bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving patient satisfaction: the virtual breakthrough series collaborative
Authors: Wijaya Made Indra , Mohamad Abd Rahim , Hafizurrachman Muhammad
Published: January 2019

Purpose

The purpose of this paper is to improve the Siloam Hospitals’ (SHs) patient satisfaction index (PSI) and overcome Indonesia’s geographical barriers.

Design/methodology/approach

The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman’s test.

Findings

The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman’s test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases (Z=3.317, p=0.003) between the baseline and continuous improvement phases (Z=6.633, p<0.001), and between the action and continuous improvement phases (Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.

Research limitations/implications

The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.

Practical implications

The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.

Originality/value

The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.
Service quality and urolithiasis patient adherence
Authors: Golshan Shabnam , Feizy Tahereh , Tavasoli Sanaz , Basiri Abbas
Published: January 2019

Purpose

Adherence to preventive recommendations improves clinical outcomes and is compulsory for long-term prevention in urolithiasis patients. Service quality can affect patients’ adherence to treatment and care. The purpose of this paper is to compare perceived service quality, using the SERVQUAL model, between urolithiasis patients who were nonadherent to their follow-up visits and those who were adherent, in a stone prevention clinic, Tehran, Iran.

Design/methodology/approach

This was a cross-sectional study on patients with urolithiasis referred to the Shahid-Labbafinejad Hospital stone prevention clinic between 2010 and 2014. All patients withdrawing from follow-up visits were selected as the nonadherent group. Patients with follow-up visits were randomly selected and appointed as the adherent group. Data included demographic, service quality (assessed using the SERVQUAL) and a questionnaire about the reason for withdrawal from follow-up visits. Man–Whitney U test, χ2 and binary logistic regression were used for data analyses.

Findings

In total, 531 nonadherent and 51 adherent patients entered the study. SERVQUAL results revealed that patients’ expectations were significantly higher than their perceptions in all five service quality dimensions in both groups. The adherent group had better-quality scores. Responsibility, assurance and empathy scores significantly increased patient adherence odds.

Research limitations/implications

Uni-center design; missing data, such as socioeconomic status and disease severity, which may influence treatment adherence; and missing data regarding adherence to medication and dietary advice were limitations.

Practical implications

Service quality needs to be improved in all dimensions.

Originality/value

Since responsiveness, assurance and empathy dimensions determined patients’ adherence, giving special attention to these dimensions could improve patient adherence.
Patients’ perceptions of healthcare quality in Ghana
Authors: Anabila Peter , Kumi Desmond Kwadjo , Anome Janet
Published: January 2019

Purpose

The purpose of this paper is to investigate the role of service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) in Ghana’s health sector and a comparative analysis of private and public hospital SQ.

Design/methodology/approach

A convenient sample of 1,236 respondents was generated from both private and public hospitals. The study utilises an asymptotic distribution free estimation technique in CB-SEM using LISREL to test the relationships, while Wilcoxon–Mann–Whitney test was used to determine the differences in SQ performances between private and public hospitals.

Findings

The study found a significant positive relationship between SQ and CS. Also, the study found a significant positive relationship between CS and CL. Finally, SQ was found to be better in private hospitals, resulting higher CS and CL.

Practical implications

The study highlights the significant role SQ plays in generating CS and CL to guide healthcare provider policy decision making to improve healthcare delivery. It also serves as a guide to patients to make informed decisions regarding the choice of alternative hospitals.

Originality/value

The study provides a useful guide to strategy and policy formulation in the healthcare sector by exploring the potential viability of SERVQUAL-related model as a relevant tool for assessing SQ in Ghana’s health sector. The results also identified SQ gap between private and public hospitals and thus have implications on how hospitals should strategise to improve their SQ.
Better get moving on laboratory quality assurance
Authors: Ali Sidra Asad , Shaikh Muhammad Shariq
Published: January 2019

Purpose

With recent advances in laboratory hematology automation, emphasis is now on quality assurance processes as they are indispensable for generating reliable and accurate test results. It is therefore imperative to acquire efficient measures for recognizing laboratory malfunctions and errors to improve patient safety. The paper aims to discuss these issues.

Design/methodology/approach

Moving algorithm is a quality control process that monitors analyzer performance from historical records through a continuous process, which does not require additional expenditure, and can serve as an additional support to the laboratory quality control program.

Findings

The authors describe an important quality assurance tool, which can be easily applied in any laboratory setting, especially in cost-constrained areas where running commercial controls throughout every shift may not be a feasible option.

