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How do digital platforms affect coordination in the restaurant market? In particular, how do they reshape firms’ positions in the quality space and their dependence on both consumers’ valuations and competitors’ choices? Focusing on the case of a widely used platform for restaurant booking and reviewing, we analyze the dine-in services market in the city of Lille, France. In line with economic sociology’s definition of markets as concrete social spaces, we frame these restaurants as a producer market in which multiple quality conventions coexist. We use sequential mixed methods and data (observations and interviews, web-scraping and business data) to show that platforms rationalize firms’ practice of observing one another as a basis for making decisions on volume and quality. The rise of digital platforms provides producers with devices that amplify their view of competitors, standardize their offerings and support the stability of their business choices over time, conditional on spatial constraints and quality choices.
In the evolving landscape of healthcare, quality and service improvement are the forefront, driving the shift towards more efficient, effective and patient-centred care. Quality in healthcare includes not only the excellence of medical interventions but also extends to the patient experience and ensuring safe, effective care. The importance of quality is highlighted by the Institute of Medicine’s (IOM) six dimensions: safety, effectiveness, patient-centredness, timeliness, efficiency and equity. These dimensions provide a comprehensive framework for evaluating and enhancing healthcare quality and services. This chapter seeks to broaden the comprehensiveness of the healthcare quality and service improvement model suggested by the IOM and provides real-life case studies in which each of the 12 dimensions is examined and discussed.
The healthcare sector is continually confronted with the issue of how to manage with less. In response, health leaders and managers must explore and use new ways to face such challenges. These issues ultimately affect the quality and safety, and the productivity and efficiency, of the health services delivered. Within each organisation, the effectiveness of the leadership and culture directly affect the quality of patient care delivered. To effectively address such challenges, leaders have begun to adopt new strategies and roles that focus on visioning and creativity.
Despite its expanding presence in codes of practice and ethical guidance for healthcare professionals, there is limited research into the precise components of compassion in clinical settings. This chapter continues the exploration of compassion in healthcare by noting occasional confusion surrounding the term ‘compassion’, and the distress that an absence of compassion can cause for patients, families, and staff. The chapter examines research that seeks to define compassionate healthcare and delineate its constituent elements. Patients experience compassionate care when healthcare providers are emotionally present, communicate effectively, enter into their experience, and display understanding and kindness. Listening and paying close attention are the most dominant features of compassionate care, along with following‐up and running tests, continuity, holistic care, and respecting preferences. Other factors include honesty and kindness, as well as specific behaviours such as smiling. These are simple ways to demonstrate the compassion that healthcare workers routinely feel but sometimes do not convey clearly, owing to challenging circumstances. The chapter concludes with considerations of cultural and ethnic factors, as well as the importance of engagement, mindful awareness, and emotional intelligence in generating and deepening compassionate practice.
Peloids are natural therapeutic muds or clays used in balneotherapy and other health treatments. The aim of this study is to prepare and qualify three artificial peloids by maturation for 360 days of some Tunisian smectitic clays with a naturally chlorinated sodic mineral water from a spring in Korbous, Tunisia. This was done to improve our understanding of the behaviour of these clays and the physicochemical changes that affect the clays during maturation, with the purpose of providing suitable raw materials as a solid phase for peloid preparation. The results showed that parameters such as mineralogy, geochemistry, granulometry, cation-exchange capacity, consistency parameters (Atterberg limits and plasticity index), specific surface area, cooling kinetics and pH are all affected by the geochemistry of the thermal water used during maturation. Mineralogical modifications mostly concern the clay minerals’ contents, particularly smectite, and subordinately the dissolution of gypsum and the neoformation of halite. The observed improvements to the plasticity index and cooling kinetics can be explained by the ability of water molecules, and especially cations, to diffuse into the clay particles. The main exchangeable cations are Na+ and Ca2+, along with Mg2+ and K+, which promote swelling and increase water retention and consequently retention of heat in thermal spa treatments. The chemical composition of the major elements is closely linked to the mineralogical compositions of the clays, and also to the chemical composition of the thermal water used in their maturation. The safety profiles of the peloids obtained at different maturation times were evaluated, particularly regarding their content of potentially toxic elements such as arsenic.
This chapter includes sample medication content that can be used to design order sets for a variety of clinical conditions that are commonly managed in an adult emergency medicine observation unit setting and are intended to be used as examples for clinicians practicing in this setting. The medication content includes typical dosing regimens for selected adult medications as well as listings of commonly-encountered formulations. Clinical highlights relating to adverse effects and place in therapy are also included in selected instances.
The Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6) resulted in many ice-sheet simulations from multiple ice-sheet models. To date, no model weighting studies have analyzed or quantified the model performance, possible duplication of the ISMIP6 ice-sheet models and the effect on mass loss projections. In this study, we adopt a model weighting scheme for the ISMIP6-Greenland that accounts for both model performance compared to observation and model similarity due to possible duplication. We choose ice velocity and thickness for the measurement of model performance, and we use all suitable variables to compute similarity indexes. We update the sea level rise contribution from ISMIP6-Greenland by the end of this century with the weights, and we find that, although the multi-model mean is not considerably shifted (mostly within $ \pm 1{\text{cm}}$), the model spreads are reduced by 10–30% after applying the model weights. The magnitude of reduction varies largely among experiments and types of model weights applied. In general, we find that the model weighting scheme is skillful in producing model weights that effectively and reasonably quantify the model performance and inter-dependency, which can potentially benefit the future phase of the Ice Sheet Model Intercomparison Project, i.e. ISMIP7.
This chapter includes sample medication content that can be used to design order sets for a variety of pediatric clinical conditions that are commonly managed in a pediatric emergency medicine observation unit setting and are intended to be used as examples for clinicians practicing in this setting. The medication content includes typical dosing regimens for selected pediatric medications as well as listings of commonly-encountered formulations. Clinical highlights relating to adverse effects and place in therapy are also included in selected instances.
In contemporary Australian society, the word ‘quality’ is ever-present in professional and political discussions about early childhood education. Educators and families are told that ‘quality is important’; curriculum documents, such as Australia’s Early Years Learning Framework (EYLF), aim to enhance quality; services are rated for the quality of education and care that they deliver; and governments regulate service conditions and provisions in order to facilitate the provision of high quality practice. Together, these social, professional and political structures communicate a strong message that quality matters for young children’s learning and wellbeing.
Limited research has examined the quality of language MOOCs and no existing instrument has been developed to gauge learners’ evaluation of LMOOC quality. This study develops an LMOOC Quality Evaluation Scale (LQES) and validates it in the Chinese context, which has the largest number of LMOOC learners in the world. The data were collected from 2,315 LMOOC learners in China using a mixed-method approach. Development and validation of the scale involved (1) generation of an initial item pool based on a semi-structured interview and literature review, (2) refinement of scale items through consultation of LMOOC experts and a focus group interview, (3) exploration of the factor structure of the scale using exploratory factor analysis, and (4) validation and confirmation of the final scale using confirmatory factor analysis. A four-factor model, comprising Instructional Design, L2 Teachers’ Competence, Teaching Implementation, and Technical Support, emerged and was validated. The 26-item LQES provides an original and comprehensive framework for understanding the complexities of LMOOC quality. This study highlights the critical factors underpinning the evaluation of LMOOC quality and paves the way for further refining of the instrument in future research.
This paper presents a Location-Allocation-Vehicle Routing Problem to design a humanitarian blood supply chain in response to earthquakes, incorporating quality concepts, reliability, and horizontal communication. The aim of the model is to minimize the total cost, minimize maximum shortage of demand points with high priority and low route value, and maximize the satisfaction of customers, including donors, hospitals, and blood transfusion centers. In order to deal with considerations of real world, the structure of the blood supply chain and all the intricacies incorporated in the model are defined based on the network and challenges of Blood Transfusion Center of Tehran. In addition, the blood demand and reliability of routes and facilities are considered uncertain, and the Interval Evidential Reasoning (IER) approach is used to handle the uncertainty. Since the problem is NP-hard, NSGAII and MOPSO algorithms have been applied to solve it. To demonstrate the efficiency of the model and compare the algorithms, several numerical examples in different sizes are designed. Finally, the most favorable algorithm is chosen for each size using the TOPSIS method.
This chapter reviews the strategies countries are employing to improve the quality of long-term care for older adults and assesses the impact of these approaches. Given that long-term care is a relatively new component of welfare systems, there is limited evidence on effective quality improvement measures. The scarcity of data on care quality in most countries further complicates the evaluation and comparison of these strategies. Despite these challenges, the chapter provides an overview of various quality improvement approaches, utilizing available evidence to understand their effects on the quality of long-term care.
Firms face an optimization problem that requires a maximal quantity output given a quality constraint. But how do firms incentivize quantity and quality to meet these dual goals, and what role do behavioral factors, such as loss aversion, play in the tradeoffs workers face? We address these questions with a theoretical model and an experiment in which participants are paid for both quantity and quality of a real effort task. Consistent with basic economic theory, higher quality incentives encourage participants to shift their attention from quantity to quality. However, we also find that loss averse participants shift their attention from quality to quantity to a greater degree when quality is weakly incentivized. These results can inform managers of appropriate ways to structure contracts, and suggest benefits to personalizing contracts based on individual behavioral characteristics.
