bluuebunny/crossref_metadata_2025 huggingface dataset:
Crystal structures of 6a,6b,7,11a-tetrahydro-6H,9H-spiro[chromeno[3′,4′:3,4]pyrrolo[1,2-c]thiazole-11,3′-indoline]-2′,6-dione and 5′-methyl-6a,6b,7,11a-tetrahydro-6H,9H-spiro[chromeno[3′,4′:3,4]pyrrolo[1,2-c]thiazole-11,3′-indoline]-2′,6-dione
Authors: Pangajavalli S. , Ranjithkumar R. , Srinivasan N. , Ramaswamy S. , Selvanayagam S.
Published: January 2019

The title compounds, C20H16N2O3S, (I), and C21H18N2O3S, (II), differ by the presence of a methyl group in position 5 on the 1H-indole-2-one ring of compound (II). The two compounds have a structural overlap r.m.s. deviation of 0.48 Å. There is a significant difference in the conformation of the thiazolidine ring: it has a twisted conformation on the fused N—C bond in (I), but an envelope conformation in compound (II) with the S atom as the flap. The planar pyrrolidine ring of the indole ring system is normal to the mean plane of the five-membered pyrrolidine ring of the pyrrolothiazole unit in both compounds, with dihedral angles of 88.71 (9) and 84.59 (8)°. The pyran rings in both structures have envelope conformations with the methylene C atom adjacent to the C=O group as the flap. In both compounds, there is a short intramolecular C—H...O contact present. In the crystal of (I), molecules are linked by C—H...O hydrogen bonds forming chains propagating along the b-axis direction. The chains are linked by N—H...π interactions, forming layers parallel to (10\overline{1}). In the crystal of (II), molecules are linked by pairs of N—H...O hydrogen bonds, forming inversion dimers which are linked by C—H...O hydrogen bonds to form a three-dimensional structure.
The key factors of total quality management in the service sector: a cross-cultural study
Authors: Bouranta Nancy , Psomas Evangelos , Suárez-Barraza Manuel F. , Jaca Carmen
Published: January 2019

Purpose

Literature refers to the key factors of total quality management (TQM) based on studies carried out in individual countries. However, few studies focus on studying the TQM factors in service companies based on multinational data. The purpose of this paper is to empirically identify the key TQM factors and their impact on internal and external customer performance measures across different countries.

Design/methodology/approach

The research questions regarding the TQM factors and their effects were examined using a sample of service organisations from three countries (131 from Greece, 70 from Mexico and 151 from Spain). TQM factors and their impact on employee and customer satisfaction were analysed separately for each country. Exploratory factor analyses, coupled with multiple linear regression analyses, were conducted.

Findings

The key TQM factors identified are common among the three participating countries and can be summarised as follows: quality practices of top management, process management, employee quality management, customer focus, and employee knowledge and education. The adoption level of these five key factors of TQM varies across service organisations in different countries. The results also confirmed that some of the TQM elements are antecedents of customer- and employee-focused performance.

Practical implications

Multinational service organisations may use such an instrument to evaluate TQM implementation among worldwide operations and then benchmark their performance. In addition, an understanding of similarities and differences among countries would help managers around the world to address difficulties of TQM implementation related to the country culture.

Originality/value

Previous studies have compared key TQM factors across different countries in manufacturing, but overall, there has been a little attempt in the literature to analyse the adoption of TQM factors among service firms, as well the relationships between quality improvement and performance across different geographical regions.
Numerical investigation on the forced laminar convection heat transfer of Al2O3-water nanofluid within a three-dimensional asymmetric heated channel
Authors: Bianco Vincenzo , Marchitto Annalisa , Scarpa Federico , Tagliafico Luca Antonio
Published: January 2019

Purpose

The purpose of this paper is to carry out a numerical investigation to study laminar convection flow of Al2O3-water nanofluids within a three-dimensional rectangular section channel asymmetrically heated.

Design/methodology/approach

A three-dimensional model of the channel is designed and simulated by using Comsol Multiphysics. The finite elements method is used to perform the numerical simulation. A variety of cases are taken into account by considering Reynolds numbers ranging from 250 up to 1,000, concentration between 0 and 6 per cent, particle dimension of 20, 40 and 60 nm and inlet temperature equal to 293.15 and 320 K. A constant heat flux of 1,000 W/m2is imposed on the top surface of the channel.

