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Chapter 3 considers the various forms of writing about the city that imagined or invoked the perspective of the stranger who walked its streets. It examines how tourist accounts of London in pocket guidebooks shared with proposals for urban improvements and surveys of the city an understanding of the visitor to London as both an audience for accounts of London and also a potential critic of the city. While map, print, and booksellers began to produce items that walked strangers around the city and pointed out its key sites, those proposing improvements expressed concerns that foreign travellers might be disappointed by a city that lacked the grand and magnificent architecture of its European neighbours. Together, these works point to a desire to accommodate strangers and to offer them an account of Britain as a polite and commercial nation.
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.
In this paper, we establish a new version of one-dimensional discrete improved Hardy’s inequality with shifts by introducing a shifting discrete Dirichlet’s Laplacian. We prove that the general discrete Hardy’s inequality as well as its variants in some special cases admit improvements. Further, it is proved that two-variable discrete $p$-Hardy inequality can also be improved via improved discrete $p$-Hardy inequality in one dimension. The result is also extended to the multivariable cases.
This chapter explains and discusses the definition of public sector innovation. Public sector innovation includes two concepts or terms: (1) public sector and (2) innovation. The first concept, “the public sector,” refers to the general government organizations owned and funded by the government and may include or exclude state-owned enterprises. The second concept, “innovation,” refers to novel ideas or practices implemented organizations. Thus, novelty and implementation are two key terms defining innovation. Therefore, public sector innovation refers to innovative activities in the public sector, and this chapter provides information about it. In addition, this chapter discusses how and in what ways innovation differs from public management reforms, organizational change, invention, creativity, entrepreneurship, and improvement.
Chapter 3 explores how the letters patent authorizing the duopoly laid the groundwork for a theatre of lavishness and innovation, thereby affiliating the restored stage to the costly improvements sweeping London after the Great Fire of 1666. Theatrical amelioration bolstered national pride – England was finally catching up with continental stagecraft – and made available luxurious viewing conditions previously reserved for court audiences. To realize these ends, management chose newly developed, upmarket neighborhoods to site their equally expensive baroque playhouses. Despite these improvements, the companies risked disappointing the very consumer expectations aroused by the culture of improvement. They simply could not afford new scenes, machines, and special effects for every play. Moreover, their playhouses were ruinously costly to operate – they required enormous manpower compared to early modern stages – and personnel expenses skyrocketed further whenever the companies ventured upon a dramatic opera or spectacle-heavy production. Not until the 1690s were strategies finally devised to escape the culture of improvement.
Design creativity describes the process by which needs are explored and translated into requirements for change. This Element examines the role of design creativity within the context of healthcare improvement. It begins by outlining the characteristics of design thinking, and the key status of the Double Diamond Model. It provides practical tools to support design creativity, including ethnographic/observational studies, personas and scenarios, and needs identification and requirements analysis. It also covers brainstorming, Disney, and six thinking hats techniques, the nine windows technique, morphological charts and product architecting, and concept evaluation. The tools, covering all stages of the Double Diamond model, are supported by examples of their use in healthcare improvement. The Element concludes with a critique of design creativity and the evidence for its application in healthcare improvement. This title is also available as Open Access on Cambridge Core.
Managing knowledge successfully is key for an organization to increase its innovative potential. The InKTI method supports the improvement of knowledge transfers in product and production engineering. To ensure acceptance, applicability, and contribution to success in practice, it is necessary to validate the InKTI method. This paper focuses on evaluating the contribution to success in a Live-Lab study with student engineering teams. Based on the results two consecutive field studies have been conducted to evaluate not only the success but also support, and applicability of the InKTI method.
