Excellent Definition Research Articles

The Significance of Quality in Health Services

Introduction: Businesses and organizations in the current period strive to thrive in a fiercely competitive environment by attracting a maximum number of consumers. Purpose: This review study seeks to examine the definition of quality in health care with the goal of promoting health. Materials and Methods: The methodology employed involved doing a comprehensive literature search of review and research studies in internationally recognized databases such as Medline, Pubmed, and Cinahl. The articles were excluded based on the criterion that they were written in a language other than English. Results: The concept of health is intricate, making it challenging to establish a precise and unambiguous definition of excellence in healthcare. Quality in healthcare is an essential focus for scientists, organizations, and healthcare personnel, as well as for individuals who receive these services. Conclusions: Undoubtedly, quality in health services is an increasingly demanding first-priority need.

Overstaying our welcome: On the rise of women's seniority in the academy

AbstractIssues surrounding gender equality are—and should be—front and centre in the water resources community, and other science, technology, engineering and mathematics (STEM) fields. Very necessarily, the focus tends to be on recruitment, offering support for students and early career academics. The leaky pipeline concept used to describe the incremental loss of women from STEM fields with career duration describes a disproportionate loss of senior women, creating a parallel problem where highly qualified, top tier academics are lost from the system after significant financial and personnel investment by institutions. Ultimately, the leaky pipeline undermines the extensive investment of the hydrology and other STEM communities in equity, diversity, inclusion and accessibility (EDIA) recruitment and retention programmes by cutting short career ambitions and the trajectories of diverse top performing individuals, resulting in no net benefit of EDIA policy investments and a lack of diversity with seniority. Addressing this critical gender gap requires the attention and support of the hydrology community of practice with specific focus on generating opportunities for advancement, confronting systemic and structural biases and improving education around allyship. Institutions and professional organizations need to consciously grow diversity in leadership and recognize and outwardly manage the perception of academic excellence around slow research and education that attracts increased diversity. Supporting allyship, reducing competitiveness among community members and reinforcing collaboration will not only attract, but retain, a higher proportion of diversity in the hydrology community, academia and STEM professions in general. It is time for the water resources (and other STEM) communities to demand broader accountability and recognition of the barriers to women, implement and reward more diverse definitions of research excellence, and offer allyship training to the community of practice at large.

Outcomes of Residency Education: Insights Into the Professional Formation of the Physical Therapist Resident.

The definition of excellence in physical therapy (PT) education is evolving, yet the role of postprofessional residency education remains uncertain. Arguments in favor of required residency have emerged through the re-visioning of PT education across the continuum. Yet, little evidence exists whether residency education further develops clinical skills, clinical knowledge, and clinical reasoning abilities. Previous studies have explored the development of the novice physical therapist in the first 2 years of practice; however, there is little evidence about the outcomes of PT residency education. Thus, this study looked to explore the development of learners through their residency education and to identify the critical elements of the teaching and learning environment in residency education. Eleven PT residency programs and 13 residents participated in a qualitative study to explore the learner development through residency. Each residency program consisted of a residency program director, one or more mentors identified by the residency program director, and at least one physical therapist resident. Semistructured interviews were conducted with program participants, and journal entries were collected from residents. Using a purposeful sample of convenience, an exploratory, multiple-site/specialty area qualitative case study design was conducted. Three emerging themes were identified including growth of self, becoming a member of the community of practice, and facilitation of learning through mentoring. Through the transformative journey of residency education, there are critical elements of the learning environment supporting deep learning within the community of practice. These elements include the provision of opportunities and adequate time and space for learning to occur. The intentional design of the community of practice through residency education facilitates the development of the novice clinician to experienced clinician in an accelerated period of time. In addition, residency graduates develop characteristics similar to adaptive learners through planned teaching and learning opportunities. Finally, the structure of residency education mattered to the resident participants such that the learning environment enhanced peer learning and the development of professional relationships.