Findings

The results demonstrate that nanofluids guarantee improved thermal performances with respect to the base fluid, as shown by the augmented Nusselt number. On the other hand, pressure drop shows a noticeable increase; therefore, an entropy generation analysis is developed to establish optimal conditions for the system under investigation.

Originality/value

The originality of this work consists in the analysis of a three-dimensional asymmetric heated channel with nanofluids in laminar convection. The present work would be beneficial to improve the design of devices with particular focus on solar thermal panel.
Numerical investigation for second law analysis of ferrofluid inside a porous semi annulus
Authors: Sheikholeslami M. , Ellahi R. , Shafee Ahmad , Li Zhixiong
Published: January 2019

Purpose

The purpose of this paper is to present the entropy analysis of ferrofluid inside a porous space with magnetic force. Homogenous model with second law analysis is also taken into account.

Design/methodology/approach

Innovative model has been proposed and designed using control volume finite element method.

Findings

Experimental results demonstrate that Bejan number augments with augment of Rayleigh. As Hartmann number rises, exergy loss enhances. Exergy loss increases by increasing Hartmann number, whereas magnetic entropy generation reduces with the decrease of Ha. The proposed model can be used for combustion process and optimizing the performance of energy conversion system like gas turbine.

Originality/value

To the best of authors’ knowledge, this model is reported for the first time.
The prediction of petition based on Big Data
Authors: Xue Ting , Liu Huiqi
Published: January 2019

Purpose

The development of Big Data and online searching engine provides a good opportunity for studying petition in China. This study has constructed a set of indices for predicting petitions in China by using online searching engines and further explored the predicting role of economic, environment and public life risk perception in various petitions.

Design/methodology/approach

Based on the study of Xue and Liu (2017), this research first re-classified offline petition by human and cluster analysis in terms of social risk perception and built online searching indices of the two sets of petition by using data from “Google Trend” and “Baidu Index.” Second, it analyzed the predicting effect of social risk perception on online searching indices of petition by using Granger causality analysis. Finally, this study integrated the results and selected significant paths from social risk perception to the two sets of petition.

Findings

The study found that the re-classification made by human was more appropriate than the categories made by cluster analysis in terms of social risk perception. For the two sets of petition, the correlations between offline petition and Baidu Index of petition were both more significant than that of Google index. Moreover, economic and finance and resource and environment risk perception had a significant predicting effect on more than one kind of online searching indices of petition.

Originality/value

The results have demonstrated the important role of economic issues in China on predicting petitions of the economic kind, as well as other kinds. They have also reflected the dominant social contradictions and their relationship in modern China.
Barriers to viability of Indian power distribution companies
Authors: Pandey Ajay Kumar , Ghodke Manjushree
Published: January 2019

Purpose

The purpose of this paper is to develop an interpretive structural modeling (ISM) of barriers related to viability of Power Distribution Companies (discoms) in India.

Design/methodology/approach

Feedback from the Experts of Indian power sector has been taken as the basis to develop the model for barriers to viability of discoms, where major barriers have been identified through extent review of literature and through discussions with experts in the power sector keeping the viability of discoms in focus, and the hierarchical structure of barriers has been developed using ISM.

Findings

An interpretive structural model has been developed for discom-related factors (barriers) affecting its viability. The hierarchical structure portrays the impeding factors of viability and showcases that lack of regulatory effectiveness, inadequate tariffs and lack of government’s expenditures on power sector are the key barriers.

Research limitations/implications

This paper has implications for both practitioners and academics. For practitioners, it provides an indicative list of major barriers affecting the viability of Indian discoms. For academics, the methodology used provides a mechanism to conduct an exploratory study by identifying the key variables of interest and emphasizing their interactions through hierarchical structures.

Originality/value

The proposed model for barriers to viability of discoms developed through qualitative modeling technique is a pioneering effort altogether in the context of power distribution companies in India. Understanding contextual relationships among key barriers to viability of discom’s is neglected in existing literature, and this paper makes a contribution in this regard.
Role of a hospital accreditation program in developing a process management system
Authors: Shakibaei Erfan
Published: January 2019

Purpose

The purpose of this paper is to clarify the effects of the Iranian Hospital Accreditation Program (IHAP) on hospital processes from the viewpoint of the staff charged with establishing the program.

Design/methodology/approach

This qualitative study is based on the data collected in semi-structured interviews conducted in 2016, which involved eight questions. Interviews were held with 70 staff members at 14 hospitals. Managerial staff were purposively interviewed based on their familiarity and involvement with the program. The hospitals were divided into five groups, comprising public, private, charity, military and social service hospitals. A thematic analysis was carried out using the collected data.

