led to tension during a time of provincial fiscal restraint on university budgets coupled with the COVID-19 pandemic and its impact on nursing education. An integrated pan-Canadian approach of regulation and accreditation may ensure public safety, continuity, and consistency in quality NP education, enhance mobility of the NP workforce, and systematic planning to guide successful future NP role development and practice.

In 1982 Dean Warren delivered the presidential address “Not for the Profession… For the People” in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. “for the people”. By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. “For the People and the Profession”.

Purpose of the ReviewThis article aims to provide an update on the designation of stroke centers, neurointerventionalist demand, and cost-effectiveness of stroke thrombectomy in the United States.Recent FindingsThere are now more than 1,660 stroke centers certified by national accrediting bodies in the United States, 306 of which are designated as thrombectomy-capable or comprehensive stroke centers. Considering the amount of nationally certified centers and the number of patients with acute stroke eligible for thrombectomy, each center would be responsible for 64 to 104 thrombectomies per year. As a result, there is a growing demand placed on neurointerventionalists, who have the ability to alter the trajectory of large vessel occlusive strokes. Numbers needed to achieve functional independence after stroke thrombectomy at 90 days range from 3.2 to 7.4 patients in the early time window and 2.8 to 3.6 patients in the extended time window in appropriately selected candidates. With the low number needed to treat, in a variety of valued-based calculations and cost-effectiveness analyses, stroke thrombectomy has proved to be both clinically effective and cost-effective.SummaryAdvancements in the early recognition and treatment of stroke have been paralleled by a remodeling of health care systems to ensure best practices in a timely manner. Stroke center–accrediting bodies provide oversight to safeguard these standards. As successful trial data from high volume centers transform into real-world experience, we must continue to re-evaluate cost-effectiveness, strike a balance between sufficient case volumes to maintain clinical excellence vs the burden and burnout associated with call responsibilities, and improve access to care for all.

The study aimed to analyze the impact of entrepreneurial orientation in achieving organizational excellence through strategic flexibility. This research is a quantitative study. The population of this study consists of all managers in the upper and middle management at the Jordanian Commercial Banks. The study conducted a comprehensive survey, by using its population as a sample, which totals 1023 managers. The data collection tool is a questionnaire that consists of 29 items was developed. The results show that the level of availability of entrepreneurial orientation, organizational excellence, and strategic flexibility has reached a high degree at Jordanian Commercial Banks. Other findings show that entrepreneurial orientation in its combined dimensions (innovative entrepreneurial orientation, proactive entrepreneurial orientation, and risk-taking entrepreneurial orientation) has a statistically significant impact on achieving organizational excellence through strategic flexibility in Jordanian commercial banks. From the findings, the authors conclude that strategic flexibility plays a partial mediating role between entrepreneurial orientation (with all its dimensions) and organizational excellence. At the same time, strategic flexibility fails to play a mediator role between entrepreneurial orientation dimensions and organizational excellence.Keywords: Entrepreneurial Orientation, Organizational Excellence, Strategic Flexibility, Commercial Banks, Jordan.JEL Classifications: L1, L2, M1DOI: https://doi.org/10.32479/irmm.12520

Background Since summer 2014, the National MCH Workforce Development Center has placed students from MCH public health graduate (Centers of Excellence and Catalyst) and undergraduate (MCH Pipeline) programs, all funded by the Maternal and Child Health Bureau, in summer internships with state and territorial Title V agencies. In 2020, due to the COVID-19 pandemic the Title V MCH Internship Program was offered virtually. Participants and Methods This manuscript includes quantitative and qualitative data from 2017 to 2020 generated by both Title V MCH Internship student interns (n = 76) and their preceptors (n = 40) with a focus on a comparison between the 2020 virtual year and the 2017–2019 years. Results Evaluation data from the 2017 to 2020 Title V MCH Internship Program from both students and preceptors revealed the implementation of a robust and successful internship program in which students increased their confidence in a variety of team, mentorship, and leadership skills while gaining direct exposure to the daily work of state Title V agencies. However, students and preceptors identified more challenges during 2020 compared to previous years. Conclusions The COVID-19 Pandemic was both a disruption and a catalyst for change in education. While there were clearly some challenges with the pivot to a virtual Title V MCH Internship Program in summer 2020, students were able to participate in meaningful internship experiences. This success can be attributed to the ability of the internship sponsor to engage in best practices, including extensive planning and provision of ongoing support to the students. Going forward, it is recognized that virtual internships may facilitate access to agencies in distant locales, eliminating issues related to housing and transportation. When both virtual and in-person relationships are available, those responsible for internship programs, including the Title V MCH Internship, will need to weigh these type of benefits against the potential missed opportunities students may have when not able to participate in on-site experiences.

