bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing knowledge for a successful competence exploration
Authors: Ahmed Dine Rabeh Hammady , Jimenéz‐Jimenéz Daniel , Martínez‐Costa Micaela
Published: March 2013

Purpose

This paper seeks to assess the importance of absorptive capacity and organizational memory in the process of internal exploitation for a higher organizational performance, and to develop an empirical framework to explain the effect of a firm's memory and its absorptive capacity on exploitation of internal resources and capabilities to generate incremental innovations and thereby improve firm performance.

Design/methodology/approach

Structural equation modeling was used to check the research hypotheses with a sample of 249 Spanish industrial companies.

Findings

The results show that organizational absorptive capacity and the firm's old knowledge positively affect exploitation of existing opportunities. In relation to the interaction between internal exploitation and firm performance, the results show a positive and significant effect. Finally, support was found for the hypothesis that there is a mediator effect of incremental innovation on the relationship between exploitation and organizational performance.

Research limitations/implications

Self‐reporting by the CEOs may be the most significant limitation since a single key informant provided the data; multiple informants would enhance the validity of the research findings. A second limitation is the cross‐sectional design of the research that does not allow observation of the short‐ and long‐term impact of the relationships among the variables; future research should use longitudinal studies. The study was also conducted in a specific national context with manufacturing firms.

Practical implications

Competence exploitation has been argued to be less costly, highly rewarding and less risky that other orientations such as competence exploration. One of the main implications for managers is to assume that both absorptive capacity and organizational memory should be considered in parallel when conducting competence exploitation. The analysis sheds new light on the importance of incremental innovation in the process of enhancing performance.

Originality/value

This paper studies some insufficiently investigated relationships concerning important managerial factors. It also presents a new model attempting to participate in the scientific debate about crucial issues such as the factors that can affect performance generation within the company.
Engaging environments: tacit knowledge sharing on the shop floor
Authors: Nakano Davi , Muniz Jorge , Dias Batista Edgard
Published: March 2013

Purpose

The purpose of this paper is to identify factors that facilitate tacit knowledge sharing in unstructured work environments, such as those found in automated production lines.

Design/methodology/approach

The study is based on a qualitative approach, and it draws data from a four‐month field study at a blown‐molded glass factory. Data collection techniques included interviews, informal conversations and on‐site observations, and data were interpreted using content analysis.

Findings

The results indicated that sharing of tacit knowledge is facilitated by an engaging environment. An engaging environment is supported by shared language and knowledge, which are developed through intense communication and a strong sense of collegiality and a social climate that is dominated by openness and trust. Other factors that contribute to the creation of an engaging environment include managerial efforts to provide appropriate work conditions and to communicate company goals, and HRM practices such as the provision of formal training, on‐the‐job training and incentives.

Practical implications

This paper clarifies the scope of managerial actions that impact knowledge creation and sharing among blue‐collar workers.

Originality/value

Despite the acknowledgement of the importance of blue‐collar workers' knowledge, both the knowledge management and operations management literatures have devoted limited attention to it. Studies related to knowledge management in unstructured working environments are also not abundant.
A critical review of supply chain management frameworks: proposed framework
Authors: Soni Gunjan , Kodali Rambabu
Published: March 2013

Purpose

The literature of supply chain management (SCM) is burgeoning with frameworks but there has been no attempt in extant literature to highlight the inconsistencies present in existing SCM frameworks. The purpose of this paper is to identify these inconsistencies by critically reviewing 57 SCM framework articles. Based on the results of reviewing these articles, an attempt is made to propose a framework that possibly suggests a way to achieve coherency in use of SCM frameworks, and hence help researchers in reducing the inconsistencies that may occur in future frameworks.

Design/methodology/approach

Review of frameworks is based on certain criteria such as novelty of frameworks, participation of practitioners and consultants in making academic frameworks, verification of frameworks, modes of verification and degree of standardization of SCM elements (or constructs).

Findings

The analysis of selected frameworks reveals major inconsistencies, such as negligence of researchers towards adapting existing frameworks, lack of significant participation of practitioners/consultants in development of SCM frameworks and highly incoherent use of elements (or constructs) in development of SCM frameworks. The findings of this paper also establish that further research in SCM should be directed towards finding a “unified theory of SCM” which must lead to a set of coherent elements (or constructs).

