bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lean healthcare: scale, scope and sustainability
Authors: Hallam Cory R.A. , Contreras Carolina 
Published: August 2018

PurposeLean healthcare is highlighted in the literature as an approach to quality improvement and operational efficiency. The purpose of this paper is to study how Lean healthcare has been implemented by analyzing empirical outcomes.Design/methodology/approachThe authors used a literature review as the primary research method, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Peer-reviewed journals were analyzed – searching for Lean healthcare implementation, tools used, wastes addressed, outcomes and sustainability.FindingsEvidence suggests that Lean can improve healthcare operational effectiveness. However, empirical studies show implementation is still highly localized with small successes. Most transformations are focused on implementing one or two Lean tools that primarily target patient waiting times and there is minimal evidence about sustainability. Establishing clear definitions for healthcare-related Lean terminology may improve practice, especially episodic care and service quality.Originality/valueThis work provides a Lean healthcare case review. The research makes a significant contribution to Lean healthcare by increasing understanding (scale, scope and sustainability). From a theory building perspective, the authors suggest that barriers to adoption include a common healthcare-specific Lean terminology, and a need to expand implementation beyond small successes. This understanding will help identify key areas for further research in Lean healthcare management.
Unmet need among married women: examining socio-religious influences on family planning use in Rwanda, 2005-2015
Authors: Mahoro Justin 
Published: August 2018

Purpose
The purpose of this paper is to determine the socio-religious factors associated with unmet need for family planning among married Rwandan women, and examine individual and contextual characteristics of married fecund women influencing their contraceptive use and future intentions to use contraception.

Design/methodology/approach
This study employed merge data, which were extracted from 2005, 2010, 2014–2015 Rwanda Demographic And Health Survey’s individual women data sets. Characteristics of married fecund women with unmet need for family planning were compared using Pearson’s χ2 test. A binary logistic regression analysis was applied to examine the influence of socio-religious factors on contraceptive use, and future intentions to use contraception among married fecund women.

Findings
Unmet need for family planning among married Rwandan women has significantly decreased over the past decade, from 39.9 percent in 2005 to 19.5 percent in 2010 and 17.5 percent in 2015. Women who are Protestants, residing in rural area, and having five or more children were significantly more likely to have an unmet need for family planning. Overall, the likelihood of having unmet need for family planning, not using contraceptives and future intentions for not using contraception was found statistically high among Protestant women compared to Catholics and low-educated women.

Research limitations/implications
Unmarried women and men are not included to examine their role play and characteristics influences on family planning use in Rwanda. Investing in education of girls should be a priority for the future, without that there will not be equality in reproductive health and rights. Factors behind the recent slow motion of family planning initiatives need to be addressed in order to meet the reproductive needs and rights of all women.

Practical implications
Public-religious collaboration to promote nationally Natural Family Planning in all healthcare facilities is extremely needed. Since the family planning initiatives have been recently very slow, investing in behavioral change programs through mass communication seems deliberately prudent.

Social implications
Investing in behavioral change programs and promoting sexual and reproductive health education would improve women’s social well-being.

Originality/value
This is the first-ever effort to examine the influence of the socio-religious values on family planning use among Rwandan fecund women.
Grounded theory of knowledge process on public ecosystem managers in Seoul
Authors: Lee Jeongseok 
Published: August 2018

Purpose
The purpose of this paper is to explore the utility of employing knowledge management (KM) as a framework for understanding how public managers perform ecosystem management. The question of how public managers in Seoul acquire, utilize and share knowledge in managing their ecosystems has been responded to by offering a particular conceptual model.

Design/methodology/approach
This study applies the grounded theory method to build a conceptual model. The model is generated by applying the concept of knowledge process to an investigation of how the urban ecosystem is publicly managed by civil servants in various offices within the municipality of Seoul, Korea. The case study encompasses the management of the 12 regions of Seoul designated as Eco-scenery Preservation Regions (ESPRs) by the Seoul Metropolitan Government.

Findings
The knowledge process of public managers in managing the ESPRs can be explained by understanding the conceptual model of “learning-by-doing,” which means public managers cannot count much on their knowledge gained previously through their past experience or education and training. Instead, they learn individually in the process of discharging their duties on a daily basis.