Findings

Three themes emerged from the data, which together comprise a process management cycle: the establishment, implementation, and control phases of the program. For each phase, various positive trends, as well as hurdles for establishing the program, declared which were framed two sub-themes as positive effects and challenges.

Originality/value

The findings contribute to the body of evidence used by policy-makers and hospital managers to improve the change management processes related to the Iranian IHAP. Although positive changes in the process management cycles at Iranian hospitals were noted, successful implementation of the program demands a thorough assessment of the hospitals’ technical and financial needs (taking into account disparities between hospitals), and there is an urgent requirement for a plan to meet these needs.
Does TeamSTEPPS affect psychological status?
Authors: Fukushima Yoshinori , Yamada Atsushi , Imoto Naruaki , Iba Toshiaki
Published: January 2019

Purpose

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program is known to improve team and clinical performance, but the relationship to psychological stress has not been clarified. The purpose of this paper is to evaluate team performance, clinical performance and psychological stress simultaneously in a simulation-based training combined with or without the TeamSTEPPS program.

Design/methodology/approach

This randomized, controlled, prospective pilot study was performed to reveal TeamSTEPPS impact on psychological stress. The course included an emergency care training course, the TeamSTEPPS program, and a scenario simulation. Ten medical student teams were randomly allocated two groups: a TeamSTEPPS group and a non-TeamSTEPPS group. Team performance, clinical performance and psychological stress were evaluated simultaneously in the course; i.e., questionnaire evaluation and an observational evaluation for team performance; an assessor’s evaluation and a simulator’s evaluation for clinical performance. Autonomic nervous activity, represented by salivary amylase levels and heart rate variability, were measured as psychological stress indicators.

Findings

Team performance and clinical performance were significantly better in the TeamSTEPPS group, while psychological stress did not differ between the groups.

Originality/value

This is the first study to examine the relationship between TeamSTEPPS and psychological stress. Although only preliminary conclusions can be drawn from this small-scale study, results suggest that the TeamSTEPPS program improved team and clinical performance without increasing psychological stress.
Oral care – identifying quality improvement areas
Authors: Andersson Maria , Wilde-Larsson Bodil , Persenius Mona
Published: January 2019

Purpose

The purpose of this paper is to describe and compare nurses’ and healthcare assistants’ oral care quality perceptions, including perceived reality (PR) and subjective importance (SI), to identify improvement areas in intensive care and short-term care, and to explore potential nursing satisfaction predictors regarding oral care.

Design/methodology/approach

Swedish staff, 154 within intensive care and 278 within short-term care responded to a modified quality of care from a patient perspective questionnaire. Descriptive and analytical statistics were used.

Findings

Staff scored oral care quality both high and low in relation to PR and SI. Improvement areas were identified, despite high satisfaction values regarding oral care. Setting, SI and PR explained 51.5 percent of the variance in staff satisfaction regarding oral care quality.

Practical implications

Quality improvements could guide oral care development.

Originality/value

This study describes oral care by comparing nurse perceptions of how important they perceive different oral care aspects and to what extent these oral care aspects are performed.
Bedside vital parameters that indicate early deterioration
Authors: Bunkenborg Gitte , Poulsen Ingrid , Samuelson Karin , Ladelund Steen , Akeson Jonas
Published: January 2019

Purpose

The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4).

Design/methodology/approach

This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals.

Findings

Respiratory rate, heart rate and patient age were significantly (p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also (p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not.

Practical implications

It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related.

Originality/value

Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.
Competencies required for healthcare improvement positions
Authors: Meyer Melanie A.
Published: January 2019

Purpose

The purpose of this paper is to examine the competencies that US healthcare organizations require for quality and performance improvement positions.

Design/methodology/approach

A US healthcare improvement job posting content analysis was conducted using the HQ Essentials competency framework.

Findings

The HQ essentials competencies most desired for improvement positions include project management, training, data analysis and applied performance improvement methods. Competency requirements varied somewhat by job focus area: performance, quality, or process improvement, and Lean and Six Sigma.

Practical implications

Healthcare leaders may use the author’s results to understand what competencies may be required for various improvement roles and to identify any gaps in required skills and knowledge areas that may need to be addressed. Educators and policy-makers should consider how these competencies align with employers’ needs and what resources or professional development may be needed to address gaps.