● Darwin’s theory of evolution by natural selection was influenced by his reading Thomas Malthus’s Essay on Population. The status of Malthusian ideas in evolutionary theory is discussed. ● An organism’s fitness is its ability to survive and reproduce. ● Natural selection influences the evolution of height (for example) precisely when individuals with different heights differ in their fitnesses. ● Fitness can be represented as a mathematical expectation, but mathematical variance matters too. ● It is almost always impossible to estimate the fitness of a single organism, but the fitnesses of traits that are possessed by multiple organisms can often be estimated. ● Two coextensive traits must have the same fitness, even if one of them helps organisms to survive and reproduce while the other does not. ● Natural selection does not inevitably lead the average fitness of organisms in a population to improve, even when the external environment is stable.
This chapter models the idea of economic growth in the period of the Enlightenment in Britain. Using methods developed in the Cambridge Concept Lab, it demonstrates that the ideas of improvement and progress supported the slow evolution of the notion of economic growth as a necessary good. It tracks the thinking of the philosopher and political economist Adam Smith as he formulated his ideas with respect to size and operation of modern capitalist economies.
This chapter discusses the four main reasons to measure outcomes: 1. measuring the change in outcomes tells you how you are doing with respect to providing health care; 2. with outcome data you can identify opportunities for learning and improvement; 3. outcome data give patients and their families critical information about what to expect when they seek care from you or your organization (or, if you work for a payer organization or employer, from the health care providers within your network); and 4. you have an ethical obligation to understand whether the care you provide is helping or harming.
This chapter discusses how to grow an outcome measurement team in a single clinical practice and covers how outcome measurement can look at scale within larger organizations that have built capabilities to leverage their electronic health records for data collection and analytics. The key steps of data management functions are referenced again to illustrate how these functions can be deployed at scale to measure outcomes. Key personnel needed to support outcome measurement at scale are also explained. Considerations for sharing data with broad audiences is described, specifically the stages of data acceptance are reviewed. Governance and leadership considerations are briefly referenced. The primary audience for this chapter is health care administrators who want to start measuring outcomes in their organization or support existing efforts.
In this chapter, we discuss and illustrate the tools of evaluating partnership work as part of a continuous improvement that you will need to make when building partnerships. As you engage with the chapter, you will learn what evaluation is and how to use evaluation to ensure that partnerships work for the benefit of children and their families. Throughout the chapter, we will explore different methods for collecting data and analysis, including various strategies that will inform the improvement and change necessary for good work in partnership-building.
Did colonialism end with decolonization? This chapter identifies threads of discursive continuity between historic colonialism and the contemporary regime for the protection of foreign investment. Those threads concern a single-minded focus on profitability and privilege, the claim that domination produces economic improvement, a prevailing distrust of local self-rule and the construction of enclaves that preserve legal entitlements for privileged classes of foreigners. Each of these features, found in colonial forms of argumentation documented by Albert Memmi and Frantz Fanon, among others, are inscribed in the discourse and practices of investment treaty law and arbitration.
Chapter 3 argues that agricultural books should be understood as a tool to appropriate the practical art of husbandry by learned culture, enabling a ‘bottom-up’ transfer of knowledge as much as a ‘top-down’ diffusion of knowledge from expert to practitioner. It argues that there was a shift around mid-seventeenth century England as the gentry became more directly engaged in farm management. It shows how the customary art of husbandry was re-imagined for gentlemen, by elevating it to science of agriculture and undermining the authority of common husbandmen and housewives. It discusses how educated men collected into writing the knowledge of husbandry stored in customary practice and oral tradition. In particular, it highlights a hidden gendered dimension, in which women’s knowledge was transferred to male authors, contributing to the increased marginalisation of women’s farm work. Finally, it draws attention to how common farmworkers resisted the extraction of their knowledge by their social superiors.
This introduction sketches the main arguments about the contribution of farming books to the development of agrarian capitalism and lays the groundwork for the detailed argument in later chapters. It first offers a critique of the standard research paradigm, the enlightenment model, which only evaluates the role of books with respect to technological change and is insensitive to early modern social relations. It then explains the research method and scope, focused on British agricultural books printed between 1660 and 1800. Since the structure of the book is thematic, it presents a broad survey of agricultural books and authors to serve as a reference for the rest of the book. It ends by summarising how the core argument is developed over seven chapters.