Originality/value

The authors focus on clinical laboratory quality control measures for providing reliable test results. The moving average appears to be a reasonable and applicable choice for vigilantly monitoring each result.
Assessing hospital quality management systems: evidence from Iran
Authors: Zarei Ehsan , Karimi Soghra , Mahfoozpour Soad , Marzban Sima
Published: January 2019

Purpose

A quality management system (QMS) is defined as interacting activities, methods and procedures used to monitor, control and improve service quality. The purpose of this paper is to describe the QMS status using the Quality Management System Index (QMSI) in hospitals affiliated to Shahid Beheshti Medical Sciences University in Tehran, Iran.

Design/methodology/approach

In this cross-sectional study, 28 hospitals were investigated. A validated 46-item questionnaire was used for data collection. Data were analyzed using descriptive statistics, Pearson correlation, independent student’s t-test and regression analysis.

Findings

The mean QMSI score was 18.4: 15.3 for public and 20.9 for non-public hospitals (p=0.001). The lowest (1.96) and the highest (2.14) scores related to “Quality policy documents” and “Quality monitoring by the board,” respectively. The difference between public and non-public hospitals was significant in all nine QMSI dimensions (p=0.001). The QMSI score was higher in non-public and small hospitals than in public and large ones (p=0.05).

Originality/value

Most QMS studies come from developed countries, and there is no systematic information about the mechanisms and processes involved in implementing QMS in developing countries like Iran. This is the first study on Iranian hospital QMS using a newly developed tool (QMSI), and results showed that QMS maturity in these hospitals was relatively good, but the non-public hospitals status (private and charity) was far better than public hospitals.
Evaluating inputs of failure modes and effects analysis in identifying patient safety risks
Authors: Simsekler Mecit Can Emre , Kaya Gulsum Kubra , Ward James R. , Clarkson P. John
Published: January 2019

Purpose

There is a growing awareness on the use of systems approaches to improve patient safety and quality. While earlier studies evaluated the validity of such approaches to identify and mitigate patient safety risks, so far only little attention has been given to their inputs, such as structured brainstorming and use of system mapping approaches (SMAs), to understand their impact in the risk identification process. To address this gap, the purpose of this paper is to evaluate the inputs of a well-known systems approach, failure modes and effects analysis (FMEA), in identifying patient safety risks in a real healthcare setting.

Design/methodology/approach

This study was conducted in a newly established adult attention deficit hyperactivity disorder service at Cambridge and Peterborough Foundation Trust in the UK. Three stakeholders of the chosen service together with the facilitators conducted an FMEA exercise along with a particular system diagram that was initially found as the most useful SMA by eight stakeholders of the service.

Findings

In this study, it was found that the formal structure of FMEA adds value to the risk identification process through comprehensive system coverage with the help of the system diagram. However, results also indicates that the structured brainstorming refrains FMEA participants from identifying and imagining new risks since they follow the process predefined in the given system diagram.

Originality/value

While this study shows the potential contribution of FMEA inputs, it also suggests that healthcare organisations should not depend solely on FMEA results when identifying patient safety risks; and therefore prioritising their safety concerns.
Drivers and internalisation of the EFQM excellence model
Authors: Escrig-Tena Ana B. , Garcia-Juan Beatriz , Segarra-Ciprés Mercedes
Published: January 2019

Purpose

Although the European Foundation for Quality Management (EFQM) Excellence Model has been widely adopted throughout Europe, a thorough examination of the factors that contribute to the internalisation of the model (i.e. a substantive adoption) has been neglected in the literature. The purpose of this paper is to present a model that analyses the drivers of the real internalisation of the EFQM excellence model, with a focus on the role of motives for adoption, and appraisal and compensation systems.

Design/methodology/approach

An empirical study was carried out based on a sample of Spanish organisations that had been awarded EFQM recognition. Structural equation models, cluster analysis and ANOVA were used to examine the research questions.

Findings

Internal motives concerning the creation of a participative style are the main driver of internalisation. Moreover, having an appraisal system-oriented towards the development of employees helps the substantive adoption of the EFQM model. These findings reinforce the importance of the soft elements of the EFQM model.

Originality/value

This study enhances evidence about the motives for adoption and their influence on the internalisation of the EFQM model. It analyses internalisation in a novel context, EFQM recognised organisations, and contributes to the debate about the efficacy of the EFQM model to performance improvement, by unveiling the factors that could foster the internalisation of the model within the organisational routines.
Determinants of student entrepreneurship
Authors: Alves André Cherubini , Fischer Bruno , Schaeffer Paola Rücker , Queiroz Sérgio
Published: January 2019

Purpose

The purpose of this paper is to analyze this phenomenon and identify its determinants using data from Brazilian higher education institutions.

Design/methodology/approach

Based on a data set comprehending 2,230 university students from 70 different institutions across the country, the authors develop five Probit models to assess impacts related to individual traits and systemic conditions on five dependent dimensions: entrepreneurial activity, potential entrepreneurs, high-impact entrepreneurship, serial entrepreneurship and innovation-driven entrepreneurship.