Originality/value

The framework articles are selected from a large population of 1,807 articles. These frameworks are critically reviewed in this paper and a debate is initiated on what is a framework and what constitutes a framework in SCM.
Exploring the ambiguity: what faculty leaders really think of sustainability in higher education
Authors: Wright Tarah , Horst Naomi
Published: March 2013

Purpose

The purpose of this paper is to examine how a cohort of university faculty leaders in Canadian universities conceptualize sustainable development, sustainable universities, the role universities play in achieving a sustainable future, key issues facing the university, and the barriers to implementing sustainability initiatives on campus.

Design/methodology/approach

Research was collected through in‐depth interviews with university faculty leaders from university members of the Association of Universities and Colleges of Canada. Interviews included both closed and open‐ended questions and two checklists focused on sustainable development and sustainable universities. Interview transcripts are analyzed through the identification of respondent themes and using N'Vivo software.

Findings

The majority of participants demonstrated they had previously given thought to their own understanding of sustainable development, but less had thought about the term sustainable university. The majority of participants would like to see their institutions incorporate sustainability in the avenues of education, research and daily operations. Participants agreed that the most obvious barriers to sustainability were financial and that leadership, incentive and demand are required to move forward with improving sustainability at universities.

Originality/value

There are few studies that explore the conceptualizations of sustainability, what constitutes a “sustainable university” and what role universities should play in achieving sustainability held by major stakeholders, including faculty leaders. Higher education scholars share a reasonably common understanding of these concepts, but if universities are accountable for creating a sustainable future, all university stakeholders too must share a common understanding. This paper attempts to make a contribution to this significant gap in the literature.
Order imbalance and returns: evidence from India
Authors: Rastogi Nikhil , Reddy V.N. , Kotha Kiran Kumar
Published: March 2013

Purpose

The purpose of this paper is to study the empirical relationship between order imbalance and returns in the backdrop of structural changes in the Indian market.

Design/methodology/approach

The study makes use of hypothesis testing and dummy variable regression to investigate the relationship between order imbalance and returns during the period 1999‐2005, which saw definitive change in the structure of the Indian markets.

Findings

Order imbalance (buying or selling pressure) has significantly reduced post the structural reforms at the daily as well as intra‐day intervals across trade, as well as value measures of order imbalance. After controlling for the number of transactions, order imbalance and return correlations have fallen in the post‐2002 period as compared to the pre‐2002 period, at daily as well as intra‐day intervals. Further, after controlling for past high and low returns, order imbalance exhibits day of the week effect in the pre‐2002 period while no such effect is seen in the post‐2002 period.

Originality/value

The work brings out order imbalance and returns relationship for the Indian market, which has different structure from that of many developed, as well as developing, markets in the backdrop of changes in its own structure. This would provide a richer literature in the area of market structure and design.
Interpretative dimension of user‐driven service innovation
Authors: Pässilä Anne , Oikarinen Tuija , Parjanen Satu , Harmaakorpi Vesa
Published: March 2013

Purpose

The purpose of this paper is to explore a possible way for service providers to learn from their customers' experiences and bridge gaps between their and their customers' perspectives. The research question is as follows: how can users' experiences be transformed through research‐based theatre, in particular Forum Theatre, into a utilizable format in the front‐end of interpretative, user‐driven service innovation in public health care organisations?

Design/methodology/approach

Research‐based theatre (RBT) is introduced in the study as both an artistic intervention technique – aiming to develop public health care services – and as a qualitative research method for interpretative user‐driven innovation processes.

Findings

The study provides a path for the application of Forum Theatre in interpretative user‐driven innovation and highlights the role of “the Joker” as a host of the interpretation.

Research limitations/implications

Further studies could be based on international longitudinal participatory research and combine qualitative and quantitative research methods.

Practical implications

The study contributes to the discussion on the potential of innovation triggered in practical contexts. The potential itself seems to be relatively widely understood, but practical measures to exploit it still seem to be missing to a great extent. This study provides an example of a Finnish application of RBT as it explores the role of Forum Theatre as a sensemaking process in a fuzzy front‐end of innovation.

Originality/value

The study improves the understanding of the implementation of artistic interventions within a user‐driven service innovation in public health care services.
Using interpretive structural modelling to identify and rank performance measures
Authors: Azevedo Susana , Carvalho Helena , Cruz‐Machado V.
Published: March 2013

Purpose

The main purpose of this paper is to identify and rank a set of performance measures using the approach of interpretive structural modelling (ISM) to support the evaluation of automotive supply chain performance.

Design/methodology/approach

The paper develops a framework to analyze the interactions among a suggested set of performance measures using the ISM approach. To identify the contextual relationships among the suggested measures, five experts from the automotive industry were consulted.

