North American Institutions Research Articles

Canadian Tissue Repository Network Biobank Certification Program: Update and Review of the Program from 2011 to 2018.

The Canadian Tissue Repository Network (CTRNet) Biobank Certification Program was first launched in 2011 to foster translational research through improved access to high quality biospecimens. This was accomplished by creating and providing biobank education and through the establishment and deployment of common standards to harmonize biospecimen quality and approaches to governance. The CTRNet program comprises registration and certification steps as two linked phases. In the two-step registration phase, the biobank is registered into the system, and an individual completes an overview educational module. In the subsequent certification phase, biobanks undergo a seven-step process, including inviting team members, assigning and completing relevant education modules, uploading documents, and undergoing a documentation audit. As of June 2018, there were 251 biobanks engaged in the CTRNet program, 193 had completed registration, and 40 were fully certified. Over 3/4 of these biobanks completed registration within a week and over 1/3 completed certification within a month. Among registered biobanks, 163 were associated with North American institutions, while 30 were from other international locations, including Australia, Europe, and Asia. The CTRNet program enables biobanks to adopt standards with a flexible approach to accommodate different types of biobanks and a measured investment of effort, creating the foundation for increased access to high quality biospecimens.

Country-of-origin and brand positioning for health care services

PurposeThe purpose of this paper is to examine the relationship between country-of-origin (COO) and brand positioning in the context of the high-involvement service of health care. This paper compares and analyzes different positioning strategies used in Europe, North America and the Middle East.Design/methodology/approachThis paper uses content analysis of promotional materials for a sample of 168 health-care organizations located in 14 countries to identify brand positioning strategies used, such as foreign, local and global consumer culture positioning. A chi-square analysis and post hoc testing is used to examine how positioning strategies differ among regions.FindingsThe findings indicate that European and Middle Eastern health-care organizations most frequently use foreign consumer culture positioning, while North American institutions tend to use global consumer culture positioning. The findings indicate that health-care organizations in countries with a better reputation for care use different positioning strategies than in countries with a lesser reputation for quality care.Practical implicationsThe findings are of value to international advertising and marketing professionals and hospitals seeking to attract patients globally in a competitive marketplace. Hospitals must consider their positioning relative to both domestic and international competitors and the COO of their target audience.Originality/valueCOO is important in high-involvement service industries because consumers lack the information needed to evaluate service quality. Consumers may rely on COO and brand positioning signals more heavily relative to goods or low-involvement services. However, little prior research exists examining COO effects and brand positioning for high involvement services and for health care specifically. This paper makes a unique contribution by filling this gap.

Reflection on the research on and implementation of biorefinery systems – a systematic literature review with a focus on feedstock

AbstractTe concept of sustainably processing biomass into a spectrum of products and bioenergy is thousands of years old. Large‐scale utilization of such processes existed in the 19th century and the term biorefinery first appeared in the late 20th century. This review addresses how different feedstock classes, products, and regions have been described in the scientific literature on the development of biorefineries (1999–2017). The results of a systematic literature review were compared with information included in two reports on the implementation of biorefineries to identify similarities and differences between theory (described in the literature) and practice (carried out in industry). The number of scientific articles per year on this topic has increased over the last decade, particularly in the fields of natural sciences and engineering. The first authors of these articles are primarily affiliated with North American and European institutions. References to lignocellulosic raw materials (especially residues, but also dedicated crops) in the feedstock are by far the most frequent and those to aquatic biomass have also increased over time. Most of the products mentioned are related to energy products (mainly fuels), and the heterogeneous class of chemicals was also strongly represented. We examined two reports on existing biorefineries in Europe and identified differences between the roles of food‐crop‐based biorefineries and lignocellulosic‐feedstock biorefineries in terms of research and practice. New studies on the practical implementation of biorefineries should be carried out, with particular attention to these discrepancies. © 2019 The Authors. Biofuels, Bioproducts and Biorefining published by Society of Chemical Industry and John Wiley & Sons, Ltd.