A Modified Protocol for Staining of Undecalcified Bone Samples Using Toluidine Blue—A Histological Study in Rabbit Models

Undecalcified bone histology is a valuable diagnostic method for studying bone microarchitecture and provides information on bone formation, resorption, and turnover. It has various clinical and research applications. Toluidine blue has been widely adopted as a staining technique for hard-tissue specimens. It provides a clear identification of bone structural and cellular features and the distinctions between them. Furthermore, the method allows for an excellent definition of the cement lines that mark the fields of bone remodeling. Some of the suggested and currently used processing and staining protocols are too complex and time-consuming, which necessitates their modification and/or optimization. This research aims to develop a simplified protocol for staining plastic-embedded undecalcified bone specimens with toluidine blue. The samples were obtained from the tibial bones of rabbits, and experiments with and without pre-etching were conducted. Our results demonstrated that the optimal visualization of the bone microstructure and its cellular components was achieved in the samples without acid pre-etching and dehydration after staining.

Widening the Gates: Redefining Excellence in Selection for Health Professions Education for a Diverse Future Workforce.

To ensure diversity in the healthcare workforce selection committees must select a cohort of students who collectively possess the wide variety of qualities necessary to serve societal needs. In practice, selection procedures primarily focus on predicting academic outcomes, which are currently based on a limited set of qualities, restricting the definition of excellence in healthcare. The authors propose a shift in the design of selection procedures by including additional considerations - student diversity and applicant perception - to select talented students who can fulfil societal needs. The authors explain the importance of incorporating these considerations into the design of selection procedures and challenges that may arise. To overcome the challenges of incorporating student diversity and applicant perception in the design of selection procedures, a new view on alignment between the profession, training and selection is needed. This starts with redefining excellence in the profession with more explicit attention to equity, diversity and inclusion (EDI). The authors argue that by employing an EDI-adjusted model of alignment, selection procedures can enhance academic outcomes, properly recognize the talents of and acknowledge the needs for a diverse future workforce and be perceived as fair by applicants.

The conflict of impact for early career researchers planning for a future in the academy

Abstract It has been argued that due to the growing importance attributed to research impact and forms of its evaluation, an academic ‘culture of impact’ is emerging. It would include certain concepts, values, and skills related to the area of generating and documenting impact. We use thematic and discourse analysis to analyse open answers from 100 questionnaires on research impact submitted by ECRs working in the social sciences and humanities (SSH) in Europe. We explore ECR’s early-career stage positions relative to societal impact and the trade-offs necessary to assure an academic career. The results show how, as the first generation of scholars to be socialized towards value of academic research beyond academia, ECRs are confronted with policy signals that encourage a drive for impact, which are at the same time often in line with respondents’ personal values around impact beyond academia. However, ECRs face a number of competing signals about research value within the evaluation spaces necessary to navigate an academic career. Current evaluative structures often dismiss the achievement of societal impact favouring instead narrower definitions of research excellence. Career structures and organizational realities are often unfavourable to impact-related activity, which has implications for an ECRs’ ability to develop coherent professional positionings.

Emerging Artist Resilience Needs: Transitional Education for a Post-COVID Creative Sector

This study investigated the impacts of the COVID-19 pandemic on recent arts graduates from three universities in the United States. We present evidence of shifting definitions of adaptability, resilience, transformation, excellence, and success in arts training. Based on surveys and interviews, it reinforces findings from the Strategic National Arts Alumni Project (SNAAP). The of experiences of recent arts and arts administration graduates affirms some current pedagogies and suggests others. We synthesize these findings to amplify some models, propose new ones, rebalance traditional outcomes toward a social mission, and consider the need for an expanded notion of excellence in the arts.

Research legitimacy as a precursor to effectiveness: the role of equitable partnerships in transforming aquatic food systems

Competing interests in aquatic food systems pose challenges for small-scale food producers trying to secure their place in the blue economy. These challenges include development aspirations, pressure from conservation interests, climate and environmental change, and blue growth agendas. Research-for-development can contribute to improving outcomes for small-scale actors in aquatic food systems in the face of uneven development, but the legitimacy and effectiveness of research have been found difficult to operationalize. An “engineering mindset” that prioritizes technical innovations, academic definitions of research excellence, unequal research collaborations, and funding constraints currently inhibit conducting strategic and transformative research. Taking ownership, equity, shared analysis, and feedback as key principles for research-in-development can assist in moving from transfer of technology to recognizing and working within the specific political and institutional contexts of aquatic food systems.