Findings

Using the ISM approach the performance measures were clustered according to their driving power and dependence power. Inventory level and lead time are the two performance measures at the bottom level of the hierarchy, implying higher driving power. Operational costs, business wastage, environmental costs, delivery time and customer satisfaction are identified as autonomous measures. This means that they are relatively disconnected from the other suggested performance measures. It is also observed that the cash‐to‐cash cycle is a weak driver but strongly dependent on the other performance measures.

Practical implications

The proposed approach gives managers a better understanding of the performance measures that have most influence on others (driving performance measures) and those measures which are most influenced by others (dependent performance measures). This kind of information is strategic for managers who can use it to identify which performance measures they should concentrate on, and how they can manage the trade‐offs between measures.

Originality/value

This paper highlights the deployment of ISM as a management decision support tool in the identification and ranking of a set of performance measures to make part of a system for the measurement of supply chain performance.
Evidence on changes in time varying volatility around bonus and rights issue announcements
Authors: Malhotra Madhuri , Thenmozhi M. , Arun Kumar G.
Published: March 2013

Purpose

The purpose of this paper is to examine the short‐term and long‐term stock price volatility changes around bonus and rights issue announcements, using historical volatility estimation and time varying volatility approach.

Design/methodology/approach

Changes in volatility around bonus and rights issues have been examined using the following methodologies. First, to capture historical volatility, change in standard deviation for 20 days and 100 days before and after announcement have been examined. Second, change in time varying volatility and unconditional volatility is examined using GARCH (1, 1) model.

Findings

The results indicate that the historical volatility has increased after bonus and rights issue announcement. The volatility persistence and unconditional variance have increased after the bonus and rights issue announcements. This evidence, extendable to any other type of issue announcement, is consistent with theories stating that volatility increases after the seasoned capital issue announcements.

Originality/value

This study analyses historical volatility, volatility persistence and unconditional volatility around bonus and rights issue announcements, which has not been observed in the previous literature. This study fills the gap in literature by empirically examining the change in short‐ and long‐term volatility before and after bonus and rights issue announcements. Moreover, measuring volatility using GARCH model overcomes the potential problem of heteroscedasticity associated with cross‐sectional data. The change in volatility persistence and unconditional volatility before and after the announcement are also examined. This study is useful for researchers and practitioners specialized in finance, international business and management, and professionals in the area of commercial policy development in emerging markets.
A replacement method in evaluating the performance of international mutual funds
Authors: Reza Tavakoli Baghdadabad Mohammad
Published: March 2013

Purpose

The purpose of this paper is to appraise the risk‐adjusted performance of international mutual funds using measures generated by the optimized variance (OV), and to promote ability of portfolio managers and investors in making logical decisions.

Design/methodology/approach

This study appraises the performance of 65 international mutual funds via the optimized risk‐adjusted measures during monthly period of 2001‐2010. Using 65 linear programming models, the OV is calculated to optimize the standard deviation of any funds. Then, another model is run to get the OV of market index. Consequently, seven optimized performance measures namely Treynor, Sharpe, Jensen's alpha, M‐squared, information ratio (IR), MSR, and FPI along with the optimized leverage factor are proposed to evaluate the performance of these mutual funds. Finally, the optimized measures are used to evaluate the funds during pre and post‐crisis periods in order to compare the funds' performance over the crisis periods.

Findings

The empirical evidence detects which OV, as measured by the Markowitz's linear programming model, is an important determinant in the performance evaluation measures. Using OV statistic and also its standard deviation, this paper shows that new optimized measures are mostly over‐performed rather than the benchmark index; in addition these optimized measures have close correlation with the conventional performance measures. The evidence shows that the average of the optimized measures during crisis has the lowest performance in comparison with other research periods. The results therefore highlight the importance of using the new optimized measures along with the conventional measures in the evaluation of mutual funds' performance.

Research limitations/implications

It can be worthwhile to compare the optimized measure and also the conventional measures in identifying their superior measures.

Practical implications

The result of this study can be directly used as initial data to make decision by investors and portfolio managers who are seeking the possibility of participating in the global stock market through international mutual funds.