Originality/value

This is the first healthcare improvement competencies analysis based on job postings.
Toxic leadership: emotional distress and coping strategy
Authors: Bhandarker Asha , Rai Snigdha
Published: January 2019

Purpose

The purpose of this paper is to elucidate the distressing impact of toxic leadership on the mental state of the subordinates and examine the unique coping mechanisms used by them to deal with such leaders. The paper also examined the relationship between psychological distress and coping strategy used by subordinates to deal with the toxic leader.

Design/methodology/approach

This study presents a validity testing of two scales. The first scale was designed to measure experienced psychological distress emanating from exposure to toxic leaders, and the second scale aims to assess the coping strategies utilized by subordinates to deal with the toxic leaders. Data were collected from 570 employees working in public as well as private organizations in India.

Findings

The results of this paper supported the theorized two three-dimensional tools to measure: psychological distress (loss of self-worth, withdrawal and agitated) and coping strategies to deal with toxic leaders (assertive coping, avoidance coping and adaptive coping). Reliability estimates and construct validity of both the tools were established. The results also suggest that the loss of self-worth was negatively related with assertive coping, avoidance coping and adaptive coping. However, withdrawal was positively related with assertive coping and avoidance coping. Finally, agitation was positively related with avoidance and adaptive coping.

Originality/value

To the authors’ knowledge, this is one of the rare studies to examine together the phenomenon of both psychological distress experienced by subordinates and the coping strategies utilized by them to deal with toxic leaders.
Test of the job demand resources model in Thailand
Authors: Kunte Manjiri , Rungruang Parisa
Published: January 2019

Purpose

The purpose of this paper is to test the hypothesized relationships between job demands, job resources and personal resources toward work engagement, by utilizing a cross section of Thai employees.

Design/methodology/approach

In this study, a group of employees (n=416) responded to a set of self-report surveys on job demands, job resources, personal resources and work engagement.

Findings

The results of the hierarchical regression analysis supported the relationships between job demands (i.e. workload and role conflict), job resources, personal resources (self-efficacy) and work engagement. In addition, the results supported the role of (positive) self-esteem as moderator in the role ambiguity and work engagement relationship, and the role of self-efficacy in buffering the effect of role conflict and workload on work engagement. The final model explained 43 percent of the variance in the dependent variable.

Research limitations/implications

This study will help managers in understanding employee expectations and providing appropriate feedback. Devising effective jobs, which lead to perceptions of meaningfulness, safety and availability leading to improved engagement.

Originality/value

This is the first study employing the job demands resources model in a cross-sectional study in Thailand.
Assessment of Lean Six Sigma Readiness (LESIRE) for manufacturing industries using fuzzy logic
Authors: Sreedharan V. Raja , Raju R. , Sunder M. Vijaya , Antony Jiju
Published: January 2019

Purpose

Many organizations have reported significant benefits after the implementation of Lean Six Sigma (LSS). Embracing LSS requires asking some important questions: How Lean Six Sigma Readiness (LESIRE) can be measured? How can an organization identify the barriers for LESIRE? Answers to these questions are critical to both academicians and practitioners. The paper aims to discuss this issue.

Design/methodology/approach

This study illustrates the development process of a Lean Six Sigma Readiness (LESIRE) evaluation model to assess an organization’s readiness for LSS deployment using the fuzzy approach. The model was developed from 4 enablers, 16 criteria and 46 attributes of LSS, identified through a literature review.

Findings

To demonstrate the efficiency of the model, this study testing the LESIRE evaluation model in three Indian SMEs. Using experts’ ratings and weight, the researchers calculated the Fuzzy Lean Six Sigma index (FLSS) which indicates the LESIRE level of an organization and the Fuzzy Performance Importance Index (FPII) that helps to identify the barriers for LESIRE.

Research limitations/implications

The main limitations of this study are that it did not consider the failure factors of LSS for model development and the LESIRE was only tested in manufacturing industries. Thus, future researchers could focus on developing a model with failure factors. The results obtained from the SMEs show that LESIRE is capable of assessing LESIRE in an industrial scenario and helps practitioners to measure LESIRE for the future decision making process.

Practical implications

The LESIRE model is easy to understand and use without much computation complexity. This simplicity makes the LESIRE evaluation model unique from other LSS models. Further, LESIRE was tested in three different SMEs, and it aided them to identify and improve their weak areas, thereby readying them for LSS deployment.