Connecting Public and Urban Archaeology: Enhancement of Urban Archaeological Heritage Through Local Archeo Plans

The paper presents some definitions and tools developed as part of the ArcheoDanube project. The contribution, as well as the project, connects the fields of urban archaeology, public archaeology, management of archaeological sites and archaeological tourism. In doing so, of course, we come across basic concepts, some of which are still lacking clear definitions. This applies especially to the term »archaeological park«, which has several uses. After reviewing various definitions in recent international doctrinal documents, we propose one based on the excellent definition in the Croatian legislation. Following is a brief discussion of the specifics of archaeological tourism. Archaeological parks namely represent an important component in its development. Afterwards, we discuss the main topic of the paper: the Local Archeo Plan, which is one of the main products of the ArcheoDanube project. The Local Archeo Plan represents a new, broader form of management plan, specially designed for the specific situation of archaeological remains. Unlike conventional management plans for monuments or monumental areas, a Local Archeo Plan can be prepared for wider areas, e.g., a city, and offers us the possibility of dealing with the archaeological remains of different areas, with various solutions for presentation and interpretation, in the frame of a common outline. We then compare the Local Archeo Plan to similar plans in force in Slovenia and elsewhere and assess its relevance and usefulness in the development of archaeological destinations.

A guide for writing anti-racist tenure and promotion letters.

In a two-page tenure letter, senior faculty can make or break a career. This power has an outsized impact on Black academics and other scholars with marginalized identities, who are awarded tenure at lower rates than their white colleagues. We suggest that this difference in tenure rates is due to an implicit, overly narrow definition of academic excellence that does not recognize all the contributions that Black scholars make to their departments, institutions and academia in general. These unrecognized contributions include the (often invisible) burdens of mentoring and representation that these scholars bear disproportionately. Here we propose a set of practical steps for writing inclusive, anti-racist tenure letters, including what to do before writing the letter, what to include (and not include) in the letter itself, and what to do after writing the letter to further support the candidate seeking tenure. We are a group of mostly non-Black academics in science, technology, engineering and mathematics (STEM) based in the United States who are learning about and working toward Black liberation in academia; we hope these recommendations will help ongoing efforts to move toward an inclusive academia that appreciates and rewards diverse ways of doing, learning and knowing.

"La Excelencia Son Los Valores": Using the Lotería Game to Understand the Foundations of Latina/o/x Excellence Cultivated at Home

This article examines the foundations of Latina/o/x excellence as a culturally-embedded practice born, taught, and cultivated in the home by the family members of Latina/o/x high school students. The research team conducted a phenomenological study on excellence in the home, school and community of Latina/o/x youth in Southern California. In this study, we examined the definition and source of excellence in the homes of Latina/o/x high school students through a Lotería Card Project inspired by artist, teacher, and professor, Dr. Luis-Genaro Garcia. Findings demonstrate that excellence involves meeting and excelling expectations in the home, is learned through intergenerational knowledge and lived experience, and is grounded in reciprocity. We offer suggestions to educators on how to learn about excellence in the lives of Latina/o/x students and their families.

What are the characteristics of excellent physicians and residents in the clinical workplace? A systematic review

ObjectivesIn order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes...

Printed Stretchable Graphene Conductors for Wearable Technology.

Skin-compatible printed stretchable conductors that combine a low gauge factor with a high durability over many strain cycles are still a great challenge. Here, a graphene nanoplatelet-based colloidal ink utilizing a skin-compatible thermoplastic polyurethane (TPU) binder with adjustable rheology is developed. Stretchable conductors that remain conductive even under 100% strain and demonstrate high fatigue resistance to cyclic strains of 20–50% are realized via printing on TPU. The sheet resistances of these conductors after drying at 120 °C are as low as 34 Ω □–1 mil–1. Furthermore, photonic annealing at several energy levels is used to decrease the sheet resistance to <10 Ω □–1 mil–1, with stretchability and fatigue resistance being preserved and tunable. The high conductivity, stretchability, and cyclic stability of printed tracks having excellent feature definition in combination with scalable ink production and adjustable rheology bring the high-volume manufacturing of stretchable wearables into scope.