Originality/value

This paper is one of the first studies that optimizes the variance of return for any fund to suggest four optimized measures of Sharpe, IR, MSR, and FPI, and then proposes a new linear programming model to get OV of market index in introducing four optimized new measures of Treynor, M‐square, Jensen's alpha, and leverage factor.
Serving culturally diverse e‐learners in business schools
Authors: van de Bunt‐Kokhuis Sylvia , Weir David
Published: March 2013

Purpose

The purpose of this paper is to highlight how future teaching in business schools will probably take place in an online (here called 24/7) classroom, where culturally diverse e‐learners around the globe meet. Technologies such as iPhone, iPad and a variety of social media, to mention but a few, give management learners of any age easy 24/7 access to information. Depending on the quality of the materials and the competences and cross‐cultural sensibilities of the teachers and trainers, this information may support the progress of e‐learning in business schools. At the same time, easy online access to knowledge and educational structures is not, in practice, equally available yet across cultures, and this will be documented with comparative cases from the Arab world and African learning communities.

Design/methodology/approach

This article contributes to multicultural education by identifying various barriers in the online management classroom. It combines theories from educational and cross‐cultural leadership studies, as well as e‐learning studies.

Findings

The outcomes of this analysis show how technical, language and cross‐cultural barriers still hinder particular adult learners to benefit from the “24/7 business school”. It is concluded that by understanding and serving a wide range of culturally diverse e‐learners in business schools, the stewardship role of the business school teacher is key.

Originality/value

The interplay between technical, language and cultural barriers in the online business school is rarely reflected upon. It is the intention of the authors to trigger a broad discussion process by focusing on culturally diverse management learners and by connecting with innovative educational insights across histories and cultures.
Keeping relationships positive or doing things right
Authors: Chao Chin‐Chung , Tian Dexin
Published: March 2013

Purpose

The present study aims at contributing to the knowledge of organizational communication and cross‐cultural female leadership by examining conflict management strategies between Taiwanese female presidents and their American counterparts in Rotary Clubs.

Design/methodology/approach

Data were collected through field observations and 25 in‐depth interviews with 14 Taiwanese female presidents and 11 American female presidents in Rotary Clubs. Theme analysis of the interpretive method was used in this research.

Findings

This study revealed that the female presidents in both cultures applied obliging and integrating strategies to handle management conflicts. Yet, due to the interference of past presidents, the Taiwanese women leaders are more likely to follow the traditional norms whereas women leaders in the United States tend to employ new approaches and adopt new conflict management strategies in different situations.

Research limitations/implications

This study has focused on exploring the conflict management strategies of only the female presidents in the Rotary Clubs in Taiwan and the USA rather than male presidents. There may be differences in conflict management between genders.

Practical implications

The application of conflict management strategies may be determined by the factors of face, in‐group relationships, and roles of the invited third party for Taiwanese subjects whereas American subjects usually adopt appropriate strategies according to the nature of the conflicts. That is, the Taiwanese female leaders would endeavor to keep relationships positive or/and keep positive relationships with their members while the American female leaders would strive do things right or/and do the right things for their conflict strategy application.

Originality/value

As the first study of its kind, this study fills a research gap by expanding female conflict management studies to cross‐cultural contexts, thus contributing to the body of human knowledge of cross‐cultural leadership in non‐profit organizations.
Specificities of EU cluster policies
Authors: Obadić Alka
Published: March 2013

Purpose

During the 1990s, most European countries have increased their interest in the direction of industrial districts, clusters and local production systems as an integral part of their industrial policy. At the same time, there have been significant changes in the consideration of industrial policy in Europe. The aim of this paper is to analyze two basic approaches in the development of cluster initiatives in the formation of cluster policy.

Design/methodology/approach

This paper analyzes two basic approaches in the development of cluster initiatives in the formation of cluster policy: top‐down and bottom‐up approach. The analysis also points to the diversity of national approaches in terms of policy clusters, but in the same time at some common trends.

Findings

The development of cluster policy is still at an early stage in most countries. There are also significant differences among the countries of Eastern and Western Europe. Among those countries that have adopted the policy of the cluster after 2000, are mostly small countries in terms of population and/or geographical size of countries in Eastern Europe.

Originality/value

Policies that encourage cluster formation have to be developed, particularly in developing countries and countries in transition that are seeking their place in the international market.
The influence of international trade of goods of the Republic of Croatia
Authors: Kovač Ivan , Kovač Ivana
Published: March 2013

Purpose

This paper aims to analyze the influence of international trade of goods of Croatia in the period from 2001 till 2010. The study shows contribution of exports and imports of goods on the real GDP growth, in time which represented the global economic crisis, of Croatia in comparison to other European countries in the region. International trade has developed as a fast solution from the crisis of every affected national economy.