Findings

The lack of significance in many of the variables included in estimations suggests that student entrepreneurship seems to be a rather random phenomenon in Brazil.

Research limitations/implications

Findings pose challenges for student entrepreneurship, as targets for intervention are not clear.

Originality/value

Over the past decades, universities have been receiving an increasing demand to go beyond their role of producing science and technology to explore its knowledge potential to produce novel commercial applications. However, while there is a growing interest in ways to foster scientific academic entrepreneurship, universities also serve as a positive environment for student entrepreneurship training, knowledge sharing, testing ideas and learning. So far, the importance of student entrepreneurship has received far less attention than it likely deserves.
Listening and perseverance – two sides to a coin in quality evaluations
Authors: Janakiraman Narayan , Bullemore Jorge , Valenzuela-Fernández Leslier , Jaramillo Jorge Fernando
Published: January 2019

Purpose

The purpose of this study is to examine how a service provider’s offer quality is evaluated (OQ).This study shows that attitude toward the salesperson in a service context (AS) is an important antecedent to OQ.

Design/methodology/approach

This study involves three studies, first is a dyadic data analyzed with HLM, second is an experiment and the third an IAT.

Findings

The findings of this study show that active empathetic listening increases offer quality evaluations, regardless of the AS level. However, at lower levels of AS,sales perseverancenegatively affects offer quality evaluations.

Originality/value

While research suggests that listening is extremely important, there is also research that suggests that perseverance is more important. Considering data from sales people and from consumers, the authors examine when listening and when perseverance is important.
Addie’s coffin: consumption decisions in pursuit of an appropriate death
Authors: Kopp Steven W. , Kemp Elyria
Published: January 2019

Purpose

Research on death and dying in Western culture holds that individuals engage in a denial and repression of thoughts about death. However, this paper aims to propose that some individuals actively make attempts to exercise control over their eventual demise by engaging in decision-making to achieve an “appropriate death.” A framework is introduced that provides the basis for exploring aspects of decision-making for end of life.

Design/methodology/approach

Depth interviews were conducted with 18 consumers about their dispositions toward death and their decision-making regarding their own funerals.

Findings

An analysis of the consumer narratives suggests that individuals make efforts to prepare for end of life by reducing conflict and finishing business, enlisting identity management strategies and coming to terms with death itself. Unique consumption experiences and decisions accompany each of these efforts.

Research limitations/implications

This research provides understanding regarding how individuals cope with death by attempting to enlist control over a situation in which they have very little control. In doing so, these individuals make efforts to achieve an “appropriate death” by making explicit decisions for end of life.

Originality/value

Instead of actively engaging in defense mechanisms to deny and repress thoughts of death, this research demonstrates that individuals may recognize the inevitability of death as fulfillment of life. In doing so, they may subscribe to positive illusions regarding end of life and make attempts to exercise control over the event.
The impact of personality and cognitive style of managers on their work types
Authors: Saha Surajit , Sharma R.R.K.
Published: January 2019

Purpose

The purpose of this paper is to explore the relationships between the personality and cognitive styles of managers and different types of work.

Design/methodology/approach

The personality types and cognitive styles of managers were measured, respectively, with the help of the Big Five personality factors and Jung’s cognitive types. Different types of works in an organization were categorized in three ways: identity, institutional and integrative work. A survey questionnaire method was used to collect data from a sample of 107 managers from a diverse range of industries, and these data were used to test the hypotheses.

Findings

The study found that intuitive feeling and intuitive thinking types of cognitive styles are suitable for identity and integrative kinds of work, respectively. Openness to experience and conscientiousness positively correlate with identity work. For institutional work, conscientious personality trait is most important for managers; agreeableness has a negative impact on identity work and institutional work.

Practical implications

This study will assist recruitment and staffing professionals, when recruiting managers for an organization, and the paper should be interesting for readers in industry (professionals in HR, managerial career development and managerial competence audit and counseling) and academia (research scholars).

Originality/value

Analysis of theses relationship types is unavailable in the literature of leadership and organizational studies. It can help organizations utilize their human resources efficiently.
State-of-the-art of probabilistic performance based structural fire engineering
Authors: Shrivastava Mayank , Abu Anthony , Dhakal Rajesh , Moss Peter
Published: January 2019

Purpose

This paper aims to describe current trends in probabilistic structural fire engineering and provides a comprehensive summary of the state-of-the-art of performance-based structural fire engineering (PSFE).

Design/methodology/approach

PSFE has been introduced to overcome the limitations of current conventional design approaches used for the design of fire-exposed structures, which investigate assumed worst-case fire scenarios and include multiple thermal and structural analyses. PSFE permits buildings to be designed in relation to a level of life safety or economic loss that may occur in future fire events with the help of a probabilistic approach.