THE POST-SECONDARY NETWORKED CLASSROOM: RENEWAL OF TEACHING PRACTICES AND SOCIAL INTERACTION

The application and use of telelearning technologies in post-secondary education is evolving from peripheral activities to central approaches. Educators are re-discovering collaborative education as they understand how electronic conferencing can support and empower teaching and learning. As students build knowledge collaboratively, asynchronous conferencing elevates engagement and participation, and increases thinking and understanding. This article presents the teaching practices of post-secondary educators who integrated asynchronous electronic conferencing in over one hundred mixed-mode courses at eight North American institutions between 1996 and 1999. Quantitative and qualitative research methods were applied to assess their practices and to further understand the correlation between the use of electronic conferencing and the degree of collaboration achieved. Based on the findings, pedagogical approaches for the use of electronic conferencing are provided, and are grouped according to the level of collaboration. As a result of this study, the authors present a suggested model for the networked classroom to foster and guide the transformation of pedagogical practice.

Immunosuppressed Patients with Crohn’s Disease Are at Increased Risk of Postoperative Complications: Results from the ACS-NSQIP Database

BackgroundThe impact of immunosuppressants on postoperative complications following colon resections for Crohn’s disease remains controversial. This study aimed to compare postoperative outcomes between immunosuppressed and immunocompetent patients with Crohn’s disease undergoing elective colon resection. MethodsAnalysis of 30-day outcomes using a cohort from the American College of Surgeons National Surgical Quality Improvement Program colectomy-specific database was performed. The database is populated by trained clinical reviewers who collect 30-day postoperative outcomes for patients treated at participating North-American institutions. Adult patients who underwent an elective colectomy between 2011 and 2015 were included. Immunosuppression for Crohn’s disease was predefined as use of regular corticosteroids or immunosuppressants within 30 days of the operation. Patients who received chemotherapy within 90 days of surgery, and patients who had disseminated cancer, preoperative shock, or emergency surgery were excluded. Primary outcome was infectious complications. ResultsThree thousand eight hundred sixty patients with Crohn’s disease required elective colon resection and met the inclusion criteria. Of these, 2483 were immunosuppressed and 1377 were immunocompetent. On multivariate analysis, the odds of infectious complications [OR 1.25; 95% CI (1.033–1.523)], overall surgical site infection [1.40; (1.128–1.742)], organ space surgical site infection [1.47; (1.094–1.984)], and anastomotic leak [1.51; (1.018–2.250)] were significantly higher for immunosuppressed compared to immunocompetent patients with Crohn’s disease. ConclusionsPatients with Crohn’s disease who were on immunosuppressant medications within 30 days of elective colectomy had significantly increased rates of infectious complications, overall surgical site infection, organ space surgical site infection, and anastomotic leak compared to patients who were not on immunosuppressive agents.

Early stage hepatocellular carcinoma treated with stereotactic body radiation therapy: A pooled analysis from two North American institutions.

