Understanding uptake of continuous quality improvement in Indigenous primary health care: lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project

<p>Abstract</p> <p>Background</p> <p>Experimentation with continuous quality improvement (CQI) processes is well underway in Indigenous Australian primary health care. To date, little research into how health organizations take up, support, and embed these complex innovations is available on which services can draw to inform implementation. In this paper, we examine the practices and processes in the policy and organisational contexts, and aim to explore the ways in which they interact to support and/or hinder services' participation in a large scale Indigenous primary health care CQI program.</p> <p>Methods</p> <p>We took a theory-driven approach, drawing on literature on the theory and effectiveness of CQI systems and the Greenhalgh diffusion of innovation framework. Data included routinely collected regional and service profile data; uptake of tools and progress through the first CQI cycle, and data collected quarterly from hub coordinators on their perceptions of barriers and enablers. A total of 48 interviews were also conducted with key people involved in the development, dissemination, and implementation of the Audit and Best Practice for Chronic Disease (ABCD) project. We compiled the various data, conducted thematic analyses, and developed an in-depth narrative account of the processes of uptake and diffusion into services.</p> <p>Results</p> <p>Uptake of CQI was a complex and messy process that happened in fits and starts, was often characterised by conflicts and tensions, and was iterative, reactive, and transformational. Despite initial enthusiasm, the mixed successes during the first cycle were associated with the interaction of features of the environment, the service, the quality improvement process, and the stakeholders, which operated to produce a set of circumstances that either inhibited or enabled the process of change. Organisations had different levels of capacity to mobilize resources that could shift the balance toward supporting implementation. Different forms of leadership and organisational linkages were critical to success. The Greenhalgh framework provided a useful starting point for investigation, but we believe it is more a descriptive than explanatory model. As such, it has limitations in the extent to which it could assist us in understanding the interactions of the practices and processes that we observed at different levels of the system.</p> <p>Summary</p> <p>Taking up CQI involved engaging multiple stakeholders in new relationships that could support services to construct shared meaning and purpose, operationalise key concepts and tools, and develop and embed new practices into services systems and routines. Promoting quality improvement requires a system approach and organization-wide commitment. At the organization level, a formal high-level mandate, leadership at all levels, and resources to support implementation are needed. At the broader system level, governance arrangements that can fulfil a number of policy objectives related to articulating the linkages between CQI and other aspects of the regulatory, financing, and performance frameworks within the health system would help define a role and vision for quality improvement.</p

Search for anomalous production of multiple leptons in association with W and Z bosons at CDF

This paper presents a search for anomalous production of multiple low-energy leptons in association with a W or Z boson using events collected at the CDF experiment corresponding to 5.1 fb(-1) of integrated luminosity. This search is sensitive to a wide range of topologies with low-momentum leptons, including those with the leptons near one another. The observed rates of production of additional electrons and muons are compared with the standard model predictions. No indications of phenomena beyond the standard model are found. A 95% confidence level limit is presented on the production cross section for a benchmark model of supersymmetric hidden-valley Higgs production. Particle identification efficiencies are also provided to enable the calculation of limits on additional models

Search for a Heavy Toplike Quark in pp̅ Collisions at √s=1.96 TeV

submitted to Phys. Rev. LettWe present the results of a search for pair production of a heavy toplike (t') quark decaying to Wq final states using data corresponding to an integrated luminosity of 5.6fb-1 collected by the CDF II detector in pp¯ collisions at s=1.96TeV. We perform parallel searches for t'→Wb and t'→Wq (where q is a generic down-type quark) in events containing a lepton and four or more jets. By performing a fit to the two-dimensional distribution of total transverse energy versus reconstructed t' quark mass, we set upper limits on the t't¯' production cross section and exclude a standard model fourth-generation t' quark decaying to Wb (Wq) with mass below 358 (340)GeV/c2 at 95% C.L

Search for new phenomena in events with two ZZ bosons and missing transverse momentum in ppˉp\bar{p} collisions at s=1.96\sqrt{s}=1.96 TeV

We present a search for new phenomena in events with two reconstructed $Z$ bosons and large missing transverse momentum, sensitive to processes $p\bar{p}\rightarrow X_2X_2 \rightarrow Z Z X_1 X_1$, where $X_2$ is an unstable particle decaying as $X_2\rightarrow ZX_1$ and $X_1$ is undetected. The particles $X_1$ and $X_2$ may be, among other possibilities, fourth generation neutrinos or supersymmetric particles. We study the final state in which one $Z$ boson decays to two charged leptons and the second decays hadronically. In data corresponding to an integrated luminosity of 4.2 fb$^{-1}$ from proton-antiproton collisions recorded by the CDF II detector at the Tevatron, with center-of-mass energy of 1.96 TeV, we find agreement between data and standard-model backgrounds. We calculate 95% confidence level upper limits on the cross section of the process $p\bar{p}\rightarrow X_2X_2 \rightarrow Z Z X_1 X_1$ ranging from 50 fb to 1 pb, depending on the masses of $X_1$ and $X_2$.We present a search for new phenomena in events with two reconstructed $Z$ bosons and large missing transverse momentum, sensitive to processes $p\bar{p}\rightarrow X_2X_2 \rightarrow Z Z X_1 X_1$, where $X_2$ is an unstable particle decaying as $X_2\rightarrow ZX_1$ and $X_1$ is undetected. The particles $X_1$ and $X_2$ may be, among other possibilities, fourth generation neutrinos or supersymmetric particles. We study the final state in which one $Z$ boson decays to two charged leptons and the second decays hadronically. In data corresponding to an integrated luminosity of 4.2 fb$^{-1}$ from proton-antiproton collisions recorded by the CDF II detector at the Tevatron, with center-of-mass energy of 1.96 TeV, we find agreement between data and standard-model backgrounds. We calculate 95% confidence level upper limits on the cross section of the process $p\bar{p}\rightarrow X_2X_2 \rightarrow Z Z X_1 X_1$ ranging from 50 fb to 1 pb, depending on the masses of $X_1$ and $X_2$

Measurement of branching ratio and Bs0 lifetime in the decay Bs0 -&gt; J/psi f0(980) at CDF

We present a study of Bs0 decays to the CP-odd final state J/psi f0(980) with J/psi -&gt; mu+ mu- and f0(980) -&gt; pi+ pi-. Using ppbar collision data with an integrated luminosity of 3.8/fb collected by the CDF II detector at the Tevatron we measure a Bs0 lifetime of tau(Bs0 -&gt; J/psi f0(980)) = 1.70 -0.11+0.12(stat) +-0.03(syst) ps. This is the first measurement of the Bs0 lifetime in a decay to a CP eigenstate and corresponds in the standard model to the lifetime of the heavy Bs0 eigenstate. We also measure the product of branching fractions of Bs0 -&gt; J/psi f0(980) and f0(980) -&gt; pi+ pi- relative to the product of branching fractions of Bs0 -&gt; J/psi phi and phi -&gt; K+ K- to be R_f0/phi = 0.257 +_0.020(stat) +-0.014(syst), which is the most precise determination of this quantity to date

Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice

\ua9 Author(s) (or their employer(s)) 2025. Background: Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice. Methods: A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS. Results: 8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care. Conclusion: Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies