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Background Communities of Practice are formed by people who interact regularly to engage in collective learning in a shared domain of human endeavor. Virtual Communities of Practice (VCoP) are online communities that use the internet to connect people who share a common concern or passion. VCoPs provide a platform to share and enhance knowledge. The Policy Circle is a VCoP that connects mid-career professionals from across Canada who are committed to improving healthcare policy and practice. We wanted to understand the perceived value of the VCoP. Methods We used qualitative and quantitative survey research to explore past and current Policy Circle members’ thoughts, feelings, and behaviours related to the program. Our research was guided by the Value Creation Framework proposed by Wenger and colleagues. Three surveys were created in collaboration with stakeholders. Data were analyzed within cohort and in aggregate across cohorts. Qualitative data was analyzed thematically, and quantitative data was analyzed using descriptive statistics (means of ranked and scaled responses). Results Survey participation was high among members (Cohort 1: 67%, Cohort 2: 64%). Participants came from a variety of disciplines including medicine, health policy, allied health, and nursing, with most members having a direct role in health services research or practice. The program was successful in helping participants make connections (mean = 2.43 on a scale from 1 to 5: 1 = yes, significantly, 5 = not at all); variances in both qualitative and quantitative data indicated that levels of enthusiasm within the program varied among individuals. Members appreciated the access to resources; quarterly meetings (n = 11/11), and a curated reading list (n = 8/11) were the most valued resources. Participants reported the development of a sense of belonging (mean = 2.29) and facilitated knowledge exchange (mean = 2.43). At the time of this study, participants felt the program had minor impact on their work (mean = 3.5), however a majority of participants (50%) from Cohort 2 planned to acknowledge the program in their professional or academic endeavours. Through reflective responses, participants expressed a desire for continued and deeper professional network development. Conclusions The Policy Circle was successful in facilitating knowledge exchange by creating a community that promoted trust, a sense of belonging and a supportive environment. Members were satisfied with the program; to promote further value, the Policy Circle should implement strategies that will continue member participation and networking after the program is finished.

Abstract While it is widely recognized that accreditation enables an organization to improve its performance and sustain a culture of quality, changing healthcare practices to align with evidence-informed guidelines (clinical and administrative) is a complex process that takes time. The true value of accreditation lies in its contribution to healthcare safety and quality as a means to prompt and support ‘knowledge to action’, a key value of accreditation that ‘has yet to be articulated’. Using the ‘knowledge to action’ cycle, a planned action framework, we illustrate that accreditation is a knowledge translation (KT) or implementation intervention that seeks to improve and increase the uptake of evidence in healthcare organizations. The accreditation components, including the quality framework, standards, self-assessment process and on-site survey visit, ultimately serve to improve quality, decreasing variation in practice and strengthening a culture of quality. With a unique perspective and alignment obtained through the implementation lens, we examine the accreditation process and components relative to the ‘knowledge to action cycle’ with implications for enhancing the value of accreditation beyond current appreciation to both accreditation bodies worldwide and those organizations that participate in accreditation programs. Until organizations and accreditation bodies embrace the accreditation process as a knowledge to action intervention to bring about meaningful and sustained change, the full benefits of the process will not be optimized nor achieved.

Background The importance of a strong safety culture for enhancing patient safety has been stated for over a decade in healthcare. However, this complex construct continues to face definitional and measurement challenges. Continuing improvements in the measurement of this construct are necessary for enhancing the utility of patient safety climate surveys (PSCS) in research and in practice. This study examines the revised Canadian PSCS (Can-PSCS) for use across a range of care settings. Methods Confirmatory factor analytical approaches are used to extensively test the Can-PSCS. Initial and cross-validation samples include 13 126 and 6324 direct care providers from 119 and 35 health settings across Canada, respectively. Results Results support a parsimonious model of direct care provider perceptions of patient safety climate (PSC) with 19 items in six dimensions: (1) organisational leadership support for safety; (2) incident follow-up; (3) supervisory leadership for safety; (4) unit learning culture; (5) enabling open communication I: judgement-free environment; (6) enabling open communication II: job repercussions of error. Results also support the validity of the Can-PSCS across a range of care settings. Conclusions The Can-PSCS has several advantages: (1) it is a theory-based instrument with a small number of actionable dimensions central to the construct of PSC; (2) it has robust psychometric properties; (3) it is validated for use across a range of care settings, therefore suitable for use in regionalised health delivery systems and can help to raise expectations about acceptable levels of PSC across the system; (4) it has been tested in a publicly funded universal health insurance system and may be suitable for similar international systems.

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O’Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.

AbstractCanada faces significant policy and economic challenges related to healthcare for frail older adults. Annual per capita healthcare costs for people over age 65 are five times those for people under 65. Flat economic growth and an aging workforce decrease tax revenue, which funds 70% of health spending. Governments are shifting policy to enhance person-centered care and shifting spending from hospitals to primary and community care. Recognizing that frailty and evidence-based frailty screening can contribute directly to reform initiatives, what are the policy and economic considerations, both nationally and internationally, around frailty screening that will benefit patients, families and/or the wider health system? Based on key informant interviews, we present recommendations for approaching policy and economic challenges in frailty through the following healthcare policy instruments: financing, funding, legislation, regulation, technology, interdisciplinary care, person-centered service and health promotion.