350 Background: To report outcomes of pooled data from patients with early stage hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) at two North American Institutions. Methods: An IRB approved collaborative review of patients with HCC treated with radical intent SBRT was conducted. Inclusion criteria included patients with Stage I-IIIA HCC (UICC/AJCC 7th Ed.) treated with SBRT (≥ 4.5 Gy/ fraction) from June 2003 until Dec 2016. Patients who were treated with SBRT were ineligible for resection, percutaneous ablative or hepatic intravascular therapies. Patients with vascular invasion and those treated with palliative intent (e.g. HCC rupture) were excluded. Overall survival, local control and toxicity of treatment were reviewed retrospectively. Results: Of 310 eligible patients, 23% were Child-Pugh (CP) class B/C (21%/2%), and 40% had failed prior liver directed therapies. The median HCC diameter was 2.4 cm (range 0.5-18.1 cm), and the median prescribed dose was 39 Gray (Gy) in 5 fractions (range: 14 - 60 Gy in 2-6 fractions). Median BED was 78.75 Gy (Range: 23.8-180.0 Gy). 8.4% of patients underwent liver transplant after SBRT. Local control at 1, 3 and 5 years was 91.5%, 82.6% and 82.6%. On multivariable analysis (MVA), the use of breath-hold motion management, but not T stage, size or dose, was significantly associated with local control (p = 0.0098). The 1, 3, and 5 year overall survival (OS) was 77.3%, 37.9% and 23.5%. Factors associated with improved OS on MVA included baseline CP A score (HR = 0.58, p < 0.0045), AFP < 10 µg/L (HR = 0.66, p = 0.0094), and transplant post SBRT (HR = 0.05, p < 0.0001). The median survival of CP A vs. B/C patients was 30.3 and 17.6 months respectively. CTCAE (v4.0) grade 3 or higher luminal gastrointestinal organ toxicity occurred in 2.5% of patients, while a decline in CP score ≥ 2 points was seen in 16.7% of patients at 3 months post SBRT. Grade 3 and above elevated liver enzymes were seen in 12.6% and 8.1% of patients at baseline and at 3 months post SBRT. Conclusions: Similar to Asian series, this North American pooled analysis found high sustained local control and excellent survival in patients with early stage HCC treated with SBRT.

An overview of transcranial magnetic stimulation research with bibliometric Indicators

Transcranial magnetic stimulation (TMS) is a noninvasive technique increasingly used in basic and clinical research practices around the world. Its established clinical applications include treatment of major depression and presurgical functional mapping of the motor and language cortexes. In experimental and clinical trials have aimed to test the therapeutic and diagnostic utility of TMS in a range of disease states, including obsessive–compulsive disorder, schizophrenia, autism, strokes, tinnitus, Alzheimer's and Parkinson's diseases, traumatic brain injury, multiple sclerosis, migraine, and dystonia. To quantitatively analyze the current worldwide progress in TMS research based on the Web of Science (WoS) database for the past 27 years. We conducted a quantitative analysis of articles regarding TMS that were published in English between 1988 and 2015 and that were indexed in the WoS database. In the past 27 years, there have been 14,077 studies on TMS indexed by the WoS database. The analysis results indicate that most of the research studies in the field were published by North American and European institutions. With respect to Asian countries, Japan also published a reasonable proportion of publications, but comparatively speaking, the number of publications is rare. From the perspective of research progress, we found that the number of published articles on TMS has increased significantly in the past 10 years.