The Kingdom of Saudi Arabia has realized that education is one of the pillars of developed countries that seek leadership and excellence. Paying attention to it has become an imperative for societies that wish to be in the ranks of nations. The paper described the development of early childhood education (ECE) in the Kingdom of Saudi Arabia. This paper outlined the components of the educational system, the objectives of the kindergarten, the curriculum, and daily activities. In 2016, the kingdom directed its attention to education through Vision 2030 to make it a main axis and pillar in order to give an important message that early childhood education must be developed. Therefore, we saw the importance of highlighting the 2030 vision in education (especially early childhood education) and the recent developments and achievements in this sector made since the launch of Saudi Vision 2030.

The diversity bonus theorem developed by Scott Page postulates that in specific environments, diversity is an absolute necessity to creating the most successful team. The theorem dispels the myth that institutions must choose between diversity and excellence. Within oral and maxillofacial surgery, this bonus is captured through expanded access to care, more equitable and relevant research, and attracting the best and brightest to the specialty. To capture the bonus, oral and maxillofacial surgery must invest in policy changes to admissions and hiring practices, and offer training in communication, cultural competency, and implicit bias.

LAY SUMMARY In 2020, the Canadian Federal Government launched the Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE). A higher proportion of Veterans experience chronic pain than the general population and the Centre wanted to understand what research topics Veterans thought the new Centre should prioritize. One-on-one interviews were conducted with 11 Canadian Veterans living with chronic pain from five provinces. Eight priority areas for future research were determined: 1) pain care in the military, 2) postoperative care in the military, 3) coordination of services through Veterans Affairs Canada, 4) military-to-civilian transition, 5) primary care provider access outside the military, 6) knowledge of pain management among civilian health care providers, 7) engaging Veterans as partners in their care, and 8) identifying effective strategies for chronic pain management. These findings will help guide research efforts of the new CPCoE.

Outsourcing in health care has become increasingly common as health system administrators seek to enhance profitability and efficiency while maintaining clinical excellence. When clinical services are outsourced, however, the outsourcing organization relinquishes control over its most important service value: high-quality patient care. Farming out work to an external service provider can have many unintended results, including inconsistencies in standards of care; harmful medical errors; declines in patient and employee satisfaction; and damage to clinicians' morale and income, and to the health organization's culture, reputation, and long-term financial performance. Research on outsourcing in the areas of emergency medicine, radiology, laboratory services, and environmental services provides concerning evidence of potentially large downsides when outsourcing is driven by short-term cost concerns or is planned without diligently considering all of the ramifications of not keeping key clinical and nonclinical services in-house. To better equip health system leaders for decision-making about outsourcing, we examine this body of literature, identify common pitfalls of outsourcing in specific clinical and nonclinical health services and scenarios, explore alternatives to outsourcing, and consider how outsourcing (when necessary) can be done in a strategic manner that does not compromise the values of the organization and its commitment to patients.

The aim of this paper is to emphasize the value of developing cultural awareness in kinesiology students to prepare them to enter the workforce in a world where the principles of justice, equity, diversity, and inclusion are evolving. The authors provide examples of sustained and impactful practices from three kinesiology units in higher education that have been recognized with the American Kinesiology Association Inclusive Excellence Award. The case studies demonstrate that institutional support for inclusive excellence is instrumental in development of sustainable experiences. Kinesiology leaders can demonstrate commitment to inclusive excellence by supporting faculty who conduct teaching, research, and service activities that meet their institution’s inclusive excellence goals. Other areas where kinesiology units can influence student development include curriculum, student engagement activities, university and community partnerships, and leadership for inclusive excellence.

Academic leadership faces tremendous pressure to build sustainable environments that demonstrate a commitment to the principles of inclusive excellence. Currently, the convergence of dual global crises—the COVID-19 pandemic and reckoning of systemic violence and racism toward individuals from historically marginalized and oppressed groups—has led to prioritizing impactful inclusive excellence leadership processes that address justice, equity, diversity, and inclusion. However, too often, in times of crisis, the strategic prioritizing and, more importantly, allocation of resources to support inclusive excellence initiatives are seen as secondary, tangential, or nonessential to the core operational mission of academic units. In this article, the authors discuss the unique realities, challenges, and opportunities academic leaders face when leading an equitable and inclusive academic workplace and culture during and after a crisis. The authors provide fundamental inclusive excellence and justice, equity, diversity, and inclusion terminology and definitions. In addition, the authors provide attributes, behaviors, and action steps for demonstrating equitable and inclusive crisis leadership.

The rise of online learning over the past few decades has raised fundamental questions about the kinds of “spaces” and “places” this mode of education creates. Do they support meaningful exchanges? Can they advance educational equity, access, and community-building? Are they comparable to in-person classroom experiences? The recent COVID pandemic and the global turn toward virtual learning in response have brought such questions into sharp relief. These were the questions and contextual factors that brought distinguished historian Carroll Pursell and international educational technology authority Toru Iiyoshi together for this policy dialogue. Their conversation takes readers on a wide-ranging discussion about the interplay between education, technology, and society writ large. And they offer insights into the past, present, and likely future of education in an era of accelerating technological change.Carroll Pursell is the Adeline Barry Davee Distinguished Professor of History (Emeritus) at Case Western Reserve University and Distinguished Honorary Professor of History at the Australian National University. He held faculty positions at the University of California at Santa Barbara and served as the Andrew W. Mellon Distinguished Professor of the Humanities at Lehigh University. Pursell is a fellow of the American Association for the Advancement of Science (AAAS), and former president of both the International Committee for the History of Technology (ICOHTEC) and the Society for the History of Technology (SHOT), which also awarded him its Leonardo da Vinci Medal for outstanding contributions to the history of technology.Toru Iiyoshi is professor and director at the Center for the Promotion of Excellence in Higher Education at Kyoto University. Previously, he was a senior scholar and director of the Knowledge Media Laboratory at the Carnegie Foundation for the Advancement of Teaching. He also served as senior strategist in the Office of Educational Innovation and Technology at Massachusetts Institute of Technology. Iiyoshi is a member of the World Economic Forum's Global Agenda Council on Technology and Education and past recipient of the Outstanding Practice Award in Instructional Development and the Robert M. Gagne Award for Research in Instructional Design from the Association for Educational Communications and Technology.HEQPolicy Dialogues are, by design, intended to promote an informal, free exchange of ideas between scholars. At the end of the exchange, we offer a list of references to readers who wish to follow up on sources relevant to the discussion.

BackgroundIn May 2021, the Scientific Advisory Committee on Nutrition (SACN) published a risk assessment on lower carbohydrate diets for adults with type 2 diabetes (T2D)(1). The purpose of the report was to review the evidence on ‘low’-carbohydrate diets compared with the current UK government advice on carbohydrate intake for adults with T2D. However, since there is no agreed and widely utilised definition of a ‘low’-carbohydrate diet, comparisons in the report were between lower and higher carbohydrate diets. SACN’s remit is to assess the risks and benefits of nutrients, dietary patterns, food or food components for health by evaluating scientific evidence and to make dietary recommendations for the UK based on its assessment(2). SACN has a public health focus and only considers evidence in healthy populations unless specifically requested to do otherwise. Since the Committee does not usually make recommendations relating to clinical conditions, a joint working group (WG) was established in 2017 to consider this issue. The WG comprised members of SACN and members nominated by Diabetes UK, the British Dietetic Association, Royal College of Physicians and Royal College of General Practitioners. Representatives from NHS England and NHS Health Improvement, the National Institute for Health and Care Excellence and devolved health departments were also invited to observe the WG. The WG was jointly chaired by SACN and Diabetes UK.

Using a unique panel dataset of virtually all German academic political scientists, we show that researchers become much more productive due to the accumulation of human capital and third party funding. We also show however, that while universities of excellence have more productive researchers, individuals who go there do not become more productive. Finally, we show how women publish only 9 percent less than men with the same level of prior publication experience, but are about 26 percent less productive over their entire career, as early productivity leads to later productivity, so that women increasingly fall behind. These results cannot be explained through the influence of childbearing. Rather, they support the ‘theory of limited differences’, which argues that small differences in early productivity accumulate to large differences over entire careers, as early success encourages later success. Apart from generally showing why political scientists publish more or less, we specifically identify accumulative advantage as the principal reason why women increasingly fall behind men over the course of their careers.

An integral part of the higher education enterprise, academic libraries found themselves at the epicenter of the response to the impacts of the novel coronavirus outbreak in early spring 2020. This...

This essay offers six reasons why the field of gifted education should retire the terms giftedness and gifted. Additionally, in the historical context of longstanding, severe, and pervasive racial and income inequities in the field of gifted education, the term Master’s Discourse is introduced and defined in this call to change terminology. Among the reasons to move on from the gifted terminology are its racist history; its association with underrepresentation; waning support for gifted programming; years of debate in the field over the use of these terms; issues with giftedness being narrowly defined by ability tests; and the need for language to evolve.

