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.

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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.

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From Neurons to Neighborhoods: The Science of Early Childhood Development

The Keys to Evaluative Methods for Quality Improvement Interventions: Understanding and Analyzing Context


 
 
 Changes in management of bone infections, particularly early transition to oral antibiotic therapy, have decreased length of stay (LOS) for children hospitalized with acute osteomyelitis. However, evaluation of differences in length of stay by race and ethnicity have been limited.
 
 
 
 Using the Kids’ Inpatient Database, we conducted a cross-sectional study of children ages 0–20 years hospitalized in 2016 or 2019 with a primary or secondary diagnosis of acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled length of study (LOS) by race and ethnicity, accounting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included predictors of LOS > 7 days (equivalent to LOS in the highest quartile), central venous catheter (CVC) placement, and time to debridement.
 
 
 
 We identified 2,388 patients discharged with acute osteomyelitis. Median LOS was 5 days (IQR 3–7). Black race (adjusted incidence rate ratio [aIRR] 1.15, 95%CI 1.05–1.27), Hispanic ethnicity (aIRR 1.11, 95% CI 1.02–1.21), and other race and ethnicity (aIRR 1.12, 95% CI 1.01–1.23) were associated with longer LOS, compared to White race (Figure 1). Additional factors associated with prolonged LOS were Medicaid/self-pay status (aIRR 1.14, 95% CI 1.07–1.21) and other insurance (aIRR 1.21, 95% CI 1.02–1.45), compared to private insurance; debridement procedure (aIRR 1.31, 95%CI 1.23–1.31); CVC placement (aIRR 1.41, 95% CI 1.31–1.51), and complex chronic condition (aIRR 1.21, 95% CI 1.11–1.33). The odds of Black children experiencing LOS > 7 days was 46% higher compared to White children (aOR 1.46, 95% CI 1.01–2.11; Figure 2). There were no differences by race and ethnicity on odds of CVC placement or time to debridement.
 Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.
 Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.
 
 
 
 Black, Hispanic, and other race and ethnicity children with acute osteomyelitis experienced longer LOS than White children. Further research into mechanisms underlying these differences, including social determinants such as access to care or structural racism, may be important to improve care for children with osteomyelitis.
 
 
 
 All Authors: No reported disclosures.


887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States

The role of pili and capsule was studied in neonatal infection with Escherichia coli K1. E coli strains were selectively cultured into three phases: mannose-sensitive (MS) piliated, non-mannose-sensitive (NMS) piliated, and nonpiliated. A high percentage of neonatal rats fed each phase of K1 strains developed bacteremia; there was no bacteremia with non-K1 strains or an acapsular mutant of K1 strain C94 (C94K-). Oral cavity colonization was noted in nearly 100% of rats fed K1 strains, non-K1 strains, or C94K-, regardless of the phase of piliation at feeding. Only MS piliated bacteria were found on oral cavity culture, indicating a rapid shift of NMS piliated and nonpiliated bacteria to the MS piliated phase. Conversely, only nonpiliated bacteria were found on blood culture when neonatal rats were fed piliated bacteria. Colonization of ileal epithelium was not observed. Thus, in vivo phase variation may be important in colonization and bacteremia with E coli K1.

Donald A. Goldmann

Papers

The Keys to Evaluative Methods for Quality Improvement Interventions: Understanding and Analyzing Context

887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States

The Role of Pili and Capsule in the Pathogenesis of Neonatal Infection with