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Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
This article examines Seneca's theory of monarchy in De clementia. It focuses in particular on Seneca's appropriation and redefinition of some key terms within Roman political thought in order to present his theory as an account of the restitution of liberty to the res publica under the government of the virtuous princeps. By relocating the Roman body politic to a Stoic moral universe, Seneca is able to draw upon parts of his philosophical inheritance in order to substantiate his claim in some depth.
Evidence indicates that workshop training, personalized feedback, and individual consultation can increase competence in motivational interviewing (MI) among highly motivated and skilled substance abuse counselors. Little is known, however, about the translational value of these training strategies for counselors with fewer counseling skills and less stated motivation to learn MI. This study presents evidence from a randomized, controlled trial of 129 behavioral health providers assigned to receive workshop training and enrichments to learn MI. A diverse group of Air Force behavioral health providers working in substance abuse treatment programs were trained in MI and subsequently observed in clinical sessions at 4, 8 and 12 months after training. Results indicate that training was effective in increasing the skill level of these clinicians; however, these gains had decreased by the 4-month follow-up point. Training enrichments in the form of personalized feedback and consultation phone calls did not have an expected, additive effect on clinician skill level. The results of this study lend support to the hypothesis that a greater investment of resources and incentives may be necessary to achieve gains in MI skills for counselors with relatively lower baseline skills than those commonly participating in research studies.
In view of the conceptual character of the Senecan ideology which Petrarch had developed in his writings about the Neapolitan rex, it is unsurprising that he resorted to the same language when describing and prescribing the principles of good monarchical government to the signori. The Petrarchan development of the Senecan argument was clear: if a ruler possessed the requisite virtues, thereby ensuring that reason reigned supreme over his own person and over the political body which he ruled, then he could be duly named as princeps, or rex, or imperator irrespective of any external apparatus which might be adduced to support such a claim. In fact, Petrarch had openly denigrated the reliance on dynastic entitlement and the physical symbolism of monarchical power in his discussions of the identity of the true prince. This line of argument was of immense utility to signorial regimes looking to consolidate their princely claims. Through Petrarch's association with the signori, a political language already indebted to the texts of Roman imperial ideology in general and to the contentions of De clementia in particular developed a fully humanist character.
Before settling in Milan in 1353 for eight years, Petrarch had corresponded with its ruler, Luchino Visconti, and with Visconti's podestà in Parma, Paganino da Milano. Writing to Paganino during the 1340s, Petrarch declared that he was well aware of the argument that the Roman Empire had increased in size far more before the establishment of the Principate, but that it was nevertheless the opinion of many great men that ‘the happiest state of the res publica is under a single, just prince’.