The rhetoric of "excellence" is pervasive across the academy. It is used to refer to research outputs as well as researchers, theory and education, individuals and organizations, from art history to zoology. But does "excellence" actually mean anything? Does this pervasive narrative of "excellence" do any good? Drawing on a range of sources we interrogate "excellence" as a concept and find that it has no intrinsic meaning in academia. Rather it functions as a linguistic interchange mechanism. To investigate whether this linguistic function is useful we examine how the rhetoric of excellence combines with narratives of scarcity and competition to show that the hyper-competition that arises from the performance of "excellence" is completely at odds with the qualities of good research. We trace the roots of issues in reproducibility, fraud, and homophily to this rhetoric. But we also show that this rhetoric is an internal, and not primarily an external, imposition. We conclude by proposing an alternative rhetoric based on soundness and capacity-building. In the final analysis, it turns out that that "excellence" is not excellent. Used in its current unqualified form it is a pernicious and dangerous rhetoric that undermines the very foundations of good research and scholarship. This article is published as part of a collection on the future of research assessment.

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Background: Heart failure (HF) necessitates frequent transport by emergency medical services (EMS), but few studies have been conducted to evaluate predictors of EMS use and of multiple EMS transports that are amenable to intervention. Objectives: To characterize prehospital clinical status of community-dwelling adults with reported HF who used EMS across 8 years and to evaluate predictors of EMS use and multiple EMS transports. Methods: Data were from a database in a large Midwestern county. Descriptive statistics, logistic and negative binomial regression were used for analysis. Results: EMS transports were evaluated for 6582 adults with 16,905 transports. The most common chief complaints were respiratory problems, feeling sick, and chest pain. Shortness of breath, chest pain, level of consciousness, age, gender, race, and hospital site predicted multiple transports. Conclusions: Clinicians need to educate patients with HF about ways to manage shortness of breath and chest pain and when to activate EMS.