Originality/value

The main contribution of this study it proposes a LESIRE model that evaluates the organization for FLSS and FPII for LESIRE, which is essential for the organization embarking on an LSS journey. Further, it improves the readiness of the organization that is already practicing LSS.
Bayesian networks for statistical process control with attribute data
Authors: Cobb Barry , Li Linda
Published: January 2019

Purpose

Bayesian networks (BNs) are implemented for monitoring a process via statistical process control (SPC) where attribute data are available on output from the system. The paper aims to discuss this issue.

Design/methodology/approach

The BN provides a graphical and numerical tool to help a manager understand the effect of sample observations on the probability that the process is out-of-control and requires investigation. The parameters for the BN SPC model are statistically designed to minimize the out-of-control average run length (ARL) of the process at a specified in-control ARL and sample size.

Findings

The BN model outperforms adaptivenpcontrol charts in all experiments, except for some cases where only a large change in the proportion of sample defects is relevant. The BN is particularly useful when small sample sizes are available and when managers need to detect small changes in the proportion of defects produced by the process.

Research limitations/implications

The BN model is statistically designed and parameters are chosen to minimize out-of-control ARL. Future advancements will address the economic design of BNs for SPC with attribute data.

Originality/value

The BNs allow qualitative knowledge to be combined with sample data, and the average percentage of defects can be modeled as a continuous random variable. The framework of the BN easily permits classification of the system operation into two or more states, so diagnostic analysis can be performed simultaneously with statistical inference.
Antecedents of indebtedness for low-income consumers: the mediating role of materialism
Authors: Matos Celso Augusto de , Vieira Valter , Bonfanti Katia , Mette Frederike Monika Budiner
Published: January 2019

Purpose

The purpose of this is to propose a model in which materialism is a mediator of the effects of self-esteem, impulsiveness, attitude toward debt, attitude toward credit card and economic vulnerability on consumer indebtedness. The effects of financial knowledge, financial ability, credit card use and demographic variables are also taken into account.

Design/methodology/approach

Survey data from a sample of 1,245 low-income consumers from Brazil were used to test the hypotheses using structural equation modeling.

Findings

First, materialism has a significant effect on consumer indebtedness; at the same time, it is influenced by self-esteem, impulsiveness and attitude toward debt. Second, materialism acts as a mediator, e.g. higher impulsiveness triggers materialism, which influences debt level. Third, indebtedness is higher for women and those who use a higher number of credit cards and are more educated.

Social implications

Financial education programs should work to increase individual’s perceived ability to manage money, as the individuals who feel less able to manage their personal finances alone (i.e. lower financial ability) presented higher indebtedness.

Originality/value

This study investigates consumer indebtedness by addressing factors that have been analyzed independently in the literature. The research combines psychological, financial and economic factors with credit card use and demographic variables to explain consumer indebtedness. Moreover, the study supports the mediating role of materialism for the antecedents of consumer indebtedness, e.g. impulsiveness and attitude toward debt.
Managing resource dependencies in electric vehicle supply chains: a multi-tier case study
Authors: Kalaitzi Dimitra , Matopoulos Aristides , Clegg Ben
Published: January 2019

Purpose

The purpose of this paper is to investigate dependencies that arise between companies during the ramp-up of production volume in the electric vehicle (EV) supply chain.

Design/methodology/approach

An inter-company case study method has been used. Data were collected via tours of manufacturing plants, workshops and interviews from multiple tiers in a supply chain, namely, a niche EV manufacturer, as well as two of its tier-one suppliers and five of its tier-two suppliers.

Findings

As production volumes increased, a more relational approach was found to be necessary in inter-company relationships. The authors’ research showed that key suppliers, in addition to providing the parts, pursued a supply chain orchestrator’s role by offering direct support and guidance to the niche EV manufacturer in designing and executing its development plans.

Research limitations/implications

The resource dependence theory (RDT) is used to analyse and explain the changing dependencies throughout the planning and execution of production ramp-up.

Practical implications

This study will help supply chain managers to better manage resource dependencies during production ramp-up.

Originality/value

This study explores dependencies during the early stages of the production ramp-up process in the EV sector, which is in itself in the early stages of evolution. RDT is used for the first time in this context. This study has moved beyond a simple dyadic context, by providing empirical insights into the actions taken by an EV manufacturer and its suppliers, towards a multi-tier supply chain context, to better manage resource dependencies.
Quantifying niche availability, niche overlap and competition for recruitment sites in plant populations without explicit knowledge of niche axes
Authors: Wandrag Elizabeth M. , Catford Jane A. , Duncan Richard P.
Published: January 2019

Niche availability, niche overlap and competitive ability are key determinants of the distribution and abundance of species. However, quantifying each of these components is difficult because it is not always possible to identify or measure relevant environmental gradients (niche axes) along which species might partition or compete for niche space.