Research limitations/implications
Although the focus is on the knowledge process of public managers, there is no escaping the fact that managerial activities are not performed in a vacuum. Rather, they take place in a complex policy and government context that is not easily captured as the important variables that influence the knowledge process. Thus, it would be worthwhile to extend this study with group, intra-, and extra-organizational-level analyses.

Practical implications
Usually different contexts lead to different interpretations on the concept of learning-by-doing. This study supplies such an interpretation that diverse ecosystems in Seoul have been managed by the learning-by-doing of public managers, which is characterized specifically as their reactive response, tinkering and limited personal network.

Social implications
There has not been a definite consensus on the question of what ecosystem management is. Scientists, policymakers and citizens all have different viewpoints on that question. Nonetheless, this study provides a useful perspective on the issue of how various ecosystems have been managed by public managers, who must be a central entity of ecosystem management particularly under the context of municipality.

Originality/value
Even though KM has been a popular subject of study in business management rather than public management, KM as a framework of study is promising as a means of understanding and potentially supporting the further development of effective ecosystem management by public managers.
Remaining useful life estimation of metropolitan train wheels considering measurement error
Authors: Jiang Zengqiang , Banjevic Dragan , E. Mingcheng , Jardine Andrew , Li Qi 
Published: August 2018

Purpose
The purpose of this paper is to develop an approach for estimating the remaining useful life (RUL) of metropolitan train wheels considering measurement error.

Design/methodology/approach
The paper proposes a wear model of a metropolitan train wheel based on a discrete state space model; the model considers the wheel’s stochastic degradation and measurement error simultaneously. The paper estimates the RUL on the basis of the estimated degradation state. Finally, it presents a case study to verify the proposed approach. The results indicate that the proposed method is superior to methods that do not consider measurement error and can improve the accuracy of the estimated RUL.

Findings
RUL estimation is a key issue in condition-based maintenance and prognostics and health management. With the rapid development of advanced sensor technologies and data acquisition facilities for the maintenance of metropolitan train wheels, condition monitoring (CM) is becoming more accurate and more affordable, creating the possibility of estimating the RUL of wheels using CM data. However, the measurements of the wheels, especially the wayside measurements, are not yet precise enough. On the other hand, few existing studies of the RUL estimation of train wheels consider measurement error.

Practical implications
The approach described in this paper will make the RUL estimation of metropolitan train wheels easier and more precise.

Originality/value
Hundreds of million yuan are wasted every year due to over re-profiling of rail wheels in China. The ability to precisely estimate RUL will reduce the number of re-profiling activities and achieve significant economic benefits. More generally, the paper could enrich the body of knowledge of RUL estimation for a slowly degrading system considering measurement error.
Lean implementation for rail substation processes
Authors: Croucamp Patrick Lindsay , Telukdarie Arnesh 
Published: August 2018

PurposeTraction substations are an integral part of the railway infrastructure. In order to ensure that machinery and equipment is available and utilised at full capacity, intelligent maintenance methods should be implemented. The purpose of this paper is to focus on the development of lean maintenance strategies implemented on traction substations and offer the maintenance manager an alternative maintenance method to be utilised during optimisation initiatives.Design/methodology/approachThe rail company under consideration has various improvement options, the maintenance supply chain is a priority. The existing maintenance process of 3 kVDCtraction substations is examined and all operations and activities directly and indirectly associated with maintenance are analysed with lean methodologies. The analysis of maintenance operations and activities reveals that some of these operations and activities are non-value-adding and, therefore, regarded as waste. These activities only prolong the maintenance process without adding value to the process. Alternative operations and activities are suggested and simulated.FindingsThe application of lean indicates that the maintenance process could be optimised to deliver on a more efficient process, which would improve the quality of maintenance by ensuring that maintenance is timeously carried out. Through reducing the downtime caused by maintenance, the availability of the system is preserved and the railway lines could be used to capacity.Research limitations/implicationsThe research is limited to 3 kVDCtraction substations and the associated maintenance process, as this was the area of opportunity for the company. The track and overhead traction equipment maintenance is not included.Practical implicationsThe practical application of this research is in optimisation of the value chain for maintenance, specifically in the rail industry.Originality/valueThis research could be applied by maintenance managers to effectively implement if a run-to-failure (RTF) maintenance philosophy is being utilised. The research offers maintenance techniques within the RTF maintenance scope which reduces the maintenance cycle and equipment downtime.
Measuring maintenance activity effectiveness
Authors: Rana Anil , Koroitamana Emosi V.M. 
Published: August 2018

Purpose
The purpose of this paper is to provide a framework for measuring the imprecise and subjective “effectiveness” of a major maintenance activity. Such a measure will not only bring objectivity in gauging the effectiveness of maintenance task carried out by the workforce without any intervention from an expert but also help in measuring the slow degradation of the performance of the concerned major equipment/system.

