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July 10, 2026 at 7:50 PM
lislehner.bsky.social
Our #deprescribing approach includes considerations of #appropriateness & #overprescribing, and focuses on #CommunityOriented and #PrimaryCare. It also includes #patient #participation.

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November 19, 2024 at 3:33 PM
epsteinweb.bsky.social
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EFTA00605675 | EFTA00605676 for undergraduates, the research university might be compared to life in a big city with a great diversity of inhabitants—undergraduates, graduate students, professional school students, and faculty reflective of that diversity—and the liberal arts college comparable to a more homogeneous and communityoriented small town populace. Each has its own advantages for under­graduates. A major component of education is real as opposed to virtual encounters between students and teachers to encourage participation and critical thinking. “Top of the pyramid”—my sole focus here—does not mean that institutions below the top are less worthy, less deserving of private or public support, or less essential in the national scheme of higher education. Nor does it imply that the current storm of criticism is irrelevant for research universities. I completely understand the need for controlling costs and expanding capacity. But it does mean that criticisms have to be as differentiated as the range of institutions: unless that happens, inappropriate remedies may damage a sector of American higher education where we are using accepted but necessarily questionable measures with the potential to lessen our status as world leaders. All systems of international university rankings agree that U.S. universities dominate the top twenty or thirty places. (Twenty-two out of thirty in the Times Higher Education survey and twentythree out of thirty in the Shanghai Jiao Tong ranking; both in 2013.) It is unlikely that American dominance is accidental, but a convincing explanation would have to be extremely complicated. History, wars, culture and customs, and resources are all involved. But all the institutions at the top of the American educational pyramid—and some others as well—share six characteristics closely associated with high quality. (My initial preference was to call these “necessary conditions,” but that seemed a bit too rigorous.) Their absence would preclude—or make it much more difficult—for research universities to achieve the highest quality, not just in this country but anywhere else. Indeed, their partial or total absence abroad helps to explain why there are relatively few foreign—especially non-Western—institutions represented at the top of the accepted surveys.3 None of the six characteristics is wholly unambiguous; all are blurry. But is not difficult to detect their presence or absence. II. Six Characteristics of Quality n Shared governance. First, these institutions all practice shared governance: the trustees and president conditionally delegate educational policy to the faculty. That would primarily include curriculum and the initial selection of those who teach, are admitted to study, and do research. The administrative style is collegial rather than top-down, faculty sharing authority in specified areas with appointed administrators and trustees, the latter holding final authority. This is a distinctly American form of shared governance, which relies on a strong executive. Presidents, provosts, and deans possess and exercise considerable authority over budgets, institutional priorities, and many other matters of consequence. This may be contrasted with the so-called “continental model” that features what, in its purist form, can only be described as “participatory democracy”—faculty elections of rectors and deans, and policy decisions sometimes placed in the hands of assemblies based on the principle of parity: faculty, students, and employees sharing authority. In my opinion, this form of governance has been a great obstacle to progress, and while it is very difficult to generalize, it seems that even continental practice is moving toward greater executive authority. More than a decade ago, I had the opportunity to study universities in developing countries all over the world while preparing a report for the World Bank and UNESCO.4 Problems and issues varied enormously depending on economic conditions, political system, history, etc. But those who were in charge of universities almost always agreed on one point: poor systems of university governance were the greatest obstacles to institutional improvement—more so than inadequate financing or anything else. Of course, poor governance meant many different things but certainly included interference by ministries of education, unclear lines of authority and perhaps, most important, barriers to faculty input or initiative. It would be a mistake to believe that poor governance applies only to the developing world. Similar obstacles For a very recent confirmation of this point, one need only look at Michele Lamont and Anna Sun’s op-ed, “How China’s Elite Universities Will Have to Change,” in The Chronicle of Higher Education, December 14, 2012. 4 Higher Education in Developing Countries: Peril and Promise, 2000. 3 60 c a r n e g i e r e p o r t e r — Wi n t e r 2014 Epstein Web iOS app on the App Store.
May 4, 2026 at 1:00 PM
jfsfutures.bsky.social
commons-based configuration for #technologyproduction. This “cosmolocal” production promotes #sustainable and convivial practices for #technologydevelopment, illustrating the benefits of #communityoriented work Tzoumakers provides a practice-informed foundation for exploring
February 3, 2025 at 11:44 AM