Editor's note

We looked up from the busyness of our work and discovered it was the 50th anniversary of Paulo Freire's classic text The Pedagogy of the Oppressed (published in 1968). William Myer had sent us a manuscript – a memoir of sorts – reflecting on the book's impact on his life's work as a minister and educator. We knew we needed to publish some kind of retrospective to mark the anniversary. The book was the first shot across the bow, a 1960s radical dismantling and reimagination of the liberative purposes and processes of education for a just society. The book has aged well. It's the grandparent of critical pedagogies and the lodestar for so many of our Wabash Center workshop participants who got into this business to make a better world. But Freire wrote from his teaching context amongst the peasants and slums of Brazil. His purpose was to empower his students to see and resist the structures of power that oppressed them. For fifty years he has been venerated by faculty working in a very different context: teaching privileged students in wealthy North American institutions of higher education. So we asked three Wabash workshop alumni to write short responses to Myer's essay, to analyze how Freire informs their classroom teaching practices. We publish these manuscripts together as a Forum in this, the January 2019 issue of the journal – as we move now into the 51st anniversary of this text that still lives and challenges us to think again about our deepest purposes as educators and the teaching practice these call us to. Freire could not have imagined the internet and the ways that contemporary media cultures could simultaneously democratize and alienate our social fabric, faster than we can absorb or adjust to. The central question of the second Forum published in this issue is: how can online education form students for ministry (see: “Forum on Seminary Teaching and Formation Online” by Deborah Gin, Barbara Blodgett, and G. Brooke Lester). An article by Kyle Oliver asks: ought not our pedagogies make use of these emerging new media tools in order to better prepare our students as leaders in this emergent media culture? (See: “Networked Religion Meets Digital Geographies: Pedagogical Principles for Exploring New Spaces and Roles in the Seminary Classroom.”) But Freire would have been very familiar with, and sympathetic to, Sarah Jobe's project to bring theological education into a woman's prison. Her article, “How Programs in Prisons are Changing the Who, Where, How, and What of Theological Education,” carefully describes and analyzes her purposes and pedagogies, which she argues are emblematic of the cutting edge of theological education today. We've included four Teaching Tactics: strategies for . . . improving students' participation in classroom discussions (Emily Kahm's “Secret Missions”), getting more out of in-class quizzes (Reid Locklin's “The (Mostly) Unmarked Quiz”), helping students become better readers (Ingie Hovland's “ICE QQ Reading Logs”), and the one that shows how we're all Freirean now – Molleen Dupree-Dominguez's “Social Location Project.” But the article I most want to call your attention to is the magisterial, encyclopedic, overview of pedagogical theory in Deborah Gin and Mark Hearn's article, “Why You Do What You Do: The Power in Knowing and Naming Pedagogies.” This 12,000 word essay takes the active learning teaching strategies that we're all familiar with and grounds them in one or another of the great philosophies of teaching that have emerged over the past century. This is an invaluable resource for understanding “why you do what you do” in the classroom (as the title promises), with lots of bibliography for further reading, and two handy appendices that helpfully organize and summarize the material. And you can bet that Freire figures prominently.

Technology-Facilitated Stalking and Unwanted Sexual Messages/Images in a College Campus Community: The Role of Negative Peer Support

Researchers have accumulated much social scientific knowledge about the scope, distribution, causes, and outcomes of the physical and sexual abuse of female students in North American institutions of higher learning. However, surveys of technology-facilitated stalking and the dissemination of unwanted sexual messages/images in college campus communities are in short supply. The few that have been conducted do not identify key sociological risk factors associated with these two electronic forms of victimization. This paper, then, has two objectives: (1) to examine the influence of two types of negative peer support and (2) to determine if being the target of technology-facilitated stalking and receiving unwanted sexual messages/images are associated with female students’ intimate partner violence and sexual assault experiences. The results confirm that the two variants of negative peer support examined in this study are significant predictors of digital victimization and that such abuse is strongly associated with intimate partner violence and sexual assault.

“What can I offer America?” A postcolonial analysis of faculty motivations and perceptions in North-South university partnerships

International university partnerships are a prevalent internationalization strategy for both North American and African higher education institutions, yet the predominance of discourses that reflect the inequities of the global knowledge economy among participants perpetuate the very challenges that they are designed to address. Using a postcolonial framework, this study provides a critical analysis of qualitative interviews conducted with faculty members from one West African and one U.S. university participating in an international higher education partnership. The paper examines the motivations and perceived benefits of the partnership among participants at both institutions. It argues that the history of inequitable relationships perpetuated by globalization continues to shape understandings and pose challenges to achieving mutuality in North-South university partnerships. Findings show, for both institutions, motivations for partnership participation are based on the expectations and anticipated benefits to their institution as well as an alignment with the individual’s personal goals and objectives. Furthermore, perceptions of power imbalances between participants at the two institutions are evident. Despite the partnership’s intent for mutuality and reciprocity, the narratives of both West African and U.S. participants reinforce inequitable hierarchies. However, they also highlight opportunities for working toward greater mutuality and intercultural learning through North-South partnerships. Recommendations for cultivating reciprocity in North-South university partnerships are provided.

