Corporate governance and financial constraints on strategic turnarounds

The paper extends the Robbins and Pearce (1992) two-stage turnaround response model to include governance factors. In addition to the retrenchment and recovery, the paper proposes the addition of a realignment stage, referring specifically to the re-alignment of expectations of principal and agent groups. The realignment stage imposes a threshold that must be crossed before the retrenchment and hence recovery stage can be entered. Crossing this threshold is problematic to the extent that the interests of governance-stakeholder groups diverge in a crisis situation. The severity of the crisis impacts on the bases of strategy contingent asset valuation leading to the fragmentation of stakeholder interests. In some cases the consequence may be that management are prevented from carrying out turnarounds by governance constraints. The paper uses a case study to illustrate these dynamics, and like the Robbins and Pearce study, it focuses on the textile industry. A longitudinal approach is used to show the impact of the removal of governance constraints. The empirical evidence suggests that such financial constraints become less serious to the extent that there is a functioning market for corporate control. Building on governance research and turnaround literature, the paper also outlines the general case necessary and sufficient conditions for successful turnarounds

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Background Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1-year period using quantitative measurement. Methods This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mock-scenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service. Results Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P  1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8–9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6–5.2) for unassisted vaginal deliveries, 18.4 (17.1–19.8) for instrumental vaginal deliveries, 8.5 (7.7–9.4) for elective caesarean section and 19.8 (18.6–21.0) for non-elective caesarean sections. Conclusions Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage

Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes

Colorado Plateau Coring Project, Phase I (CPCP-I): a continuously cored, globally exportable chronology of Triassic continental environmental change from western North America

Phase 1 of the Colorado Plateau Coring Project (CPCP-I) recovered a total of over 850&thinsp;m of stratigraphically overlapping core from three coreholes at two sites in the Early to Middle and Late Triassic age largely fluvial Moenkopi and Chinle formations in Petrified Forest National Park (PFNP), northeastern Arizona, USA. Coring took place during November and December of 2013 and the project is now in its post-drilling science phase. The CPCP cores have abundant detrital zircon-producing layers (with survey LA-ICP-MS dates selectively resampled for CA-ID-TIMS U-Pb ages ranging in age from at least 210 to 241&thinsp;Ma), which together with their magnetic polarity stratigraphy demonstrate that a globally exportable timescale can be produced from these continental sequences and in the process show that a prominent gap in the calibrated Phanerozoic record can be filled. The portion of core CPCP-PFNP13-1A for which the polarity stratigraphy has been completed thus far spans  ∼ 215 to 209&thinsp;Ma of the Late Triassic age, and strongly validates the longer Newark-Hartford Astrochronostratigraphic-calibrated magnetic Polarity Time-Scale (APTS) based on cores recovered in the 1990s during the Newark Basin Coring Project (NBCP).Core recovery was  ∼ 100&thinsp;% in all holes (Table 1). The coreholes were inclined  ∼ 60–75° approximately to the south to ensure azimuthal orientation in the nearly flat-lying bedding, critical to the interpretation of paleomagentic polarity stratigraphy. The two longest of the cores (CPCP-PFNP13-1A and 2B) were CT-scanned in their entirety at the University of Texas High Resolution X-ray CT Facility in Austin, TX, and subsequently along with 2A, all cores were split and processed at the CSDCO/LacCore Facility, in Minneapolis, MN, where they were scanned for physical property logs and imaging. While remaining the property of the Federal Government, the archive half of each core is curated at the NSF-sponsored LacCore Core Repository and the working half is stored at the Rutgers University Core Repository in Piscataway, NJ, where the initial sampling party was held in 2015 with several additional sampling events following. Additional planned study will recover the rest of the polarity stratigraphy of the cores as additional zircon ages, sedimentary structure and paleosol facies analysis, stable isotope geochemistry, and calibrated XRF core scanning are accomplished. Together with strategic outcrop studies in Petrified Forest National Park and environs, these cores will allow the vast amount of surface paleontological and paleoenvironmental information recorded in the continental Triassic of western North America to be confidently placed in a secure context along with important events such as the giant Manicouagan impact at  ∼ 215.5&thinsp;Ma (Ramezani et al., 2005) and long wavelength astronomical cycles pacing global environmental change and trends in atmospheric gas composition during the dawn of the dinosaurs.</p

The ‘mosaic habitat’ concept in human evolution: past and present

The habitats preferred by hominins and other species are an important theme in palaeoanthropology, and the ‘mosaic habitat’ (also referred to as habitat heterogeneity) has been a central concept in this regard for the last four decades. Here we explore the development of this concept – loosely defined as a range of different habitat types, such as woodlands, riverine forest and savannah within a limited spatial area– in studies of human evolution in the last sixty years or so. We outline the key developments that took place before and around the time when the term ‘mosaic’ came to wider palaeoanthropological attention. To achieve this we used an analysis of the published literature, a study of illustrations of hominin evolution from 1925 onwards and an email survey of senior researchers in palaeoanthropology and related fields. We found that the term mosaic starts to be applied in palaeoanthropological thinking during the 1970’s due to the work of a number of researchers, including Karl Butzer and Glynn Isaac , with the earliest usage we have found of ‘mosaic’ in specific reference to hominin habitats being by Adriaan Kortlandt (1972). While we observe a steady increase in the numbers of publications reporting mosaic palaeohabitats, in keeping with the growing interest and specialisation in various methods of palaeoenvironmental reconstruction, we also note that there is a lack of critical studies that define this habitat, or examine the temporal and spatial scales associated with it. The general consensus within the field is that the concept now requires more detailed definition and study to evaluate its role in human evolution

The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

Extent: 9p.Background:The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD) unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods: The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results: 365 (6%) patients lived ≥100 km from their nearest PD unit (distant group), while 6183 (94%) lived <100 km (local group). Median time to first peritonitis in distant patients (1.34 years, 95% CI 1.07-1.61) was significantly shorter than in local patients (1.68 years, 95% CI 1.59-1.77, p = 0.001), whilst overall peritonitis rates were higher in distant patients (incidence rate ratio 1.32, 95% CI 1.20-1.46). Living ≥100 km away from a PD unit was independently associated with a higher risk of S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47). Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008) and receive antifungal prophylaxis (4% vs 10%, p = 0.01), but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p < 0.001). Using multivariable logistic regression analysis of peritonitis outcomes, distant patients were more likely to be cured with antibiotics alone (OR 1.55, 95% CI 1.03-2.24). All other outcomes were comparable between the two groups. Conclusions: Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients.Yeoungjee Cho, Sunil V Badve, Carmel M Hawley, Stephen P McDonald, Fiona G Brown, Neil Boudville M, Kathryn J Wiggins, Kym M Bannister, Philip Clayton, and David W Johnso