The Good Governance Quandary: The Elusive Search for Role Models

A substantial consensus has emerged in development circles that the reason why some countries are rich and others poor is largely a reflection of the quality of their institutions – political, bureaucratic, and legal – and that countries with seriously dysfunctional institutions cannot expect to pursue a successful long-term trajectory of economic and social development. Many studies support this consensus, but institutional reform efforts for developed countries have resulted in mixed to weak results; many of these efforts have failed, for example, to establish a robust rule of law to protect the rights of citizens, publicly accountable political regimes, a meritocratic, noncorrupt, and efficient bureaucracy, and an independent media. Reportedly up to 60% of donor-assisted reforms have yielded no measurable increase in government effectiveness. It is inferred from this disappointing result that institutional transplants are often ineffective, and the path dependence, caused by accretions of the particularities of given countries’ histories, cultures, politics, ethnic and religious make-up, and geography leaves each country, for the most part, “to write its own history”.

Barriers to obtaining reliable results from evaluations of teaching quality in undergraduate medical education

Background Medical education is characterized by numerous features that are different from other higher education programmes, and evaluations of teaching quality are an integral part of medical education. Although scholars have made extensive efforts to enhance the quality of teaching, various issues unrelated to teaching that interfere with the accuracy of evaluation results remain. The purpose of this study is to identify the barriers that prevent objective and reliable results from being obtained during the evaluation process. Methods This study used mixed methods (3 data sources) to collect opinions from different stakeholders. Based on purposive sampling, 16 experts familiar with teaching management and 12 s- and third-year students were invited to participate in interviews and discussions, respectively. Additionally, based on systematic random sampling, 74 teachers were invited to complete a questionnaire survey. All qualitative data were imported into NVivo software and analysed using thematic analysis in chronological order and based on grounded theory. Statistical analyses of the questionnaire results were conducted using SPSS software. Results Sixty-nine valid questionnaires (93.24%) were recovered. A total of 29 open codes were extracted, and 14 axial codes were summarized and divided into four selective codes: evaluation preparation, the index system, the operation process, and the consequences of evaluation. The main barriers to obtaining reliable evaluation results included inadequate attention, unreasonable weighting, poor teaching facilities, an index without pertinence and appropriate descriptions, bad time-points, incomplete information on the system, lagged feedback, and disappointing result application. Almost all participants suggested lowering the weight of students as subjects, with a weight of 50–60% being appropriate. Students showed dissatisfaction with evaluation software, and the participants disagreed over the definition of good teaching and the management of student attendance. Conclusions This study reveals the difficulties and problems in current evaluations of teaching in medical education. Collecting data from multiple stakeholders helps in better understanding the evaluation process. Educators need to be aware of various issues that may affect the final results when designing the evaluation system and interpreting the results. More research on solutions to these problems and the development of a reasonable evaluation system is warranted.

Brazil oil auctions fall short of expectations

Subject Pre-salt oil auctions. Significance Two major oil auctions on November 6 and 7 frustrated the government’s expectations of achieving inflows of more than 110 billion reais (26.4 billion dollars). Major oil companies stayed away despite initial interest, and only three out of nine areas attracted bids. High prices, investments by state-controlled Petrobras in the areas and uncertainties about Brazil were key factors in the disappointing result. Impacts Petrobras will consolidate as the dominant operator of Brazil’s large oil reserves. Political uncertainties and high costs will continue to limit foreign investor enthusiasm. The government is likely to change the exploratory regime for future offshore auctions.

A Systemically Collaborative Approach to Achieving Equity in Higher Education

Colleges and universities have long recognized the need to address inequities affecting students from underrepresented or underserved groups. Despite efforts undertaken by dedicated individuals, large-scale, national change in this area has not been realized. In this article, we address two major factors underlying this disappointing result—the structures of isolation common in our institutions of higher learning, and the inadequate addressing of our own implicit biases—and offer a model of systemic collaboration aimed at ameliorating these problems so that colleges and universities throughout the nation can achieve the equity goals that have proved so elusive for so many of them.

Evaluation of Moxifloxacin-Containing Regimens in Pathologically Distinct Murine Tuberculosis Models

ABSTRACTIn the recently concluded REMox-TB trial, two 4-month moxifloxacin-containing regimens did not meet the criteria for noninferiority compared to the current 6-month first-line regimen to treat tuberculosis (TB). Despite the disappointing result, this phase 3 clinical trial provides a rare opportunity to gauge the predictive accuracy of the nonclinical models used to support regimen development. In parallel with the REMox-TB trial, we compared the efficacy of the same three regimens against chronic TB infection in the commonly used BALB/c mouse strain and in C3HeB/FeJ mice, which have attracted recent interest as a nonclinical efficacy model because they develop caseous lung lesions which may better resemble human TB. In long-term treatment experiments at two institutions, using low-dose aerosol infection models with 6- to 8-week incubation periods in both mouse strains, control mice received rifampin, isoniazid, pyrazinamide, and ethambutol (RHZE), and test mice received the same regimen with moxifloxacin replacing isoniazid (RMZE) or ethambutol (RHZM). Outcome measures were lung CFU counts during treatment and relapse after various durations of treatment. At both institutions and in both mouse strains, RMZE and RHZM reduced by approximately 1 month and 0 to 1 month, respectively, the treatment duration needed to produce the same relapse rate as RHZE. These results demonstrating generally similar treatment-shortening effects of the moxifloxacin-containing regimens in each mouse strain, with effect sizes consistent with the REMox-TB trial results, reinforce the predictive value of murine models for TB regimen development.

GUIDING THE IMPLEMENTATION OF QUALITY IMPROVEMENT PROJECTS: A TOC APPROACH

Many research has shown that approximately 70% of every medium to large scale industries have some type of quality improvement (QI) program. Depending on various independent studies, researchers have concluded that only onefifth of all QI projects show attractive output. The reason for this disappointing result is most of the QI programs are not result oriented. The main aim of this paper is to elaborate the value of using the Theory of Constraints (TOC), so that a result-oriented QI program can be achieved with a better bottom-line impact, which will be better than the traditional cost based selection process.