Design/methodology/approach
The paper follows a three-step approach. First, identify a set of parameters considered important for estimating the maintenance activity effectiveness. Second, generate a set of data using expert opinions on a fuzzy performance measure of maintenance activity effectiveness (output). Also, find an aggregated estimate of the effectiveness by analysing the consensus among experts. This requires using a part of the “fuzzy multiple attribute decision making” process. Finally, train a neuro-fuzzy inference system based on input parameters and generated output data.

Findings
The paper analysed major maintenance activity carried out on diesel engines of a power plant company. Expert opinions were used in selection of key parameters and generation of output (effectiveness measure). The result of a trained adaptive neuro-fuzzy inference system (ANFIS) matched acceptably well with that aggregated through the expert opinions.

Research limitations/implications
In view of unavailability of data, the method relies on training a neuro-fuzzy system on data generated through expert opinion. The data as such are vague and imprecise leading to lack of consensus between experts. This can lead to some amount of error in the output generated through ANFIS.

Originality/value
The originality of the paper lies in presentation of a method to estimate the effectiveness of a maintenance activity.
The emergence and evolution of researcher identities
Authors: Omanović Vedran 
Published: August 2018

PurposeThe purpose of this paper is to investigate and reflect on mutual relationships between the researcher’s life experiences, encounters and personal learning, and how they can influence the research process of designing and writing research publications as well as their dialectical influences on the emergence and evolution of researcher identities in these processes.Design/methodology/approachThis research is inspired by auto-ethnography. While the descriptions and analyses of the selected moments from the pre-research period are based on retrospective reflection and memory, the descriptions and analyses of the moments from the research period are in addition to the memories, based on notes and diary entries about my encounters with various people, documents, events and literature.FindingsThe paper shows that researchers’ attempts to understand the Other through studies of certain phenomena are a production between them and their past, their experiences and people encountered, as well as between them and the research literature they use. In these encounters and processes, the researcher’s multiple identities emerge and evolve with significance for how the research is socially produced.Originality/valueThe paper takes a broader perspective than usually seen in studies of researcher identities and is based on a researcher’s life history rather than only on a specific field-situation. As such, it has a longitudinal character, and it implies a broader, multilevel area of reflection, emphasizing dialectical relationships between the researcher, the context(s) and people involved in these, as well as the subject(s) of research, which are characterized by mutuality and continuality.
Gendered imaginaries: situating knowledge of epigenetic programming of health
Authors: Chiapperino Luca , Panese Francesco 
Published: August 2018

AbstractOur paper explores the value‐laden and epistemic resources that scientists working in epigenetics and developmental programming of health and disease (DOHaD) mobilise to produce scientific representations of pregnancy and parenthood, which in turn imagine norms, values, and responsibilities for the protection of future generations. In order to do so, we first describe the place of questions regarding the relative weight of paternal and maternal influences on the health of the offspring in the discursive formalisation of this research in scientific publications. This enables us to identify the mutual constitution of ‘prototypes’ (i.e. experimental designs, settings, techniques) and ‘stereotypes’ (i.e. social meanings, beliefs, norms and values) of parental roles in DOHaD and epigenetic biomedical sciences, by means of a specific gendered figuration of paternal influences: the ‘father‐as‐sperm’. Second, and drawing from a set of interviews (N = 15), we describe a tension between this dominant, objectifying molecular discourse and the perspective of individual scientists. The situated perspective of individual researchers provides in fact evidence for a conflictual (moral and epistemic) economy of gendered engagements with parental figurations in DOHaD and epigenetic research, and consequently suggests a more fine‐grained, as well as conflictual web of socio‐political positioning of this ‘knowledge’ in its societal circulation.
Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial
Authors: Hyldig N , Vinter CA , Kruse M , Mogensen O , Bille C , Sorensen JA , Lamont RF , Wu C , Heidemann LN , Ibsen MH , Laursen JB , Ovesen PG , Rorbye C , Tanvig M , Joergensen JS 
Published: August 2018

