John James

Here is what to know about the candidates running for Governor of Michigan.

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Background Health services often fail to make evidence-based innovations routine practice. However, implementation science has been more successful at documenting these failures than explaining them. Existing frameworks identify barriers and facilitators but do not specify causal mechanisms. This study extends Normalization Process Theory (NPT) by theorizing implementation failure as the systematic decoupling of interdependent mechanisms, that is, individually present but no longer operating in relation to one another. Methods We conducted a mixed-methods process evaluation of a four-month pilot of an integrated diabetes care intervention implemented in two public primary healthcare centers in Mendoza Province, Argentina. Data comprised semi-structured interviews with healthcare professionals (n = 11), two focus group discussions with patients (n = 11) and caregivers (n = 4), an online survey, and monitoring reports. Analysis combined inductive thematic analysis with NPT-driven coding. Results Both sites failed to embed the intervention in all its components, to make them routine, but through contrasting mechanism configurations. At the larger center, activity was carried by two individuals who neither enrolled others nor shared a coherent account of what the intervention required; enactment thus proceeded without enrollment or coherence. This constituted a failure mode of enactment without enrollment, characterized by two conflation pathways - one rooted in professional identity, one in task structure—that produced misdirected activity. At the smaller center, a committed, coordinated team sustained implementation throughout the pilot, but without a sufficiently coherent account of the intervention or whether it was working. This is a failure mode of effort without coherence: enrollment and coordinated enactment were present, but oriented by the team’s own priorities rather than the intervention’s logic. Conclusions Implementation failure is better understood as mechanism decoupling than as absence. The failure modes identified have distinct logics, distinct detection requirements, and distinct implications for adapting implementation strategies ahead of the definitive trial. This reorientation, from asking whether implementation work occurred to asking whether interdependent mechanisms were operating, has direct consequences for process evaluation design and trial adaptation in similar settings.

It's buyers' choice as the state's housing market cools; A hand-built Lincoln home is filled with art and memories; Winooski's Ruth and Brian Steinmetz promote “dwellness”; Architect Turner Brooks revisits his angular structures.

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As election season heats up in Michigan, candidates vie to succeed outgoing, term-limited Gov. Gretchen Whitmer. Democrat Secretary of State Jocelyn Benson, Republican U.S. Rep. John James and several third-party candidates will battle it out on the ballot this November. Here's what to know about the six people running in the gubernatorial race.

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From costumed musical tributes to a rock reimagining of a classic ghost story, Halloween weekend will be a hell of a good time in Burlington and beyond.

From costumed musical tributes to a rock reimagining of a classic ghost story, Halloween weekend will be a hell of a good time in Burlington and beyond.