We describe a method that uses seed addition experiments to quantify the number of ‘safe‐sites’ (microsites suitable for a species to recruit from seed) at a location and show how this method can be used to quantify niche availability, niche overlap and competitive ability. We illustrate our approach using two seed addition experiments in grassland.

In the first experiment, we added seeds of one native and two exotic grass species, alone and in mixture, to plots that were arrayed along a gradient of soil moisture availability. We show that the three species partitioned safe‐sites, implying that all three species could locally co‐occur through niche partitioning, in part due to different responses to moisture availability.

In the second experiment, we added seeds of three commonly co‐occurring native grass species, alone and in mixture, to plots with no obvious environmental gradients. One species out‐competed two others for site occupancy, allowing us to quantify both the degree of niche overlap and the relative ability of each species to compete for safe‐site occupancy without a priori knowledge of the niche axes. Results from both experiments demonstrate the fine‐scales at which species can partition niches to facilitate co‐occurrence.

Synthesis. By conceptualising a plot of ground as containing a limited number of microsites that are safe for the recruitment of a given species, and using seed addition experiments to measure both the number of safe‐sites and degree of safe‐site overlap among species, we show how niche availability, niche overlap and competitive ability can be quantified at fine‐scales without a priori knowledge of niche axes. Our approach allows questions about niche availability and competition for shared niche space to be empirically tested, and to examine how these processes vary along environmental gradients to shape species distributions and patterns of co‐occurrence.
Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies
Authors: Ramler Paul I. , van den Akker Thomas , Henriquez Dacia D. C. A. , Zwart Joost J. , van Roosmalen Jos , van Lith Jan M. M. , van der Bom Johanna G. ,   the TeMpOH‐1 study group
Published: January 2019

Introduction

Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high‐income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years.

Material and methods

Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands.

Results

Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56‐75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81‐101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250‐6000) to 6000 mL (interquartile range 4500‐8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006.

Conclusions

The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care.
Adjusting the focus: A public health ethics approach to data research
Authors: Ballantyne Angela
Published: January 2019

This paper contends that a research ethics approach to the regulation of health data research is unhelpful in the era of population‐level research and big data because it results in a primary focus on consent (meta‐, broad, dynamic and/or specific consent). Two recent guidelines – the 2016 WMA Declaration of Taipei on ethical considerations regarding health databases and biobanks and the revised CIOMS International ethical guidelines for health‐related research involving humans – both focus on the growing reliance on health data for research. But as research ethics documents, they remain (to varying degrees) focused on consent and individual control of data use. Many current and future uses of health data make individual consent impractical, if not impossible. Many of the risks of secondary data use apply to communities and stakeholders rather than individual data subjects. Shifting from a research ethics perspective to a public health lens brings a different set of issues into view: how are the benefits and burdens of data use distributed, how can data research empower communities, who has legitimate decision‐making capacity? I propose that a public health ethics framework – based on public benefit, proportionality, equity, trust and accountability – provides more appropriate tools for assessing the ethical uses of health data. The main advantage of a public health approach for data research is that it is more likely to foster debate about power, justice and equity and to highlight the complexity of deciding when data use is in the public interest.
A Statistical Method for Joint Estimation of Cis-eQTLs and Parent-of-Origin Effects Under Family Trio Design
Authors: Zhabotynsky Vasyl , Inoue Kaoru , Magnuson Terry , Mauro Calabrese J. , Sun Wei
Published: January 2019

RNA sequencing allows one to study allelic imbalance of gene expression, which may be due to genetic factors or genomic imprinting (i.e., higher expression of maternal or paternal allele). It is desirable to model both genetic and parent-of-origin effects simultaneously to avoid confounding and to improve the power to detect either effect. In studies of genetically tractable model organisms, separation of genetic and parent-of-origin effects can be achieved by studying reciprocal cross of two inbred strains. In contrast, this task is much more challenging in outbred populations such as humans. To address this challenge, we propose a new framework to combine experimental strategies and novel statistical methods. Specifically, we propose to study genetic and imprinting effects in family trios with RNA-seq data from the children and genotype data from both parents and children, and quantify genetic effects by cis-eQTLs. Towards this end, we have extended our method that studies the eQTLs of RNA-seq data (Sun, Biometrics 2012, 68(1): 1–11) to model both cis-eQTL and parent-of-origin effects, and evaluated its performance using extensive simulations. Since sample size may be limited in family trios, we have developed a data analysis pipeline that borrows information from external data of unrelated individuals for cis-eQTL mapping. We have also collected RNA-seq data from the children of 30 family trios, applied our method to analyze this dataset, and identified some previously reported imprinted genes as well as some new candidates of imprinted genes.
A Sensitivity Analysis Approach for Informative Dropout Using Shared Parameter Models
Authors: Su Li , Li Qiuju , Barrett Jessica K. , Daniels Michael J.
Published: January 2019