Findings

This paper brings together existing research on various sources of uncertainty in probabilistic structural fire engineering, such as elements affecting post-flashover fire development, material properties, fire models, fire severity, analysis methods and structural reliability.

Originality/value

Prediction of economic loss would depend on the extent of damage, which is further dependent on the structural response. The representative prediction of structural behaviour would depend on the precise quantification of the fire hazard. The incorporation of major uncertainty sources in probabilistic structural fire engineering is explained, and the detailed description of a pioneering analysis method called incremental fire analysis is presented.
Intellectual structure of international new venture research
Authors: Rodríguez-Ruiz Félix , Almodóvar Paloma , Nguyen Quyen T.K.
Published: January 2019

Purpose

This paper aims to identify the most influential papers/authors, publication outlets and theoretical and empirical research topics of the international new venture (INV) literature.

Design/methodology/approach

The authors examine the intellectual structure of the INV literature using bibliometric citation and co-citation analysis. The authors focus on the 100 most cited papers in this research stream published between 1994 and 2015. In the post-hoc reading, they supplement their main bibliometric techniques with the content analysis method to shed light on some issues.

Findings

The authors find that the literature has grown significantly over the past two decades, increasing its relevancy in the academic discourse. The findings show the interdisciplinary nature of the INV literature, where we can find different research topics: Definition of INVs, measurements of “newness” and “degree of internationalization” and the characteristics of international entrepreneurs; time dimension in terms of speed of internationalization; international versus domestic new ventures; and the relationships between firm-specific advantages, international strategy and INV performance.

Originality/value

The authors identify the most influential studies and authors in the INV discipline and show its evolution from the very start to the present. They present the key topics in the literature and highlight the theoretical debates and the inconsistencies between theoretical conceptualization and measurements in the empirical work. The authors offer suggestions for promising future research directions and identify the major conceptual framework on which future research can be constructed. Overall, this study contributes to enhance the understanding of the INV phenomenon and provides useful new insights.
Changing disturbance‐diversity relationships in temperate ecosystems over the past 12000 years
Authors: Kuneš Petr , Abraham Vojtěch , Herben Tomáš
Published: January 2019

Disturbances such as fires and grazing have major impacts on biodiversity. While it has been suggested that species richness is highest with intermediate levels of disturbance, currently there is no consensus due to an absence of data covering large temporal and spatial scales.

We developed a new method to examine disturbance‐diversity relationships (DDR) using sedimentary pollen data linked with species’ disturbance ecology. We reconstructed disturbance and diversity dynamics in the region of the European temperate zone over the last 12,000 years and calculated DDR for 900‐year sequential temporal windows.

Disturbance frequency was highest in the early and late Holocene, while remaining low in the mid‐Holocene. Diversity increased continuously from the start of the Holocene. Our results demonstrate that over the past 12,000 years DDR changed from hump‐shaped into monotonic increasing pattern. While both highly disturbed and undisturbed sites were strongly impoverished in the early Holocene, as species migrated, biodiversity levels have subsequently affected disturbance regimes with highly disturbed sites now being the highest in species richness.

Synthesis. Land‐use changes in the last 4,000 years created an increasingly patchy landscape, allowing invasive species adapted to high‐frequency disturbance to migrate across the landscape. The link between high diversity and disturbed areas is relatively recent and may anticipate even greater disturbance frequencies in future. Our findings also support a hypothesis that species migration, and the structure of the species pool critically determines the response of biota to external factors such as disturbance.
Climate–fire–vegetation interactions and the rise of novel landscape patterns in subalpine ecosystems, Colorado
Authors: Calder William John , Stefanova Ivanka , Shuman Bryan
Published: January 2019

Interactions at multiple scales can shape how forest ecosystems respond to both climate change and disturbance. At landscape scales, feedbacks cause vegetation and wildfire regimes to alter one another, while forest patterns at local scales can result from feedbacks between plants and their abiotic environment. Consequently, disturbances and abiotic changes may give rise to forest patterns that further affect processes like wildfire.

Examples may exist in the history of subalpine ribbon forests, which are alternating areas of forest and meadow where snow drifting and linear bands of trees depend upon each other. Just as ongoing climate changes may change snow levels and the dynamics in these forests, past climate changes and wildfires may have generated the conditions suitable for ribbon forests.

To examine feedbacks in subalpine forests and the potential that climate changes and fires gave rise to ribbon forests, we obtained six fossil pollen records from a subalpine landscape in Colorado. Forests there may have responded to climate change and widespread wildfires ˜1,000 years ago when >80% of sites on the landscape burned within a century. The fires coincided with regional warming, but the extent of burning declined before the climate cooled, possibly driven by changes in fuel structure and composition.