Design/methodology/approach

To determine previous comprehension of the problems of this research, the data were collected by documentary analysis of domestics and foreign scientific and academic literature. The data were complemented by statistics provided by Croatian Bureau of Statistics, Croatian National Bank, Eurostat and authors' own calculations of the data collected. The paper aims to clarify the level of international trade of goods, imports dependency, exports propensity, and degree of openness and involvement of Croatia in the international trade of goods.

Findings

This study implies that for the Croatian economy, its growth and the development, it is important to raise profit in exports which would result in higher coverage of imports by exports. Main focus in this research is to explore the Croatian industry, its development, competitiveness and international integration; thereby investigate foreign trade of goods. Exports of goods don't have a significant positive contribution to the realised GDP growth rate of Croatia such as other countries in the region.

Originality/value

It is suggested that international market success depends on the competitive ability of all business subjects included in the international trade.
A conceptual valuation framework (VF) for home telecare system devices
Authors: Collinge William H.
Published: March 2013

Purpose

The aim of this paper is to present a conceptual valuation framework to allow telecare service stakeholders to assess telecare devices in the home in terms of their social, psychological and practical effects. The framework enables telecare service operators to more effectively engage with the social and psychological issues resulting from telecare technology deployment in the home and to design and develop appropriate responses as a result.

Design/methodology/approach

The paper provides a contextual background for the need for sociologically pitched tools that engage with the social and cultural feelings of telecare service users before presenting the valuation framework and how it could be used.

Findings

A conceptual valuation framework is presented for potential development/use.

Research limitations/implications

The valuation framework has yet to be extensively tested or verified.

Practical implications

The valuation framework needs to be tested and deployed by a telecare service operator but the core messages of the paper are valid and interesting for readership.

Social implications

In addressing the social and cultural perspectives of telecare service stakeholders, the paper makes a link between the technologies in the home, the feelings and orientations of service users (e.g. residents, emergency services, wardens, etc.) and the telecare service operator.

Originality/value

The paper is an original contribution to the field as it details how the sociological orientations of telecare technology service users should be valued and addressed by service operators. It has a value through the conceptual arguments made and through valuation framework presented.
The politics of securing borders and the identities of disease
Authors: Taylor Rosemary C.R.
Published: March 2013

This article compares the policies adopted by Britain, France and Germany to cope with health threats thought to be posed by entrants and migrants and explains why these governments screened at their borders for tuberculosis but not for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). In order to understand these outcomes, we must recognise that diseases acquire durable identities, conditioned by collective imaginaries and institutional contexts when they first come to attention, which bias subsequent decisions, notably about how to balance the value of mandatory testing against the rights of the individual.
Association Between Preoperative Diuretic Use and In‐hospital Outcomes After Cardiac Surgery
Authors: Bandeali Salman J. , Kayani Waleed T. , Lee Vei‐Vei , Elayda MacArthur , Alam Mahboob , Huang Henry D. , Wilson James M. , Jneid Hani , Birnbaum Yochai , Deswal Anita , Farmer John , Ballantyne Christie M. , Virani Salim S.
Published: March 2013

Background

There is a paucity of evidence on the association between preoperative diuretics use and outcomes following cardiac surgery. We hypothesized that diuretic use prior to cardiac surgery will be associated with adverse in‐hospital clinical outcomes.

Methods

We evaluated patients undergoing cardiac surgery at a single institution between January 1, 2000, and December 31, 2011. Patients were grouped as follows: isolated coronary artery bypass grafting (CABG) (n = 8759), CABG plus valve surgery (n = 1188), and valve surgery only (n = 2646). A fourth group “All cardiac surgery” is comprised of patients from all three groups. Preoperative diuretic use was defined as patient on any diuretic till the day of surgery. Primary outcome was the incidence of major adverse events (MAEs) defined as the composite of mortality, postoperative renal dysfunction, myocardial infarction, stroke, and new‐onset atrial fibrillation (AF). Logistic regression analysis and propensity score matching were performed.

Results

We included 12,593 patients [3546 on diuretic (28%)]. After logistic regression analyses, preoperative diuretic use was associated with an increased risk of the following: (1) MAE among all groups except the concomitant CABG and valve surgery group, (2) AF in “All cardiac surgery” and isolated CABG groups, (3) postoperative renal dysfunction in all groups. After propensity score matching (n = 3050 in each group), preoperative diuretic use was significantly associated with MAE (48% vs. 43%; P < 0.0001), postoperative renal dysfunction (19% vs. 14%; P < 0.0001), and AF (34% vs. 32%; P = 0.03) in the “All cardiac surgery” group.