Rhenium-based low resistivity and low annealing temperature ohmic contacts to n-GaN

We report an ohmic contact metallization scheme for n-GaN based on a Re–Al–Ni–Au multilayer stack that offers low-resistivity and provides better edge sharpness and lower surface roughness at reduced annealing temperature compared to standard Ti–Al-based metallization. We studied three sets of samples with Re thicknesses of 10, 30, and 60 nm and measured specific contact resistances using the circular transmission line method. We obtained reliable ohmic contacts with specific contact resistance of the order of 10−6 Ω cm2 at 550 °C temperature with the contact stack having a large annealing temperature window of &amp;gt;300 °C for resistivity below 5 × 10−6 Ω cm2. The lowest contact resistivity, below 10−7 Ω cm2, is achieved at annealing temperature around 650–700 °C. A reduction in surface roughness by a factor of 4, with excellent edge definition for Re &amp;gt;30 nm thickness is observed as compared to Ti–Al contacts. Grazing incidence x-ray diffraction and electron dispersive x-ray spectroscopy (EDS) show intermetallic phases of RexNy, Re–Al–Ni, Al–Re, and Al–Au being formed. Atomic force microscope and EDS measurements show the formation of crystalline Re–Al–Ni agglomerates, surrounded by phases of AlAu2 and Al2Au5. The presence of Re seems to suppress the formation of viscous AlAu4 phase, thus minimizing the lateral flow of the metals and providing better edge acuity. The temperature dependence of contact resistivity suggests a field-emission mechanism for current transport across the contact. Our results show that Re-based ohmic contacts, with their lower annealing temperature and excellent edge definition, may offer a promising alternative to Ti–Al contacts.

Nontoxic N-Heterocyclic Olefin Catalyst Systems for Well-Defined Polymerization of Biocompatible Aliphatic Polycarbonates.

Herein, N-heterocyclic olefins (NHOs) are utilized as catalysts for the ring-opening polymerization (ROP) of functional aliphatic carbonates. This emerging class of catalysts provides high reactivity and rapid conversion. Aiming for the polymerization of monomers with high side chain functionality, six-membered carbonates derived from 2,2-bis(hydroxymethyl)propionic acid (bis-MPA) served as model compounds. Tuning the reactivity of NHO from predominant side chain transesterification at room temperature toward ring-opening at lowered temperatures (-40 °C) enables controlled ROP. These refined conditions give narrowly distributed polymers of the hydrophobic carbonate 5-methyl-5-benzyloxycarbonyl-1,3-dioxan-2-one (MTC-OBn) (Đ < 1.30) at (pseudo)first-order kinetic polymerization progression. End group definition of these polymers demonstrated by mass spectrometry underlines the absence of side reactions. For the active ester monomer 5-methyl-5-pentafluorophenyloxycarbonyl-1,3-dioxane-2-one (MTC-PFP) with elevated side chain reactivity, a cocatalysis system consisting of NHO and the Lewis acid magnesium iodide is required to retune the reactivity from side chains toward controlled ROP. Excellent definition of the products (Đ < 1.30) and mass spectrometry data demonstrate the feasibility of this cocatalyst approach, since MTC-PFP has thus far only been polymerized successfully using acidic catalysts with moderate control. The broad feasibility of our findings was further demonstrated by the synthesis of block copolymers for bioapplications and their successful nanoparticular assembly. High tolerability of NHO in vitro with concentrations ranging up to 400 μM (equivalent to 0.056 mg/mL) further emphasize the suitability as a catalyst for the synthesis of bioapplicable materials. The polycarbonate block copolymer mPEG44-b-poly(MTC-OBn) enables physical entrapment of hydrophobic dyes in sub-20 nm micelles, whereas the active ester block copolymer mPEG44-b-poly(MTC-PFP) is postfunctionalizable by covalent dye attachment. Both block copolymers thereby serve as platforms for physical or covalent modification of nanocarriers for drug delivery.

Demonstrating Excellence in Plastic Surgery Residency.