The pollen records indicate that large vegetation changes coincided with the widespread wildfires at five of the six sites. Pollen assemblages consistent with ribbon forests first became important at this time as sagebrush (Artemisia) and other meadow taxa increased and conifers, especially spruce (Picea) declined. The ribbon forests emerged as novel fuel breaks at the time when temperatures rose ˜0.5°C but the number of sites burned per century declined. Cooling during the Little Ice Age then expanded the openings and extent of ribbon forests, probably helping to reduce the frequency of fires across our sites to its minimum.

Synthesis. The rise of ribbon forests in northern Colorado illustrates how climate and fire can interact to rapidly transform landscapes and disturbance regimes. The interactions can produce forest patterns with unexpected consequences such as reduced wildfire despite regional warming.
Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL IIItrial)
Authors: Nijman TAJ , van Baaren GJ , van Vliet EOG , Kok M , Gyselaers W , Porath MM , Woiski M , de Boer MA , Bloemenkamp KWM , Sueters M , Franx A , Mol BWJ , Oudijk MA
Published: January 2019

Objective

To assess the cost‐effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth.

Design

An economic analysis alongside a randomised clinical trial (theAPOSTEL IIIstudy).

Setting

Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium.

Population

Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban.

Methods

We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses.

Main outcome measures

Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes.

Results

Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) −€8479 [95% confidence interval (CI) −€14,327 to −€2016)]; multiple pregnancies: €90,248 versus €102,292,MD−€12,044 (95%CI−€21,607 to € −1671). There was a non‐significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group.

Conclusion

Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation.

Tweetable abstract

In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
Authors: Cook Benjamin L. , Wang Ye , Sonik Rajan , Busch Susan , Carson Nicholas , Progovac Ana M. , Zaslavsky Alan M.
Published: January 2019

Introduction

After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warning dissemination.

Methods

We analyzed antidepressant prescriptions for youth aged 5‐17 in 2002‐2006 Medicaid claims data from four states (CA, FL, NC, and NY). In multilevel models, we assessed provider‐ and patient‐level contributions to changes in antidepressant use by race/ethnicity and compared responses to the box warning between providers with large (>2/3) and small (<1/3) proportions of minority patients.

Results

A significant amount of variance in overall prescribing patterns (calculated by the ICC) was explained at the provider level. Significant provider‐level variation was also identified in the differential effect of the box warning by racial/ethnic group. In a test of the influence of provider panel mix, we found that providers with large proportions of minority patients reduced antidepressant prescribing more slowly after the box warning than other providers.

Discussion

This study is the first to assess provider‐ and patient‐level variation in the impact of a health care policy change on treatment disparities. Black and Latino youth Medicaid beneficiaries were seen by largely different providers than their White counterparts, and these distinct providers were influential in driving antidepressant prescription patterns following the box warning. Concerted outreach to providers of minority beneficiaries is needed to ensure that risk warnings and clinical innovations diffuse swiftly across racial/ethnic minority groups.
The uneasy alliance of organisational culture and equal opportunities for ethnic minority groups: A British example
Authors: Ogbonna Emmanuel
Published: January 2019

Recent statistics suggest that there is a continuing disparity in labour market outcomes between ethnic minority (EM) groups and their White counterparts. However, although there is now an abundance of statistical and anecdotal evidence that speaks to the disadvantage of EM groups, there is less understanding of the intraorganisational dynamics that give rise to the outcomes that are reported. Drawing on postcolonial, cultural capital, and social capital theories, this article argues that the dominant approach through which organisational culture is conceptualised and the ways in which it is commonly managed may encourage labour market inequality and disadvantage for EM groups (defined as access to employment and having opportunities for promotion while in employment). The article explores three intraorganisational interventions that are common in culture management initiatives (leadership, selective recruitment, and internal promotion) to illustrate the arguments. The article concludes by discussing a series of implications and highlighting the pivotal role of the HR academy and practitioners in generating deeper insights and attention into the potential sources of EM disadvantage that are linked to culture and culture management.
Impact of a Women‐focused Professional Organization on Academic Retention and Advancement: Perceptions From a Qualitative Study
Authors: Lin Michelle P. , Lall Michelle D. , Samuels‐Kalow Margaret , Das Devjani , Linden Judith A. , Perman Sarah , Chang Anna Marie , Agrawal Pooja
Published: January 2019

Objectives

Organizations to promote career networking and mentorship among women are recommended as a best practice to support the recruitment and retention of women physicians; however, the impact of such organizations is unknown. Our primary objective is to describe the impact of a national woman‐focused organization for academic emergency physicians on retention and advancement.