Conclusion

Preoperative diuretics use is associated with an increased incidence of MAEs after cardiac surgery.
Association of slugs with the fungal pathogen Epichloë typhina (Ascomycotina: Clavicipitaceae): potential role in stroma fertilisation and disease spread
Authors: Hoffman G.D. , Rao S.
Published: March 2013

Epichloë spp. are endophytes of grasses, and form epiphytic external stromata on flowering tillers. E. typhina was first noticed infecting Dactylis glomerata (= orchardgrass, cocksfoot) stands in the Willamette Valley in 1996, and soon became the primary factor limiting the longevity of seed production fields. Several species of slugs are present in these fields, and we investigated their role in E. typhina biology. Pre‐dawn surveys of D. glomerata fields in 2009 and 2010 found Prophysaon andersoni and Arion subfuscus slugs feeding on the fungal stromata. When unfertilised and fertilised immature stromata predominated, approximately 80% of the individuals of these two species that were seen on plants were found on the stromata. As the majority of stromata reached maturity the presence of these species on stromata declined to between 20–40%. The common agricultural slug pest, Deroceras reticulatum, was on stromata only 20% of the time early in the season, and declined to <5% at stromata maturity. Observations of frass from slugs determined that the most common constituent was the food sources upon which the slug species was usually found during these surveys. Typically 100% of the frass from P. andersoni and A. subfuscus contained stroma material, compared to 25% for D. reticulatum. Spermatia, and ascospores later in the season, were commonly seen in the frass of slugs that consumed stromata. Some slugs that had no stroma material in their frass appeared to have consumed spermatia and ascospores from the leaf surface. A multiple‐choice laboratory test confirmed the different proportional preferences of P. andersoni and D. reticulatum for stroma (0.72 vs 0.20) and leaf (0.07 vs 0.38), respectively. Two laboratory multiple‐choice tests, and a field survey, found that P. andersoni preferred unfertilised and immature stroma over mature stroma. D. reticulatum is the most common and abundant slug in Willamette Valley grass seed fields, yet it is the least likely to move spermatia between unfertilised stromata, or ascospores to uninfected plants. P. andersoni and A. subfuscus are mycophagous, frequently transport viable spermatia and ascospores in their frass; yet they are generally confined to field edges. Data and observations suggest the role of slugs in the epidemiology of E. typhina is small compared to other factors.
Providers' Perceptions of the Factors Influencing the Implementation of the New York State Mandatory HIV Testing Law in Two Urban Academic Emergency Departments
Authors: Schnall Rebecca , Clark Sunday , Olender Susan , Sperling Jeremy D.
Published: March 2013

Objectives

Of the 1.1 million people in the United States infected with human immunodeficiency virus (HIV), more than 20% are unaware of their infection. To increase early diagnosis and treatment, New York State recently passed legislation mandating that HIV testing be offered to all patients, ages 13 to 64 years, receiving health care services. Implementation of this legislation is complex, especially in the emergency department (ED). This study explores ED providers' perceptions of the factors affecting the implementation of the law.

Methods

The authors conducted six focus group sessions and three in‐depth interviews with ED health care providers from two New York City teaching hospitals. Sessions were audiotaped and transcribed. Data were coded and summarized thematically through an iterative process after each session.

Results

A total of 49 providers participated and data saturation was achieved. Six factors were identified that predispose a provider to offer an HIV test: 1) self‐efficacy, 2) behavioral intention, 3) the testing process, 4) provider knowledge of the legislation, 5) type of HIV test, and 6) follow‐up procedures. Five factors were identified that enable providers to offer an HIV test: 1) resources related to time, 2) space, 3) staff, 4) type of test, and 5) timing of the offer. Improving access to HIV testing, linkage to care, and public health were all key factors in reinforcing providers' desire to offer HIV tests. Concerns regarding overall cost saving and coverage for the test were indicated as barriers that needed to be resolved to reinforce the providers to offer an HIV test.