Shared parameter models (SPMs) are a useful approach to addressing bias from informative dropout in longitudinal studies. In SPMs it is typically assumed that the longitudinal outcome process and the dropout time are independent, given random effects and observed covariates. However, this conditional independence assumption is unverifiable. Currently, sensitivity analysis strategies for this unverifiable assumption of SPMs are underdeveloped. In principle, parameters that can and cannot be identified by the observed data should be clearly separated in sensitivity analyses, and sensitivity parameters should not influence the model fit to the observed data. For SPMs this is difficult because it is not clear how to separate the observed data likelihood from the distribution of the missing data given the observed data (i.e., ‘extrapolation distribution’). In this article, we propose a new approach for transparent sensitivity analyses for informative dropout that separates the observed data likelihood and the extrapolation distribution, using a typical SPM as a working model for the complete data generating mechanism. For this model, the default extrapolation distribution is a skew-normal distribution (i.e., it is available in a closed form). We propose anchoring the sensitivity analysis on the default extrapolation distribution under the specified SPM and calibrate the sensitivity parameters using the observed data for subjects who drop out. The proposed approach is used to address informative dropout in the HIV Epidemiology Research Study.
Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer
Authors: Ramos Jorge D. , Holt Sarah K. , Schade George R. , Galsky Matthew D. , Wright Jonathan L. , Gore John L. , Yu Evan Y.
Published: January 2019

Objective

To assess the association of venous thromboembolism (VTE) with different chemotherapy regimens in patients with urothelial tract cancer.

Patients and Methods

We identified patients aged ≥66 years, diagnosed with urothelial tract cancer in the period 1998 to 2011 in the Surveillance, Epidemiology, and End Results (SEER) Medicare‐linked database. The chemotherapy regimens analysed were gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (CarboG). Propensity scores for treatment regimen based on comorbidities, tumour characteristics, age, and year of diagnosis were calculated. VTE rates within 120 days of chemotherapy initiation were calculated. VTE risk stratified by chemotherapy regimen was modelled using multivariable logistic regression, adjusting for treatment propensity scores and additional demographic characteristics. Overall survival stratified by VTE and chemotherapy regimen was estimated using Kaplan–Meier methods and the log‐rank test.

Results

Of 5594 identified patients, a VTE occurred in 13.0%. The VTE rates within 120 days of chemotherapy initiation were 15.3% for GC, 8.7% for MVAC, and 12.0% for CarboG. On multivariable analysis, MVAC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.94) and CarboG (OR 0.71, 95% CI: 0.59–0.85) were associated with lower VTE risk compared with GC. VTE was associated with worse overall survival (P < 0.001).

Conclusions

Compared with GC, MVAC and CarboG were associated with a lower rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Additionally, patients with a VTE had worse survival outcomes than those without a VTE. Analysis of the risk of blood clots with different chemotherapy regimens in patients with urothelial tract cancer showed that GC was associated with the highest rate. We also found that blood clots were associated with worse patient outcomes.
Leukodystrophy caused by plasmalogen deficiency rescued by glyceryl 1‐myristyl ether treatment
Authors: Malheiro Ana R. , Correia Barbara , Ferreira da Silva Tiago , Bessa‐Neto Diogo , Van Veldhoven Paul P. , Brites Pedro
Published: January 2019