Methods

We conducted semistructured interviews of past and present organization leaders, as well as members at varying stages in their careers. Physicians with experience in qualitative methods conducted interviews and coded all transcripts using inductive content analysis techniques. Themes were reviewed and discussed to ensure consensus.

Results

We performed 17 interviews lasting 20 to 30 minutes each, resulting in 476 total minutes of transcript. Participants represented varying stages of career experience, ranging from 2 to 35 years since residency completion (median = 9.5 years). Median years of participation in the woman‐focused organization was 10 years. Over half (53%) of participants were past presidents of the organization. The dominant themes encompassed facilitating academic advancement through scholarly productivity, leadership experiences, awards, and promotions; mentorship and sponsorship; peer support and collaborations; reduced professional isolation; and initiatives to address systemic gender inequities and challenges, including strategies to navigate bias, promote pay equity, and advocate for family‐friendly workplace policies.

Discussion

Active participation in a woman‐focused professional organization enhances members’ career retention and advancement by creating opportunities and relationships that facilitate leadership, enabling scholarly work to advance equity and inclusion, and cultivating a sense of belonging. While challenges and barriers persist, the myriad benefits of a women‐focused professional organization reported by members and leaders represent important steps toward greater equity for women and other underrepresented groups in academic medicine.
Pharmaceutical payments to physicians may increase prescribing for opioids
Authors: Nguyen Thuy D. , Bradford W. David , Simon Kosali I.
Published: January 2019

Background and Aims

Given the recent complete suspension of opioid‐related promotional activities aimed at physicians, interest has renewed in understanding the role of promotion in the US opioid crisis. The present analysis aimed to measure associations between such interactions and opioid prescribing.

Design

Data on all promotions by pharmaceutical companies directly to physicians were linked to physician‐level data on opioid prescriptions filled in a federal insurance program and analyzed using multivariate regression.

Setting

United States.

Participants

A total of 865 347 US physicians, with prescriptions filled in Medicare Part D, that might receive payments from pharmaceutical promotional activities from 2014 to 2016.

Measurements

The outcome variable was days’ supply dispensed by each prescriber, by year, for all opioids (collectively) and separately for the following opioid classes: hydrocodone, oxycodone, fentanyl, tapentadol, morphine and a catch‐all ‘other opioids’. The independent variables were receipt of any payments and dollar amounts of payments received by each prescriber by year for all opioids and separately for opioid categories.

Findings

Prescribers who received opioid‐specific payments prescribed 8784 opioid daily doses per year more than their peers who did not receive any such payments (P < 0.001). Recipient of hydrocodone‐related payments was associated with 5161 additional daily doses of hydrocodone (P < 0.001). Recipient of oxycodone‐related payments was associated with 3624 additional daily doses of oxycodone (P < 0.001). Prescribers receiving any fentanyl‐specific payments prescribed 1124 daily doses per year more than their peers (P < 0.001). Among recipients of opioid‐specific payments (63 062 physicians), a 1% increase in amount of payments was associated with 50 daily doses of opioid prescription (P < 0.001).

Conclusions

In the United States, physicians who receive direct payments from providers for opioid prescribing tend to prescribe substantially larger quantities, particularly for hydrocodone and oxycodone.
The ethics of biobanking: Assessing the right to control problem for broad consent
Authors: Manson Neil C.
Published: January 2019

The biobank consent debate is one with deeply held convictions on both the ‘broad’ and ‘specific’ side with little sign of resolution. Recently, Thomas Ploug and Soren Holm have developed an alternative to both specific and broad consent: a meta‐consent framework. The aim here is to consider whether meta‐consent provides a ‘solution’ to the biobank consent debate. We clarify what ‘meta‐consent’ actually is (arguing that the label is a misnomer and ‘consent à la carte’ is more accurate). We identify problems with Ploug and Holm's arguments, and some challenges for meta‐consent. We focus on whether there is any ethical obligation to provide consent à la carte. There may seem to be so, especially if we draw upon an unclear appeal to the ethical significance of ‘respect for autonomy’. Similarly, there might seem to be an intuitive inference from the fact that ethically legitimate research requires informed consent to the conclusion that it thereby requires consent à la carte. It is shown that this line of inference is mistaken.
Changes in ostracod assemblages and morphologies during lake‐level variations of Lago Cardiel (49°S), Patagonia, Argentina, over the last 15.6 ka
Authors: Ramos Lorena , Alperin Marta , Schwalb Antje , Markgraf Vera , Ariztegui Daniel , Cusminsky Gabriela
Published: January 2019