Conclusions

Understanding the factors influencing the practice of ED providers charged with carrying out this mandate is critical. Despite earlier research that indicated that offering HIV testing to ED patients is largely influenced by cost, this study found additional factors that are important to consider to effectively implementing HIV testing in the ED.
Pediatric Emergency Medicine Fellow Training in Ultrasound: Consensus Educational Guidelines
Authors: Vieira Rebecca L. , Hsu Deborah , Nagler Joshua , Chen Lei , Gallagher Rachel , Levy Jason A.
Published: March 2013

The importance of point‐of‐care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.
Emergency Department Management of Childhood Pneumonia in the United States Prior to Publication of National Guidelines
Authors: Neuman Mark I. , Shah Samir S. , Shapiro Daniel J. , Hersh Adam L.
Published: March 2013

Background

Recent publication of national guidelines by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) provide recommendations around diagnostic testing and antibiotic treatment for children with community‐acquired pneumonia (CAP). These guidelines emphasize limited use of chest radiograph (CXR) and complete blood count (CBC) and routinely performing viral testing and use of narrow‐spectrum antibiotics.

Objectives

The objective was to estimate the rate of emergency department (ED) visits for pediatric CAP in the United States and to describe management of patients prior to publication of consensus national guidelines.

Methods

Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits from 2001 through 2009 for children with CAP.

Results

During the study period there were an estimated 375,000 ED visits for CAP annually; 85% occurred within a general, rather than pediatric, ED. Overall, 20% of children with CAP were hospitalized. Among children discharged from EDs with CAP, CBC was performed during 30% of visits, CXR during 83%, and viral testing in only 13%. Twelve percent of children discharged from EDs with CAP had blood cultures obtained. No major differences were observed in the rates of laboratory testing or antibiotic administration between children treated in general versus pediatric EDs. During the study period, only 21% of children discharged from EDs with CAP received amoxicillin, the guideline‐recommended antibiotic.

Conclusions

Most ED visits for CAP in the United States occur in general EDs. To encourage care that is consistent with national guidelines, efforts should be made to reduce the performance of certain diagnostic testing, such as CBC and CXR, among children discharged from EDs with CAP. Additionally, the use of narrow‐spectrum antibiotics should be encouraged.
A Novel Approach to Incorporating Evidence‐based Medicine Into an Emergency Medicine Clerkship
Authors: Snashall Jonathan , Fair Malika , Scott James
Published: March 2013

Objectives

Despite the growing emphasis of evidence‐based medicine (EBM) in the medical school curriculum, and the recognition of EBM's role in the practice of emergency medicine (EM), there are no current guidelines on how to teach EBM to fourth‐year medical students during their EM rotations. The goal was to create a unique EM clerkship curriculum that teaches students to incorporate EBM into their clinical decision‐making and complies with the core curriculum recommendations of the Clerkship Directors in Emergency Medicine (CDEM).

Project Description

Prior to a scheduled, case‐based small group discussion, students are provided with a clinically relevant question to investigate. Case discussions are led by EM faculty with each case highlighting a core EM topic developed by CDEM. During the case discussion, the assigned clinical question is addressed and a plan of care is presented based on the tenets of EBM. Faculty members function as moderators for these discussions and provide individual feedback regarding search strategies, appraisal of the literature findings, and applicability to the patient population. This multifaceted approach to EBM through the incorporation of individual student literature searches, clinical vignettes, small group discussion with consensus building, and faculty moderation with timely feedback is an innovative educational technique. Future educational research must explore the efficacy of this curriculum and whether or not the model produces greater long‐term understanding of EBM by students and if similar curricula can be executed at other institutions.

Conclusions

The authors have developed a novel fourth‐year EM clerkship curriculum that integrates EBM through the use of a highly interactive, faculty‐led, small group‐learning environment that encourages students to develop the necessary skills to integrate EBM into their clinical practice.
Assessing the Validity Evidence of an Objective Structured Assessment Tool of Technical Skills for Neonatal Lumbar Punctures
Authors: Iyer Maya S. , Santen Sally A. , Nypaver Michele , Warrier Kavita , Bradin Stuart , Chapman Rachel , McAllister Jennifer , Vredeveld Jennifer , House Joseph B.
Published: March 2013

Background

The lumbar puncture (LP) is a procedural competency deemed necessary by the Accreditation Council for Graduate Medical Education and the Emergency Medicine and Pediatric Residency Review Committees. The emergency department (ED) is a primary site for residents to be evaluated performing neonatal LPs. Current evaluation methods lack validity evidence as assessment tools.

Objectives

This was a pilot study to develop an objective structured assessment of technical skills for neonatal LP (OSATS‐LP) and to document validity evidence for the instrument in regard to five sources of test validity: content, response process, relation to other variables, inter‐rater reliability, and consequences of testing.