Despite enormous efforts at healthcare improvement, major challenges remain in achieving optimal outcomes, safety, cost, and value. This Element introduces the concept of learning health systems, which have been proposed as a possible solution. Though many different variants of the concept exist, they share a learning cycle of capturing data from practice, turning it into knowledge, and putting knowledge back into practice. How learning systems are implemented is highly variable. This Element emphasises that they are sociotechnical systems and offers a structured framework to consider their design and operation. It offers a critique of the learning health system approach, recognising that more has been said about the aspiration than perhaps has been delivered. This title is also available as open access on Cambridge Core.
Many governments and universities have pursued excellence by emulating world-class models and relying on international ranking schemes for validation and ideas for improvement. Others have relied on traditional notions of quality and research productivity. These approaches rely on the accumulation of wealth and talent – strategies that are “rivalrous” limiting the opportunities of others to be as effective. Focusing on portraits of eight different institutions reveals other approaches to excellence, all of which rely on defining and pursuing a purpose.
We examine a common pool resource (CPR) where appropriations deteriorate the quality of the resource and, thus, its impact on the exploitation of the CPR. We focus on two settings: (i) firms use the CPR without abatement efforts, and (ii) abatement is allowed. We provide comparisons between these two settings and identify socially optimal appropriation levels. We find that (i) higher quality of the CPR could induce firms to overuse the resource, and (ii) first-period appropriations with abatement decrease in the regeneration rate. However, abatement induces an overuse of the resource when the quality of the CPR improves.
Extubation failure after neonatal cardiac surgery is associated with increased intensive care unit length of stay, morbidity, and mortality. We performed a quality improvement project to create and implement a peri-extubation bundle, including extubation readiness testing, spontaneous breathing trial, and high-risk criteria identification, using best practices at high-performing centers to decrease neonatal and infant extubation failure by 20% from a baseline of 15.7% to 12.6% over a 2-year period.
Methods
Utilising the transparency of the Pediatric Cardiac Critical Care Consortium database, five centres were identified as high performers, having better-than-expected neonatal extubation success rates with the balancing metric of as-expected or better-than-expected mechanical ventilation duration. Structured interviews were conducted with cardiac intensive care unit physician leadership at the identified centers to determine centre-specific extubation practices. Data from those interviews underwent qualitative content analysis which was used to develop a peri-extubation bundle. The bundle was implemented at a single-centre 17-bed cardiac intensive care unit. Extubation failure, defined as reintubation within 48 hours of extubation for anything other than a procedure, ventilator days and bundle compliance was tracked.
Results
There was a 41.4% decrease in extubation failure following bundle implementation (12 failures of 76 extubations pre-implantation; 6 failures of 65 extubations post-implementation). Bundle compliance was 95.4%. There was no difference in ventilator days (p = 0.079) between groups.
Conclusion
Implementation of a peri-extubation bundle created from best practices at high-performing centres reduced extubation failure by 41.4% in neonates and infants undergoing congenital heart surgery.
This Research Communication describes the frequency of occurrence of P. fluorescens, P. putida and P. aeruginosa in raw goat milk stored at 4 and 9°C, to evaluate the spoilage potential and capacity of these species and the presence of the aprX gene, responsible for the synthesis of metalloprotease aprX. Samples of raw goat milk stored at 4 and 9°C for 72 h were plated on Pseudomonas CFC agar base (25°C for 48 h). The presence of P. fluorescens, P. putida, P. aeruginosa and aprX gene were confirmed by polymerase chain reaction. The isolates were evaluated for their proteolytic and lipolytic spoilage capacity and potential using milk agar (10%) and tributyrin agar base (1%), respectively (21°C for 72 h). A total of 184 strains of Pseudomonas spp. were obtained. At both temperatures, P. fluorescens was the most frequent, mostly proteolytic, and the only one to express high proteolytic and lipolytic potentials. Regardless of the temperature, all isolated strains of P. putida were lipoproteolytic, with a predominance of protease synthesis. Strains of P. aeruginosa (4,3%) were isolated occasionally (4.3% of total isolates) but only at 4°C, and 75% of these were lipoproteolytic. The storage temperature of raw goat milk influenced the frequency of P. aeruginosa, but not its spoilage potential. The presence of the aprX gene was verified in most strains isolated from all species at the two temperatures evaluated, although some of these strains did not express proteolytic capacity. Most isolates of Pseudomonas spp. showed lipoproteolytic capacity, which emphasizes the importance of ensuring low initial populations of this genus in raw chilled goat milk when it is used to produce dairy products.
Several disciplines, such as economics, law, and political science, emphasize the importance of legislative quality, namely well-written legislation. Low-quality legislation cannot be easily implemented because the texts create interpretation problems. To measure the quality of legal texts, we use information from the syntactic and lexical features of their language and apply these measures to a dataset of European Union legislation that contains detailed information on its transposition and decision-making process. We find that syntactic complexity and vagueness are negatively related to member states’ compliance with legislation. The finding on vagueness is robust to controlling for member states’ preferences, administrative resources, length of texts, and discretion. However, the results for syntactic complexity are less robust.