Changes in the ostracod assemblages from two sediment cores collected from Lago Cardiel in southeastern Patagonia (49°S) reflect the main regional abrupt climatic changes over the last 15.6 cal. kaBP. Shifts in species abundance and switches in dominances suggest that these were mainly driven by variable salinity. During the Late Pleistocene,Limnocythere rionegroensiswas abundant and dominant, indicating waters with high salinity and prevalence of evaporative processes. Between 12.6 and 10.8 cal. kaBP, Lago Cardiel expanded markedly and reached an Early Holocene highstand of +55 m above present lake level. A major change in ostracod assemblage in whichLimnocythere patagonicaappears as the dominant species in parallel with the disappearance ofL. rionegroensisandEucyprisaff.cecryphaliummirrored this transitional period between the cold and dry Late Pleistocene and the humid and warm Early Holocene. Over the last 4 cal. kaBP,L. rionegroensisreturned to the species assemblage andRiocypris whatleyiincreased its abundance pointing towards increasing salinities. The variations in size, shape and ornamentation ofL. rionegroensisandR. whatleyifossil valves were examined using geometric morphometric techniques and further compared to those of modern Patagonian sites.Limnocythere rionegroensisspecimens displayed high morphological variability during the evolution of Lago Cardiel. More specifically, the switch in reproductive mode – from sexual to parthenogenetic– and the increase in valve ornamentation around 12.7 cal. kaBPsuggest that these changes were promoted by the hydrological alteration that occurred in the Late Pleistocene. This exercise provides a robust range of morphological variation for these proxies, which will be useful in further taxonomic and palaeoenvironmental studies adding more information about different factors influencing the observed morphological trends.
Vegetation and climate during the penultimate interglacial of the northeastern Russian Arctic: the Lake El'gygytgyn pollen record
Authors: Zhao Wenwei , Andreev Andrei A. , Tarasov Pavel E. , Wennrich Volker , Melles Martin
Published: January 2019

We present a high‐resolution reconstruction of the vegetation and climate dynamics during the penultimate interglacial, corresponding with Marine Isotope Stage (MIS) 7, based on detailed palynological analyses of lacustrine sediments from Lake El'gygytgyn, northeastern Siberia. The analysed sediments were deposited between 246 and 181 ka ago (late MIS 8 to early MIS 6.6). The interglacial vegetation was characterized by herb and shrub (mainly alder and birch) dominated plant communities. Pollen‐based biome reconstruction shows a dominance of the tundra (TUND) biome, thus indicating rather open vegetation. Warmer intervals (MIS 7.5, 7.3 and 7.1) were marked by an increase in the cold deciduous forest (CLDE) biome scores and a synchronous decrease in the cold steppe (STEP) biome scores. The thermal maximum occurred during MIS 7.1, as indicated by the highest CLDE biome scores occurring in this period, and lasted ~10 ka, possibly favoured by the high precession‐related summer insolation and the legacy of the preceding mild and dry stadial (MIS 7.2). In contrast, MIS 7.3 and 7.5 were characterized by shorter durations (~4 ka) and lower summer temperatures. The preceding cold glacial and stadial (MIS 8 and 7.4, respectively) might have led to an extensive distribution of permafrost that hindered vegetation development during the subsequent warm intervals. MIS 7.4 and 6.6 were cold and wet, probably triggered by low obliquity values and coevally low precession‐related summer insolation. As a result, these periods were marked by significantly reduced summer temperatures and an enhanced snow‐ice albedo feedback. The obtained reconstructions provide potential scenarios for future climate changes and allow a better understanding of the relationship between vegetation, climate and external/internal forcings in the high latitudes.
Maintenance of long remission in adult T‐cell leukemia by Tax‐targeted vaccine: A hope for disease‐preventive therapy
Authors: Kannagi Mari , Hasegawa Atsuhiko , Nagano Yoshiko , Iino Tadafumi , Okamura Jun , Suehiro Youko
Published: January 2019

Adult T‐cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disease caused by human T‐cell leukemia virus type 1 (HTLV‐1). Multi‐agent chemotherapy can reduce ATL cells but frequently allows relapses within a short period of time. Allogeneic hematopoietic stem cell transplantation (allo‐HSCT) following chemotherapy is now a standard therapy for ATL in Japan as it can achieve long‐term remission in approximately one‐third of recipient ATL patients; however, it also has a risk of treatment‐related mortality. Allo‐HSCT often induces HTLV‐1 Tax‐specific cytotoxic T cells (CTL) as well as graft‐versus‐host (GVH) response in ATL patients. This observation led to development of a new therapeutic vaccine to activate Tax‐specific CTL, anticipating anti‐ATL effects without GVH response. The newly developed Tax‐DC vaccine consists of autologous dendritic cells pulsed with Tax peptides corresponding to CTL epitopes that have been identified in post‐allo‐HSCT ATL patients. In a pilot study of Tax‐DC therapy in three ATL patients after various initial therapies, two patients survived for more than 4 years after vaccination without severe adverse effects (UMIN000011423). The Tax‐DC vaccine is currently under phase I trial, showing a promising clinical outcome so far. These findings indicate the importance of patients’ own HTLV‐1‐specific T‐cell responses in maintaining remission and provide a new approach to anti‐ATL immunotherapy targeting Tax. Although Tax‐targeted vaccination is ineffective against Tax‐negative ATL cells, it can be a safe alternative maintenance therapy for Tax‐positive ATL and may be further applicable for treatment of indolent ATL or even prophylaxis of ATL development among HTLV‐1‐carriers.
Comparison of inducible nitric oxide synthase mRNA expression in different airway portions and association with nitric oxide parameters from patients with asthma
Authors: Sato Yoko , Chibana Kazuyuki , Horigane Yukiko , Uchida Nobuhiko , Masawa Meitetsu , Koike Ryosuke , Nakamura Yusuke , Watanabe Taiji , Shiobara Taichi , Arai Ryo , Shimizu Yasuo , Takemasa Akihiro , Ishii Yoshiki
Published: January 2019

