According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Biofilms--matrix-enclosed microbial accretions that adhere to biological or non-biological surfaces--represent a significant and incompletely understood mode of growth for bacteria. Biofilm formation appears early in the fossil record (approximately 3.25 billion years ago) and is common throughout a diverse range of organisms in both the Archaea and Bacteria lineages, including the 'living fossils' in the most deeply dividing branches of the phylogenetic tree. It is evident that biofilm formation is an ancient and integral component of the prokaryotic life cycle, and is a key factor for survival in diverse environments. Recent advances show that biofilms are structurally complex, dynamic systems with attributes of both primordial multicellular organisms and multifaceted ecosystems. Biofilm formation represents a protected mode of growth that allows cells to survive in hostile environments and also disperse to colonize new niches. The implications of these survival and propagative mechanisms in the context of both the natural environment and infectious diseases are discussed in this review.

/pdf/bacterial-biofilms-from-the-natural-environment-to-4pdlw3zbzj.pdf

Bacterial biofilms: from the natural environment to infectious diseases.

Part I. Experimental Studies: 2. Experiment in psychology 3. Experiments on perceiving III Experiments on imaging 4-8. Experiments on remembering: (a) The method of description (b) The method of repeated reproduction (c) The method of picture writing (d) The method of serial reproduction (e) The method of serial reproduction picture material 9. Perceiving, recognizing, remembering 10. A theory of remembering 11. Images and their functions 12. Meaning Part II. Remembering as a Study in Social Psychology: 13. Social psychology 14. Social psychology and the matter of recall 15. Social psychology and the manner of recall 16. Conventionalism 17. The notion of a collective unconscious 18. The basis of social recall 19. A summary and some conclusions.

Remembering. A Study in Experimental and Social Psychology, Cambridge (University Press) 1964.

http://diposit.ub.edu/dspace/bitstream/2445/122776/1/gbd2016riskfactorscollaborators2017_3028.pdf

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

/pdf/from-neurons-to-neighborhoods-the-science-of-early-childhood-3bfl5g72ow.pdf

From Neurons to Neighborhoods: The Science of Early Childhood Development

Problem In 2006, despite a focus on infection control, Salford Royal had the fourth highest rate of Clostridium difficile infection in north west England Design Interrupted time series in five collaborative wards (intervention group) and 35 non-collaborative wards (control group) Setting University teaching hospital with 850 acute beds Key measures for improvement Number of cases of C difficile infection per 1000 occupied bed days Strategies for change In February 2007, a newly formed antimicrobial team led the implementation of revised guidelines in all wards and departments From March to December 2007, five wards participated in an improvement collaborative Since December 2007, the changes from the collaborative have been collated and implemented throughout the organisation Effects of change At baseline the non-collaborative wards had 115 (95% CI 103 to 129) cases per 1000 occupied bed days In August 2007 cases reduced 56% from baseline (051, 044 to 060), which has been maintained since that time In the collaborative wards, there were 260 (211 to 317) cases per 1000 occupied bed days at baseline A shift occurred in April 2007 representing a reduction of 73% (069, 050 to 091) from baseline, which has been maintained Lessons learnt Careful use of antimicrobial drugs is important in reducing the number of cases of C difficile infection A collaborative learning model can enable teams to test and implement changes that can accelerate, amplify, and sustain control of C difficile

Reducing Clostridium difficile infection in acute care by using an improvement collaborative.

Improving health care involves many actors, often working in complex adaptive systems. Interventions tend to be multi-factorial, implementation activities diverse, and contexts dynamic and complicated. This makes improvement initiatives challenging to describe and evaluate as matching evaluation and program designs can be difficult, requiring collaboration, trust and transparency. Collaboration is required to address important epidemiological principles of bias and confounding. If this does not take place, results may lack credibility because the association between interventions implemented and outcomes achieved is obscure and attribution uncertain. Moreover, lack of clarity about what was implemented, how it was implemented, and the context in which it was implemented often lead to disappointment or outright failure of spread and scale-up efforts. The input of skilled evaluators into the design and conduct of improvement initiatives can be helpful in mitigating these potential problems. While evaluation must be rigorous, if it is too rigid necessary adaptation and learning may be compromised. This article provides a framework and guidance on how improvers and evaluators can work together to design, implement and learn about improvement interventions more effectively.

/pdf/a-framework-for-learning-about-improvement-embedded-5c7bbdgyci.pdf

A framework for learning about improvement: embedded implementation and evaluation design to optimize learning.

Infusion-associated septicemia is an appreciable hazard to the more than 8 million patients who receive intravenous therapy in U.S. hospitals each year. Rigorous infection control measures...

Guidelines for infection control in intravenous therapy

A rational approach to the control of pediatric infectious diseases requires an appreciation of their epidemiology and mechanisms of transmission. The setting in which the exposure occurs may have a major influence on the risk of infection. Unfortunately, the epidemiology of many important pediatric pathogens is complex and incompletely understood. Recent advances in diagnostic microbiology and molecular epidemiology may help to solve some of the remaining riddles.

Transmission of Infectious Diseases in Children

Most information in hospital epidemiology comes from observational studies of hospitalized patients rather than planned experiments, and in such observational studies the characteristics of study patients may vary widely, even within a single hospital. Any comparison between hospital populations will usually contain additional, unintended contrasts among patients with varying degrees of health. Adult patients, for example, may have vastly different underlying diseases, and infants may be of substantially different birth weights. We used both underlying disease and birth weight as indices of the basic severity of illness in order to adjust for confounding by differences in underlying disease in reanalyses of several published studies. We give an example in which differing birth weights among groups of infants compared artifactually double the apparent effect of nosocomial infections as a cause of mortality, and another example in which differing degrees of severity of underlying illness artifactually halve the apparent effect of appropriate antibiotics in preventing death from bacteremia with gram-negative bacilli. We describe simple intuitive methods based on stratification, adapted from chronic disease epidemiology, to remove confounding effects during analyses.

Donald A. Goldmann

Papers

Reducing Clostridium difficile infection in acute care by using an improvement collaborative.

A framework for learning about improvement: embedded implementation and evaluation design to optimize learning.

Guidelines for infection control in intravenous therapy

Transmission of Infectious Diseases in Children

Confounding and the analysis of multiple variables in hospital epidemiology.