Re-conceptualising strategy in design management education

The aim of this paper is to explain the current place of ‘strategy’ in design management education in the UK. The research questions concern the extent to which design management education meets the needs of future strategic roles in management and secondly the ways in which design management education is keeping abreast with current theory and practice of management strategy. The paper draws on research from a UK research council project, The Metamorphosis of Design Management Network (MDMN).The methodology uses a qualitative approach to analyse the transcripts and activities undertaken in symposia over a five year period from 2007-2012, with a focus on four events held from 2010-12. The findings on education and strategic designer development were matched against the content analysis of strategy in conference papers presented at British Academy of Management from 2009-13. The findings demonstrate the exposure of students to organisations and different design contexts. However other strategic management developments in strategy-as-practice, dynamic capabilities and scenario building provide new opportunities to extend design management education. The conclusion summarises the opportunities for design education and the development of students as strategic designers through new interdisciplinary approaches

Organisational interventions designed to reduce caesarean section rates: a systematic review protocol.

INTRODUCTION: There is a growing body of evidence to indicate that both primary and subsequent caesarean sections are associated with increased maternal and perinatal morbidity. Efforts to reduce the number of clinically unnecessary caesarean sections are urgently required. Our objective is to systematically review published evidence on the effectiveness of maternity service organisational interventions, such as models of maternity care, that aim to reduce caesarean section rates. METHODS AND ANALYSIS: Databases will be searched, including the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS. Search terms related to caesarean section and organisational intervention will be used. Research published before 1980 will be excluded and only randomised controlled trials, cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies will be included. Data extraction and quality assessments will be undertaken by two authors. ETHICS AND DISSEMINATION: Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences. PROSPERO REGISTRATION NUMBER: CRD42016039458

Maternity service organisational interventions that aim to reduce caesarean section: a systematic review and meta-analyses

Background Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. Method A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. Results Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. Conclusion Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews

A New Unified Approach for the Simulation of a Wide Class of Directional Distributions

The need for effective simulation methods for directional distributions has grown as they have become components in more sophisticated statistical models. A new acceptance-rejection method is proposed and investigated for the Bingham distribution on the sphere using the angular central Gaussian distribution as an envelope. It is shown that the proposed method has high efficiency and is also straightforward to use. Next, the simulation method is extended to the Fisher and Fisher-Bingham distributions on spheres and related manifolds. Together, these results provide a widely applicable and efficient methodology to simulate many of the standard models in directional data analysis. An R package simdd, available in the online supplementary material, implements these simulation methods

Caenorhabditis elegans Operons Contain a Higher Proportion of Genes with Multiple Transcripts and Use 3′ Splice Sites Differentially

RNA splicing generates multiple transcript isoforms from a single gene and enhances the complexity of eukaryotic gene expression. In some eukaryotes, operon exists as an ancient regulatory mechanism of gene expression that requires strict positional and regulatory relationships among its genes. It remains unknown whether operonic genes generate transcript isoforms in a similar manner as non-operonic genes do, the expression of which is less likely limited by their positions and relationships with surrounding genes. We analyzed the number of transcript isoforms of Caenorhabditis elegans operonic genes and found that C. elegans operons contain a much higher proportion of genes with multiple transcript isoforms than non-operonic genes do. For genes that express multiple transcript isoforms, there is no apparent difference between the number of isoforms in operonic and non-operonic genes. C. elegans operonic genes also have a different preference of the 20 most common 3′ splice sites compared to non-operonic genes. Our analyses suggest that C. elegans operons enhance expression complexity by increasing the proportion of genes that express multiple transcript isoforms and maintain splicing efficiency by differential use of common 3′ splice sites

Factors associated with chest injuries to front seat occupants in frontal impacts

Objective: Improving crash protection for older car occupants is a matter of urgency since the number of older car users is forecast to grow dramatically over the next two decades. The thorax is particularly vulnerable in older occupants, and this study aimed to provide real-world in-depth analysis of factors contributing to chest injuries in frontal impacts involving European cars. Methods: Real world crash injury data were interrogated, focusing on cars with current restraint components. The research examined belted front-seat occupants in frontal impacts where air bags, pretensioners and load limiters were present. Results: The chest was the most often injured body region at AIS 2+, 3+ and 4+ injury levels. The rate of AIS 2+ and AIS 3+ chest injuries was highest among elderly occupants and lowest among young occupants, and elderly occupants sustained proportionally more severe chest injuries in low/moderate speed impacts compared to young and middle-aged occupants. However, it should be noted that rates of AIS 2 chest injury were also significantly higher for middle-aged occupants compared to the young. The front passenger seat was shown to be more often associated with significant chest injury than the driver seat. The higher proportion of elderly female occupants was postulated as a reason for this. Skeletal injury was the most frequent type of AIS 2+ chest injury and the rate of injury for elderly occupants with such injuries was higher than for young and middle-aged occupants. With the increase in the number of rib fractures, the risk of pulmonary complications and organ injuries tended to increase. The major cause of chest injury was identified as restraining loads transmitted to the chest via the seat belt. The absence of intrusion in the majority of cases, suggests an opportunity for the restraint system to better manage the crash pulse. Not only for elderly occupants but for those who are middle-aged as well. Conclusions: This study shows the necessity for safety interventions, through new vehicle crashworthiness systems to improve chest protection especially for middle aged and elderly car occupants. Deployment of appropriate injury risk criteria, use of an appropriate dummy thorax, development of a low energy restraint test, and the development of more adaptive restraints have been discussed as possible solutions to the problem

Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise: A subgroup analysis of a randomised controlled trial

Background: No previous clinical trials have investigated MRI findings as effect modifiers for conservative treatment of low back pain. This hypothesis-setting study investigated if MRI findings modified response to rest compared with exercise in patients with chronic low back pain and Modic changes. Methods: This study is a secondary analysis of a randomised controlled trial comparing rest with exercise. Patients were recruited from a specialised outpatient spine clinic and included in a clinical trial if they had chronic low back pain and an MRI showing Modic changes. All patients received conservative treatment while participating in the trial. Five baseline MRI findings were investigated as effect modifiers: Modic changes Type 1 (any size), large Modic changes (any type), large Modic changes Type 1, severe disc degeneration and large disc herniation. The outcome measure was change in low back pain intensity measured on a 0-10 point numerical rating scale at 14-month follow-up (n = 96). An interaction = 1.0 point (0-10 scale) between treatment group and MRI findings in linear regression was considered clinically important. Results: The interactions for Modic Type 1, with large Modic changes or with large Modic changes Type 1 were all potentially important in size (-0.99 (95% CI -3.28 to 1.29), -1.49 (-3.73 to 0.75), -1.49 (-3.57 to 0.58), respectively) but the direction of the effect was the opposite to what we had hypothesized-that people with these findings would benefit more from rest than from exercise. The interactions for severe disc degeneration (0.74 (-1.40 to 2.88)) and large disc herniation (-0.92 (3.15 to 1.31)) were less than the 1.0-point threshold for clinical importance. As expected, because of the lack of statistical power, no interaction term for any of the MRI findings was statistically significant. Conclusions: Three of the five MRI predictors showed potentially important effect modification, although the direction of the effect was surprising and confidence intervals were wide so very cautious interpretation is required. Further studies with adequate power are warranted to study these and additional MRI findings as potential effect modifiers for common interventions