Background

Fractional exhaled nitric oxide concentration (FeNO) is widely used to support diagnosis and monitoring of bronchial asthma (BA). Tsoukias and George proposed a two‐compartment model (2CM) for assessing the alveolar concentration of NO, referred to as CANO(2CM), while Condorelli et al proposed a model based on the trumpet shape of the airway tree and axial diffusion (TMAD), referred to as CANO(TMAD). In addition, Högman et al proposed non‐linear model, referred to as CANO(non‐linear).

Objective

We examined associations between the expression of inducible nitric oxide synthase (iNOS) mRNA in airway cells (ACs) by bronchoscopy and NO‐parameters calculated by the three methods and identified which of them accurately reflected expression of iNOS mRNA from different airway portions.

Methods

We retrospectively analysed data of 18 patients with stable, mild‐moderate asthma, including 10 steroid‐naïve BA (snBA) patients. Samples were obtained from airway brushings and bronchoalveolar lavage (BAL). Expressions of iNOS protein in tissue samples were evaluated by immunostaining. The iNOS mRNA in ACs was measured by qPCR. NO‐parameters calculated by the three methods above and evaluated whether they were associated with iNOS mRNA in ACs derived from proximal (2nd carina), distal (10‐15th) airways and alveolar regions.

Results

Immunostaining revealed expression of iNOS proteins mainly in epithelial cells in the airways, while it was mainly expressed in macrophages in the alveolar region in the snBA group. The iNOS mRNA expression was increased in both proximal and distal ACs in the snBA group compared with steroid‐treated BA group (stBA). CANO(2CM) negatively associated with FEV1 (%predicted) and also associated with iNOS mRNA in distal ACs significantly. However, CANO(TMAD) and CANO(non‐linear) showed no correlation with lung function nor iNOS mRNA expression in any portions of ACs.

Conclusions

These results suggested that CANO(2CM) reflected distal airway inflammation in steroid‐naïve asthma.
LncRNA Riken‐201 and Riken‐203 modulates neural development by regulating the Sox6 through sequestering miRNAs
Authors: Zhang Lei , Xue Zhenyu , Yan Jia , Wang Jie , Liu Qidong , Jiang Hong
Published: January 2019

Objectives

Long non‐coding RNAs (LncRNAs) play important roles in epigenetic regulatory function during the development processes. In this study, we found that through alternative splicing, LncRNA C130071C03Riken variants Riken‐201 (Riken‐201) and Riken‐203 (Riken‐203) are both expressed highly in brain, and increase gradually during neural differentiation. However, the function of Rik‐201 and Rik‐203 is unknown.

Materials and methods

Embryonic stem cells (ESCs); RNA sequencing; gene expression of mRNAs, LncRNAs and miRNAs; over‐expression and RNA interference of genes; flow cytometry; real‐time quantity PCR; and Western blot were used in the studies. RNA pull‐down assay and PCR were employed to detect any miRNA that attached to Rik‐201 and Rik‐203. The binding of miRNA with mRNA of Sox6 was presented by the luciferase assay.

Results

Repression of Rik‐201 and Rik‐203 inhibited neural differentiation from mouse embryonic stem cells. Moreover, Rik‐201 and Rik‐203 functioned as the competing endogenous RNA (ceRNA) to repress the function of miR‐96 and miR‐467a‐3p, respectively, and modulate the expression of Sox6 to further regulate neural differentiation. Knockout of the Rik‐203 and Rik‐201 induced high ratio of brain developmental retardation. Further we found that C/EBPβ might potentially activated the transcription of Rik‐201 and Rik‐203.

Conclusions

These findings identify the functional role of Rik‐201 and Rik‐203 in facilitating neural differentiation and further brain development, and elucidate the underlying miRNAs‐Sox6‐associated molecular mechanisms.