O cenário pandêmico causado pelo coronavírus SARS-COV-2, levou instituições do mundo todo a fecharem as portas e encerrarem as atividades presenciais, com o intuito de diminuir a disseminação do novo coronavírus e assim conter os avanços da pandemia. O Brasil, sendo um dos países mais afetados por essa nova emergência global, seguiu a linha adotada por outros países e suspendeu as atividades presenciais das instituições de ensino por tempo indeterminado. Para tentar minimizar o prejuízo da suspensão dos calendários e dar continuidade às atividades de ensino, foi implantada uma modalidade alternativa de educação, com foco na educação remota a partir do uso de plataformas e ferramentas digitais. No entanto, quando falamos em atividades práticas, intrínsecas à formação médica, o seguimento das atividades educacionais via ensino remoto emergencial é insuficiente para suprir as demandas do futuro profissional de saúde, impactando adversamente na formação desses. Sendo assim, esse artigo aborda a problemática colocada no âmbito da graduação médica na Universidade Federal de Jataí e propõe protocolos de biossegurança – no que tange as medidas de proteção individual, a utilização dos espaços das universidades e a organização para a realização das atividades práticas em laboratórios – que podem ser implementados nos planejamentos de retorno as atividades presenciais nas Instituições de Ensino Superior, a fim de garantir a segurança da comunidade acadêmica e a excelência educacional.

The ability to partner with patients to design healthcare systems is an increasingly critical skill for healthcare leaders. Guest editors Anne Wojtak and Neil Stuart spoke with Vincent Dumez, co-director of the Montreal-based Centre of Excellence on Partnership with Patients and the Public, to gain an understanding of what true patient partnership looks like and how healthcare system design can be transformed.

Purpose As few studies have explored the causal relationship between both the triple bottom line (TBL) of sustainability and the lean practices in higher education institutions (HEIs), the purpose of this paper is to analyze the relationships between lean practices and sustainable practices in Brazilian HEIs. Design/methodology/approach A survey was conducted with 454 public and private HEIs workers in Brazil. Confirmatory factor analysis and structural equations modeling were used for data analysis. Findings The results support the hypotheses of the study that HEI lean practices are positively related to environmental, economic and social practices in HEIs. Practical implications HEI managers must evaluate the use of lean practices in the organizational processes, to identify their weaknesses and to improve the aspects that influence a balanced TBL of sustainability practices. Social implications The findings highlight the importance of leadership as a support for the workers, as a continuous improvement practice on a daily basis and a focus on the student as a basic principle of HEI success. Originality/value This article provides new measurement and structural models to analyze Lean thinking practices as the predictors of sustainability practices. The work could assist any HEI in prioritizing its strategies and actions and to contribute to excellence in decision-making. This study could contribute as a source of empirical data for transferability in other contexts for HEIs.

The increased focus on professional-led, continuous health care improvement has not produced formalized processes for identifying, recognizing, and rewarding excellence in quality improvement. Moreover, the team-based nature of improvement requires a mechanism to document interprofessional contributions. In 2018, the authors created a health care improvement portfolio to document and demonstrate individual impact for the purpose of promotion. A draft portfolio was developed from a review of the literature and publicly available quality improvement and educational portfolios. The portfolio was further refined through a 2-round, modified Delphi consensus process with a panel of interprofessional experts across North America. In the first round, 35 panelists gave feedback through open-ended comments on the design and content of the portfolio. In the second round, 34 panelists rated the comprehensiveness and clarity of the portfolio on a Likert scale of 1-9 (1 = lowest, 9 = highest) and provided comments. Consensus was defined as an average score over 8.0. Panelists in the second round achieved consensus, with average scores of 8.4 in comprehensiveness and 8.3 in clarity (range 6-9). The finalized portfolio includes the following sections: personal statement; health care improvement training and certification; leadership and administrative roles; health care improvement project activities; health care improvement coaching, teaching, and curricular activities; health care improvement honors, awards, and recognitions; and supporting documents. The portfolio facilitates the documentation of health care professionals' contributions to and impact in health care improvement and covers the breath of interprofessional health care improvement (i.e., projects, leadership, education, scholarship). The portfolio can be tailored to an individual's area of specific expertise. While this portfolio was originally developed for interprofessional faculty at academic institutions, the content and structure of the portfolio is easily adapted for health care providers in other health care settings.

Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.