Plasmalogens are the most abundant form of ether phospholipids in myelin and their deficiency causes Rhizomelic Chondrodysplasia Punctata (RCDP), a severe developmental disorder. Using the Gnpat‐knockout (KO) mouse as a model of RCDP, we determined the consequences of a plasmalogen deficiency during myelination and myelin homeostasis in the central nervous system (CNS). We unraveled that the lack of plasmalogens causes a generalized hypomyelination in several CNS regions including the optic nerve, corpus callosum and spinal cord. The defect in myelin content evolved to a progressive demyelination concomitant with generalized astrocytosis and white matter‐selective microgliosis. Oligodendrocyte precursor cells (OPC) and mature oligodendrocytes were abundant in the CNS of Gnpat KO mice during the active period of demyelination. Axonal loss was minimal in plasmalogen‐deficient mice, although axonal damage was observed in spinal cords from aged Gnpat KO mice. Characterization of the plasmalogen‐deficient myelin identified myelin basic protein and septin 7 as early markers of dysmyelination, whereas myelin‐associated glycoprotein was associated with the active demyelination phase. Using in vitro myelination assays, we unraveled that the intrinsic capacity of oligodendrocytes to ensheath and initiate membrane wrapping requires plasmalogens. The defect in plasmalogens was rescued with glyceryl 1‐myristyl ether [1‐O‐tetradecyl glycerol (1‐O‐TDG)], a novel alternative precursor in the plasmalogen biosynthesis pathway. 1‐O‐TDG treatment rescued myelination in plasmalogen‐deficient oligodendrocytes and in mutant mice. Our results demonstrate the importance of plasmalogens for oligodendrocyte function and myelin assembly, and identified a novel strategy to promote myelination in nervous tissue.
Can reporting more lead to less? The role of metrics in assessing liver transplant program performance
Authors: Mikolajczyk Adam E. , Rao Vijaya L. , Diaz Geraldine C. , Renz John F.
Published: January 2019

Appropriate metrics for performance analysis is an active topic of debate within the transplant community. This study explores current proposals on metric expansion as well as potential metrics and prospective collaborations that have not received widespread discussion within the transplant community. The premature introduction of additional, nonvalidated metrics risks behaviors that may undermine donor utilization and patient access to transplantation.
Lucio phenomenon mimicking antiphospholipid syndrome: The occurrence of antiphospholipid antibodies in a leprosy patient
Authors: Guevara Bryan E.K. , Saleem Suhail , Chen Wan‐Ting , Hsiao Pa‐Fan , Wu Yu‐Hung
Published: January 2019

Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32‐year‐old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid‐fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.
Biomimicry for Sustainable Innovation: The Answers Are All Around Us
Authors: GaleWyrick Seth
Published: January 2019

Trying to design a new and sustainable solution to a human problem? Chances are some other species has already done it for you.

Got a design problem? Biomimicry offers solutions that are elegant as well as sustainable.
Environment, Meet Design
Authors: Wogsland Andrea
Published: January 2019

Sustainability requires breaking through barriers to entry, navigating needed organizational change, and identifying change makers—all tools of design thinking—and part of that work involves bringing business and financial models to the world of nonprofit conservation organizations.

Bringing business and financial know‐how to the world of nonprofit conservation organizations.
Vegetation type controls root turnover in global grasslands
Authors: Wang Jinsong , Sun Jian , Yu Zhen , Li Yong , Tian Dashuan , Wang Bingxue , Li Zhaolei , Niu Shuli
Published: January 2019

Aim

Root turnover is an important process determining carbon and nutrient cycling in terrestrial ecosystems. It is an established fact that root turnover is jointly regulated by climatic, edaphic and biotic factors. However, the relative importance of these forces in determining the global patterns of root turnover time is far from clear.

Location

Global.

Time period

1946–2017.

Major taxa studied

Grasslands.

Methods

We compiled a database of 141 sites with 433 observations on root turnover time and applied structural equation modelling (SEM) to investigate the relative contribution of climate, soil properties and vegetation type to the observed variations in root turnover time.

Results

Root turnover time was 3.1 years on average across the global grasslands and differed significantly among grassland types (tropical grassland and savanna, temperate grassland and meadow, alpine grassland and meadow, tundra and desert). It decreased with mean annual temperature, mean annual precipitation and Palmer drought severity index but increased with soil organic carbon content, total nitrogen content and carbon : nitrogen ratio. Soil bulk density and soil texture also significantly affected root turnover time, with clay content negatively correlating to root turnover time and explaining more variations than bulk density and sand content. The SEM showed that climatic factors had dominant effects on root turnover time when vegetation type was not considered. Vegetation type became the primary driver when it was included in the SEM.

Main conclusions

Our results indicate that the influences of climatic and edaphic factors on root turnover time are predominantly manifested through vegetation type. The critical role of precipitation as revealed for the first time in this study challenges our current understanding of climate impacts on root turnover time. The findings necessitate accurate representation of vegetation type in Earth system models to predict root function dynamics under global change.