Background:Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of faculty members affiliated with Accreditation Council for Graduation Medical Education–accredited plastic surgery residency programs regarding qualities indicative of resident excellence.Methods:A survey including Likert scales and rank-ordering was distributed to plastic surgery program directors and faculty with the intent to assess perspectives regarding resident excellence at each stage of training. Responses were analyzed using marginal homogeneity tests and summary tables.Results:In total, 90 respondents completed the survey. An estimated 94.5% believe it is possible for residents to achieve excellence at any stage of clinical training, and 87.7% report their definition of excellence differs by training level. Top three metrics indicative of resident excellence for interns and junior residents were preparation for operative cases, bedside manner, and personality. For seniors: preparation for operative cases, leadership capability, and bedside manner. For chief residents: preparation for operative cases, leadership capability, and technical operative expertise.Conclusions:A resident who displays excellence inspires mentorship, which can propel future career success. Faculty agree excellence can be achieved by residents of any stage, although the qualities that define this evolve by training year. Preparation for operative cases is considered a critical component of resident performance at all levels. Bedside manner and personality are ways intern and junior level residents excel, whereas leadership ability and technical expertise in the operating room become significant in senior and chief trainees.

Defining Clinical Excellence for Palliative Care Specialists: A Concept Whose Time Has Come.

Experts in the field of palliative care in the United States (U.S.) have defined competence, or "good," mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or "great," applicable to palliative care specialists of all professions will elevate the field in the U.S. by providing an aspirational target usable for individual assessment and self-assessment, highlighting the common ground between team roles, and promoting a deeper understanding of teamwork, utilization, and productivity. We call for research that utilizes inclusive methods and broad representation of diverse voices to design a vivid, practical, and evidence-based definition of clinical excellence for palliative care specialists.

Rhytidoplasty Through Minimal Incisions (Rhythmic).

BackgroundIn the present report, an innovative alternative approach for rhytidoplasty is described. Rhytidoplasty Through Minimal Incisions (Rhythmic) is an effective, efficient, safe, and reproducible alternative procedure for facial rejuvenation. It has several advantages over traditional procedures.ObjectiveThe main objective of this report is to describe the surgical technique of Rhythmic.MethodsThe surgical technique for the foreheadplasty requires only a transverse ~7-mm incision ~1 cm behind the hairline at the midline. The upper and lower blepharoplasty are made with incisions of ~3 mm, and no suture is needed. Liposuction of the neck can also be performed, and the face-lift can be achieved through preauricular incisions.ResultsHere, we summarize the results obtained in 741 patients subjected to rhytidoplasty through minimal incisions. The follow-up of these patients extended up to 20 years. This technique drastically reduced the length of scars; the eyebrows elevated 8-13 mm, and in some cases, the tip of the nose was also elevated ~7 mm. It minimized or eliminated the vertical frown lines and the horizontal furrows in the forehead. The use of this technique allowed an excellent definition of the cervicofacial angle in the patients.ConclusionsIn conclusion, rhytidoplasty through minimal incisions drastically reduced the length of scars, bleeding, surgical time, avoided the use of drains, reduced costs, and shorted the convalescent period. It also offered the patients a natural appearance with minor complications.Level of Evidence: 2

Free-running cardiac and respiratory motion-resolved 5D whole-heart coronary cardiovascular magnetic resonance angiography in pediatric cardiac patients using ferumoxytol

BackgroundCoronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions.MethodsIn 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm3 isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness.ResultsData collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar.ConclusionsA simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.

The Last Shall Be First: πανύστατος in Apollonios and Homer

Abstract This article considers the intertextual significance of Apollonios’s use on two occasions in the Argonautika of πανύστατος, a Homeric τρὶς λεγόμενον, found twice in the Iliad and once in the Odyssey. Homer applies it to Eumelos’s finishing position in the chariot race and the emergence of Polyphemos’s ram from the cave, Apollonios to Herakles’s endurance in the rowing contest and Aietes’s equally belated emergence from his palace. πανύστατος in itself simultaneously evokes belatedness and the sense of being the last remaining, in keeping with Apollonios’s epigonal poetics and his archaizing depiction of Herakles and Aietes. Intertextually, Herakles’s impromptu contest and Aietes’s role in the crypto-athletic ἄεθλος he sets Jason resonate with the Homeric funeral games and their exploration of the definition of excellence and how it is measured, through the figure of Eumelos who is both πανύστατος and ἄριστος. Polyphemos’s ram, whose superficially humble lastness conceals Odysseus’s victory, renders the relationship more complex still.