Chapter 9 explores the many situations in which new IP is developed under a licensing or other agreement, and how that IP is owned and licensed. Attention is given both to licensee developments (improvements and derivative works of licensed rights), which may be subject to grantback and license-back arrangements (Kennedy v. NJDA) and new IP developed by a licensor under a services arrangement (e.g., commissioned works, customizations) (IXL v. AdOutlet) and the incorporation of third party components in developed technologies. The chapter also addresses the complex issues that arise from joint development of IP, including treatment of foreground, background and sideground IP, and how IP is used in the context of joint ventures (Pav-Saver v. Vasso). The chapter concludes with a discussion of the allocation of responsibility for IP management, maintenance and prosecution.
Chapter 5 examines the fate of transformative demographic governance in the eighteenth century, beginning with the proliferation of demographic numbers and political-arithmetical arguments in a range of print genres: sermons and sacred histories, literary essays and satires, newspapers and pamphlets. These encouraged a new demographic subjectivity in their audiences – a sense of participation in demographic processes – that raised questions of agency and its limits. Some concerned the constraints of environment, conceived of in discussions of medicine and public health as a partially manipulable “situation”; others concerned the power or responsibility of the public to foster the improvement of populations through projects such as Societies for the Reformation of Manners or Coram’s Foundling Hospital. In colonial contexts, debate raged over the relationship between climate, health and race, and – as Benjamin Franklin’s work shows – over both the relative fecundity of America and Europe and the ideal racial composition of the colonies and the world. By the later eighteenth century, demographic governance had become a point of contention between colony and metropole.
Chapter 4 connects the emergence of transformative demographic governance to changes in natural philosophy, in particular to Francis Bacon’s works and their influence among projectors associated with the Hartlib Circle in the mid-seventeenth century. The problem of managing the qualities of populations in an empire raised the question of natural constraints on the power of policy to “improve” populations; the chapter examines Hartlibian projects concerned with this question on a large scale, including some in which putatively immutable racial boundaries and the enslavement of Africans indicate both limits to and paradoxes of demographic governance. It then turns to Cromwellian Ireland, showing that opposed arguments for either Irish transplantation or English –Irish mixture proceeded from a similar centering of demographic governance. Mid-century projects fed into William Petty’s “political arithmetic” in the Restoration. This fused Baconianism, alchemical ideas and quantification, treating the control of the numbers and of the economic, political, religious and cultural qualities of populations in England, Ireland and the empire as essentially similar problems for the state.
The extraction of wealth from British colonial territories would be justified by the ingenious combination of ideas about improvement and chattel slavery. While the establishment of the Atlantic settlements was an affair of colonial companies and private proprietors, they were gradually taken into direct government by Westminster. But the conflict between settlers’ defence of their autonomy under the theory of the ancient rights of Englishmen and metropolitan sovereignty would eventually push the settlements into statehood – a result that could be understood to open a wholly new global commercial order. By contrast, the East India Company continued to operate as a lucrative, though diminishing source for private enrichment until crown sovereignty was given formal imprimatur in 1813. Not keen to expand Britain’s administrative duties across the world, British lawyers and political leaders would reimagine their empire in terms of occasional interventions to protect private investments and to enforce the system of international rules they held valid all over the world.
This chapter explores Scott’s writing about familiar landscapes comprising cultivated land, rivers and coastlines. Topics include the history of farming and effects of new agricultural policies associated with enlightenment and the culture of ‘improvement’. The expansion of sheep farming is discussed with attention to changes in soil structure, flora and rural population levels. Sections address foods that are associated with Scotland, including salmon, beef and mutton. Whisky is explored for its ecological and national significance. River and offshore environments are considered in terms of the use of marine products and technologies that threatened fish stocks. The chapter has a temporal framework that looks from the nineteenth century back to the end of the last great ice age, exploring Scott’s interest in environmental history through his accounts of fossils, prehistoric tools and animal bones found in peat bogs. Environmental memory, folklore, supernatural creatures and eco-gothic tropes of haunting are key themes.