Methods

Pediatric residents were videotaped in the fall of 2011 for comparison of faculty evaluation of resident performance during a neonatal LP using a video‐delayed format. Residents completed a demographic experience survey evaluating relations to other variables. Content and response process validity was obtained through expert panel meetings and resulted in the following seven domains of performance for the OSATS‐LP: preparation, positioning, analgesia, needle insertion, cerebrospinal fluid (CSF) collection, management of laboratory studies, and sterility. t‐tests assessed significance between level of training, previous intensive care unit experience, and residents' self‐assessed confidence in comparison with their total performance score. The inter‐rater agreement of the OSATS‐LP was obtained using the Fleiss' kappa for each domain.

Results

Sixteen pediatric residents completed the simulation with six raters evaluating each resident (96 ratings). The domains of sterility and CSF collection had moderate statistical reliability (κ = 0.41 and 0.51, respectively). The domains of preparation, analgesia, and management of laboratories had substantial reliability (κ = 0.60, 0.62, and 0.62, respectively). The domains of positioning and needle insertion were less reliable (κ = 0.16 and 0.16, respectively). Individuals who had completed one or more rotations in the neonatal intensive care unit (NICU) had a higher total score (12.5 vs. 16.9; p < 0.01). The residents' own perception of ability to perform an LP unsupervised did not result in a higher total score.

Conclusions

The OSATS‐LP has reasonable evidence in four of the five sources for test validity. This study serves as a launching point for using this tool in clinical environments such as the ED and, therefore, has the potential to provide real‐time formative and summative feedback to improve resident skills and ultimately lead to improvements in patient care.
Interpreting Red Blood Cells in Lumbar Puncture: Distinguishing True Subarachnoid Hemorrhage From Traumatic Tap
Authors: Czuczman Amanda D. , Thomas Lisa E. , Boulanger Alyson B. , Peak David A. , Senecal Emily L. , Brown David F. , Marill Keith A.
Published: March 2013

Objectives

The study purpose was to determine the optimal use of lumbar puncture (LP) red blood cell (RBC) counts to identify subarachnoid hemorrhage (SAH) when some blood remains in the final tube.

Methods

A case series was performed at a tertiary emergency department (ED). Records of 4,496 consecutive adult patients billed for LPs between 2001 and 2009 were reviewed. Inclusion criteria were headache (HA), final tube RBCs ≥ 5, and neurovascular imaging within 2 weeks of the visit. Demographics, relevant history and physical examination components, LP results, and neuroimaging findings were recorded for 280 patients. True‐positive (TP) and true‐negative (TN) SAH were strictly defined. Primary outcomes were the areas under the receiver operating characteristic curves (AUC) for final tube RBC count, differential RBC count between the final and initial tubes, and absolute differential RBC count between the final and initial tubes divided by the mean RBC count of the two tubes (also called the percent change in RBC count).

Results

There were 26 TP and 196 TN results; 58 patients were neither. The TP group consisted of 19 patients with visible or possible SAH on imaging (17 on noncontrast head computed tomography [CT; 12 definite and five possible] and two on magnetic resonance imaging), six with xanthochromia and a vascular lesion (aneurysm or arteriovenous malformation [AVM] > 2 mm), and one with xanthochromia and polymerase chain reaction (PCR)‐positive meningitis. As a test for SAH, final tube RBC AUC was 0.85 (95% confidence interval [CI] = 0.80 to 0.91). Interval likelihood ratios (LRs) for final tube RBC count were LR 0 (95% CI = 0 to 0.3) for RBCs < 100, LR 1.6 (95% CI = 1.1 to 2.3) for 100 < RBCs < 10,000, and LR 6.3 (95% CI = 4.8 to 23.4) for RBCs > 10,000. Differential RBC count was not associated with SAH, with AUC 0.45 (95% CI = 0.31 to 0.60). However, the percent change in RBC count between the final and initial tubes had an AUC 0.84 (95% CI = 0.78 to 0.90), and the optimal test threshold for SAH was 0.63, with positive LR 3.6 (95% CI = 2.7 to 4.7) and negative LR 0.10 (95% CI = 0.03 to 0.4) for percent change <63% and >63%, respectively. This test added additional independent information to the final tube RBC count based on improved logistic regression model fit and discriminatory ability as measured by the LR test and c statistic, respectively.

Conclusions

Final LP tube RBC count and the percent change in RBC count, but not the simple differential count between the final and initial tubes, were associated with SAH. In this sample, there were no patients with SAH who had RBCs < 100 in the final tube, and RBCs > 10,000 increased the odds of SAH by a factor of 6.