Bayesian analysis of macroevolutionary mixtures (BAMM) is a statistical framework that uses reversible jump Markov chain Monte Carlo to infer complex macroevolutionary dynamics of diversification and phenotypic evolution on phylogenetic trees. A recent article by Moore et al. (MEA) reported a number of theoretical and practical concerns with BAMM. Major claims from MEA are that (i) BAMM's likelihood function is incorrect, because it does not account for unobserved rate shifts; (ii) the posterior distribution on the number of rate shifts is overly sensitive to the prior; and (iii) diversification rate estimates from BAMM are unreliable. Here, we show that these and other conclusions from MEA are generally incorrect or unjustified. We first demonstrate that MEA's numerical assessment of the BAMM likelihood is compromised by their use of an invalid likelihood function. We then show that \"unobserved rate shifts\" appear to be irrelevant for biologically plausible parameterizations of the diversification process. We find that the purportedly extreme prior sensitivity reported by MEA cannot be replicated with standard usage of BAMM v2.5, or with any other version when conventional Bayesian model selection is performed. Finally, we demonstrate that BAMM performs very well at estimating diversification rate variation across the ~20% of simulated trees in MEA's data set for which it is theoretically possible to infer rate shifts with confidence. Due to ascertainment bias, the remaining 80% of their purportedly variable-rate phylogenies are statistically indistinguishable from those produced by a constant-rate birth–death process and were thus poorly suited for the summary statistics used in their performance assessment. We demonstrate that inferences about diversification rates have been accurate and consistent across all major previous releases of the BAMM software. We recognize an acute need to address the theoretical foundations of rate-shift models for phylogenetic trees, and we expect BAMM and other modeling frameworks to improve in response to mathematical and computational innovations. However, we remain optimistic that that the imperfect tools currently available to comparative biologists have provided and will continue to provide important insights into the diversification of life on Earth.

Healthy aging can be promoted by enhanced metabolic fitness and physical capacity. Mitochondria are chief metabolic organelles with strong implications in aging that also coordinate broad physiological functions, in part, using peptides that are encoded within their independent genome. However, mitochondrial-encoded factors that actively regulate aging are unknown. Here, we report that mitochondrial-encoded MOTS-c can significantly enhance physical performance in young (2 mo.), middle-age (12 mo.), and old (22 mo.) mice. MOTS-c can regulate (i) nuclear genes, including those related to metabolism and proteostasis, (ii) skeletal muscle metabolism, and (iii) myoblast adaptation to metabolic stress. We provide evidence that late-life (23.5 mo.) initiated intermittent MOTS-c treatment (3x/week) can increase physical capacity and healthspan in mice. In humans, exercise induces endogenous MOTS-c expression in skeletal muscle and in circulation. Our data indicate that aging is regulated by genes encoded in both of our co-evolved mitochondrial and nuclear genomes. Exercise has beneficial effects on metabolism and overall physiologic fitness in aged organisms. Here the authors show that MOTS-c is a mitochondrial-encoded exercise-induced peptide that regulates skeletal muscle metabolism and improves healthspan of older mice.

Key Points Biofilm formation by Candida albicans on implanted medical devices is a major source of infection. Advances in expression profiling and genetic manipulation have provided insights into the mechanisms and regulatory pathways that govern C. albicans biofilm formation and biofilm-based drug resistance. Major regulatory genes and their targets have been connected to biofilm formation. Relevant targets include many cell surface proteins; some are adhesins, but many are still not understood mechanistically. Identifying the regulators has provided insight into the signals that control biofilm development, including nutrients, hyphae formation and quorum sensing molecules. Increasingly, mechanistic studies have focused on diverse biofilms, including mucosal infection models, in vivo implanted-device models and mixed-species biofilms. One of the common themes to emerge is the requirement for hyphae formation and for the transcription factor biofilm and cell wall regulator 1 (Bcr1). Biofilm induction assays have shown a unique biological function for non-mating white cells in creating cohesive biofilms that promote mating, and have uncovered a hybrid signal transduction pathway that mediates this behaviour. Biofilms of most species are associated with epigenetic resistance to antimicrobials. Resistance of C. albicans biofilms is conferred by multiple mechanisms that include drug binding by extracellular matrix material and the production of persisters. Finally, the cells released from a preformed biofilm have unique properties that favour invasive infection. The dispersed cells are yeast-form cells, and their production depends on several regulators of the yeast–hypha transition. The formation of Candida albicans biofilms on implanted medical devices is a major source of infection. Here, Finkel and Mitchell review the latest insights into the mechanisms and regulatory pathways that govern C. albicans biofilm formation and biofilm-based drug resistance. Candida species cause frequent infections owing to their ability to form biofilms — surface-associated microbial communities — primarily on implanted medical devices. Increasingly, mechanistic studies have identified the gene products that participate directly in the development of Candida albicans biofilms, as well as the regulatory circuitry and networks that control their expression and activity. These studies have uncovered new mechanisms and signals that govern C. albicans biofilm development and associated drug resistance, thus providing biological insight and therapeutic foresight.

Positive (synergistic) and negative (trade-off) relationships among ecosystem services are influenced by drivers of change, such as policy interventions and environmental variability, and the mechanisms that link these drivers to ecosystem service outcomes. Failure to account for these drivers and mechanisms can result in poorly informed management decisions and reduced ecosystem service provision. Here, we review the literature to determine the extent to which drivers and mechanisms are considered in assessments of ecosystem service relationships. We show that only 19% of assessments explicitly identify the drivers and mechanisms that lead to ecosystem service relationships. While the proportion of assessments considering drivers has increased over time, most of these studies only implicitly consider the drivers of ecosystem service relationships. We recommend more assessments explicitly identify drivers of trade-offs and synergies, which can be achieved through a greater uptake of causal inference and process-based models, to ensure effective management of ecosystem services.