ObjectiveTo evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section.DesignMulticentre randomised controlled trial.SettingFive hospitals in Denmark.PopulationObese women (prepregnancy body mass index (BMI) ≥30 kg/m2) undergoing elective or emergency caesarean section.MethodThe participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention‐to‐treat. Blinding was not possible due to the nature of the intervention.Main outcome measuresThe primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health‐related quality of life.ResultsIncisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30–0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups.ConclusionProphylactic use of incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women giving birth by caesarean section.Tweetable abstractRCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.
Increasing Prevalence of Assisted Living as a Substitute for Private‐Pay Long‐Term Nursing Care
Authors: Silver Benjamin C. , Grabowski David C. , Gozalo Pedro L. , Dosa David , Thomas Kali S. 
Published: August 2018

ObjectiveGiven the tremendous growth in assisted living (AL) over the past 20 years, it is important to understand how expansion has affected the demand for long‐term care (LTC) provided in nursing homes (NHs). We estimated the effect of a change in county‐level AL beds on the prevalence of private‐pay residents and private‐pay resident days at the NH‐level.Data SourcesNational census of large AL providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014.Study DesignRetrospective longitudinal analysis of LTC markets.Principal FindingsMean AL beds per county increased from 285 to 324, while NHs exhibited a decrease in private‐pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 AL beds at the county level is associated with a reduction of 0.44 percentage points in private‐pay resident days but is not significantly associated with percent of private‐pay residents.ConclusionsThese results suggest that increases in AL capacity have potentially allowed NH residents to delay or decrease their privately financed lengths of stay. As demand for AL continues to grow, it will be important to assess the effects on other LTC sectors.
Effect of Hospital and Post‐Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending
Authors: Agarwal Divyansh , Werner Rachel M. 
Published: August 2018

ObjectiveTo test for differences in patient outcomes when hospital and post‐acute care (PAC) providers participate in accountable care organizations (ACOs).Data/SettingUsing Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO‐participating hospitals and PAC providers.DesignWe compared changes in outcomes among patients discharged from ACO‐participating hospitals/PACs before and after participation to changes among patients discharged from non‐participating hospitals/PACs over the same time period.ResultsPatients discharged from an ACO‐participating hospitals and skilled nursing facilities (SNF) had lower readmission rates (−1.7 percentage points, p‐value = .03) than before ACO participation and non‐participants; and lower per‐discharge Medicare spending (−$940, p‐value = .001), and length of stay (−3.1 days, p‐value <.001) in SNF. Effects among ACO‐participating hospitals without a co‐participating SNF were smaller. Patients discharged from an ACO‐participating hospital and home health agency had lower Medicare per‐discharge spending (−$209; p‐value = .06) and length of stay (−1.6 days, p‐value <.001) for home health compared to before ACO participation and non‐participants. Discharge from an ACO‐participating hospital and inpatient rehabilitation facility did not impact patient outcomes or spending.ConclusionsHospital and SNF participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay. These results lend support to the ACO payment model.
The pH regulator PacC: a host‐dependent virulence factor in Botrytis cinerea
Authors: Rascle Christine , Dieryckx Cindy , Dupuy Jean William , Muszkieta Laetitia , Souibgui Eytham , Droux Michel , Bruel Christophe , Girard Vincent , Poussereau Nathalie 
Published: August 2018

SummaryThe phytopathogenic fungus Botrytis cinerea is able to infect a wide variety of plants and plant tissues with differing chemical compositions. During its interaction with the host, this pathogen modulates its ambient pH by secreting acids or ammonia. In this work, we examined the Pal/Pac pathway, the fungal ambient pH‐responsive signalling circuit, and investigated the role of the PacC transcription factor. Characterization of the BcpacC deletion mutant revealed an alteration of both fungal growth and virulence depending on the pH of the culture medium or of the host tissue. The pathogenicity of the mutant was altered on plants exhibiting a neutral pH and not on plants with acidic tissues. The capacity of the mutant to acidify its environment and, more particularly, to produce oxalic acid was affected, as was production of reactive oxygen species. Finally, proteomic profiling of the mutant secretome revealed significant changes in plant cell wall polysaccharides proteins and lipid degradation and oxidoreduction, highlighting the importance of BcPacC in the necrotrophic lifestyle of B. cinerea.