Summary Haematological malignancies account for almost 10% of all cancers diagnosed in sub-Saharan Africa, although the exact incidences and treatment outcomes are difficult to discern because population-based cancer registries in the region are still underdeveloped. More research on haematological malignancies in sub-Saharan Africa is required to establish whether these cancers have a natural history similar to those diagnosed in high-income countries, about which more is known. Several factors negatively affect the outcome of haematological malignancies in sub-Saharan Africa, showcasing a need for improved understanding of the clinicobiological profile of these cancers to facilitate prevention, early detection, diagnosis, and appropriate treatment through increased capacity building, infrastructure, community awareness, coordinated resource mobilisation, and collaboration across the world. The east African governments have pooled resources for common investments to tackle non-communicable diseases, developing the East Africa's Centres of Excellence for Skills and Tertiary Education project funded by the African Development Bank, an initiative that could be replicated for the care of haematological malignancies in other countries in sub-Saharan Africa. Translation For the French translation of the abstract see Supplementary Materials section.

Topic The development of the Critical Care Beacon Collaborative to achieve meaningful recognition. Clinical Relevance Recognizing nurses for contributions to their work environment and care delivery is important for their professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level. The American Nurses Credentialing Center’s Magnet Recognition Program acknowledges nursing excellence at the organizational level. It would, however, be difficult for an organization to achieve Magnet designation without nursing excellence at the unit level. To recognize excellence at the unit level, the American Association of Critical-Care Nurses developed the Beacon Award in 2003. Objective To describe one academic medical center’s journey toward winning Beacon Awards across 8 units within the adult critical care service. Content Covered The Critical Care Beacon Collaborative resulted in a Beacon Award for each unit and important staff outcomes. This article describes the organization, the process before the Critical Care Beacon Collaborative convened and the desired state, and the methods used to achieve our goal. It also discusses unit- and service-level stakeholder involvement. The successes, lessons learned, sustainability, and growth of the Critical Care Beacon Collaborative are shared to assist readers who aspire to pursue a Beacon Award.

Despite advances in medicine, some children will always die; a decline in pediatric intensive care unit (PICU) mortality to zero will never be achieved. The mortality decline is correspondingly asymptotic, yet we remain preoccupied with mortality outcomes. Are we at the nadir, and are we, thus, as good as we can get? And what should we focus to benchmark our units, if not mortality? In the face of changing case-mix and rising complexity, dramatic reductions in PICU mortality have been observed globally. At the same time, survivors have increasing disability, and deaths are often characterized by intensive life-sustaining therapies preceded by prolonged admissions, emphasizing the need to consider alternate outcome measures to evaluate our successes and failures. What are the costs and implications of reaching this nadir in mortality outcomes? We highlight the failings of our fixation with survival and an imperative to consider alternative outcomes in our PICUs, including the costs for both patients that survive and die, their families, healthcare providers, and society including perspectives in low resource settings. We describe the implications for benchmarking, research, and training the next generation of providers. Conlusion: Although survival remains a highly relevant metric, as PICUs continue to strive for clinical excellence, pushing boundaries in research and innovation, with endeavors in safety, quality, and high-reliability systems, we must prioritize outcomes beyond mortality, evaluate “costs” beyond economics, and find novel ways to improve the care we provide to all of our pediatric patients and their families.

The climate impact of air travel is increasingly being acknowledged and problematized. As work in the academic sector often involves frequent long-distance travel, this development calls into question academic practices and is causing academics and academic institutions to reconsider, debate, and adapt their travel behavior and policies. This paper discusses a case study at ETH Zurich, one of the first universities with an ongoing, university-wide project to reduce greenhouse gas emissions due to air travel by faculty, staff, and students. Based on a qualitative analysis of interviews (N = 15), a survey (N = 176), and other data sources, I outline arguments for and against reducing air travel. I focus on assumed causal relations between air travel and doing ‘good’ academic work. The results reveal that the participants expected reduced air travel to affect their productivity, success, excellence, internationality, quality of research, teaching, visibility and presence, role modelling, consistency, freedom, and the humanitarian impact of their research. While the dominant assumption was that reducing air travel would harm science, this study reveals alternative assumptions that science would benefit or remain unaffected. Results also show that the debate on reducing air travel may encourage transformations in the organization of academia. Drawing on the experience of the air travel project at ETH Zurich may help other institutions and individuals initiate or advance discussions on the ethics, necessity, and future of academic air travel while acknowledging the diversity of viewpoints on air travel reduction as well as its deep implications for academia., Travel Behaviour and Society, 25, ISSN:2214-367X