Branches From the “SEAD”: Sustained and Feasible Expansion of the Surgical Exploration and Discovery Program

ProblemA predicted shortage of surgeons and attrition among surgical residents has highlighted the need to attract well-suited medical students to surgical specialties. Literature suggests that early exposure may increase interest by addressing misconceptions and allowing students more time to make an informed career decision. ApproachThe Surgical Exploration and Discovery (SEAD) program was created in 2012 with the goal of providing medical students with comprehensive and multifaceted exposure to surgical specialties to develop their knowledge and skills, and in turn positively influence their interest in pursuing a surgical career. The purpose of this innovation report is to describe the challenges, successes, and evolution of the SEAD program. OutcomesSince its inception, SEAD has expanded to include 5 North American institutions and has educated nearly 400 participants in 5 y. Through a replication strategy, SEAD has maintained its basic curriculum, while accommodating the constraints and innovative approaches unique to each institution. Short-term results have demonstrated improved knowledge of curricular objectives, student perception of significant value of the program, and the generation of interest in a career in surgery. ConclusionsFuture directions include the evaluation of long-term impact on pursuing a career in surgery and continuing further expansion using the current replication model, while maintaining a high-quality surgical education program.

SCID genotype and 6-month posttransplant CD4 count predict survival and immune recovery

AbstractThe Primary Immune Deficiency Treatment Consortium (PIDTC) performed a retrospective analysis of 662 patients with severe combined immunodeficiency (SCID) who received a hematopoietic cell transplantation (HCT) as first-line treatment between 1982 and 2012 in 33 North American institutions. Overall survival was higher after HCT from matched-sibling donors (MSDs). Among recipients of non-MSD HCT, multivariate analysis showed that the SCID genotype strongly influenced survival and immune reconstitution. Overall survival was similar for patients with RAG, IL2RG, or JAK3 defects and was significantly better compared with patients with ADA or DCLRE1C mutations. Patients with RAG or DCLRE1C mutations had poorer immune reconstitution than other genotypes. Although survival did not correlate with the type of conditioning regimen, recipients of reduced-intensity or myeloablative conditioning had a lower incidence of treatment failure and better T- and B-cell reconstitution, but a higher risk for graft-versus-host disease, compared with those receiving no conditioning or immunosuppression only. Infection-free status and younger age at HCT were associated with improved survival. Typical SCID, leaky SCID, and Omenn syndrome had similar outcomes. Landmark analysis identified CD4+ and CD4+CD45RA+ cell counts at 6 and 12 months post-HCT as biomarkers predictive of overall survival and long-term T-cell reconstitution. Our data emphasize the need for patient-tailored treatment strategies depending upon the underlying SCID genotype. The prognostic significance of CD4+ cell counts as early as 6 months after HCT emphasizes the importance of close follow-up of immune reconstitution to identify patients who may need additional intervention to prevent poor long-term outcome.

Barriers to worldwide institutionalization of social and environmental disclosure

ABSTRACTThis study analyzes how groups of organizations that share their social and environmental information are formed in a similar way to identify barriers to the homogenization of social and environmental disclosure (SED) at the international level. Based on a sample of observations of listed firms from six different countries, results suggest that SED does not homogenize globally, spontaneously, because of cultural and geographical barriers. The institutions of environmental disclosure (ED) and social disclosure (SD) are different, thus forming different organizational fields at the international level. The spoken language is a barrier to the international isomorphism of ED and therefore to its comparability. However, language is a less important barrier to SD. When cultural institutions are weaker or have the same roots as North American institutions, cultural diversity does not stop the homogenization of the SD. Moreover, the ED is more isomorphic/comparable at the global level than SD, while the SD is more isomorphic/comparable at the level of culturally distinguishable subsets than ED.

Spatial and topical imbalances in biodiversity research.

The rapid erosion of biodiversity is among the biggest challenges human society is facing. Concurrently, major efforts are in place to quantify changes in biodiversity, to understand the consequences for ecosystem functioning and human wellbeing, and to develop sustainable management strategies. Based on comprehensive bibliometric analyses covering 134,321 publications, we report systematic spatial biases in biodiversity-related research. Research is dominated by wealthy countries, while major research deficits occur in regions with disproportionately high biodiversity as well as a high share of threatened species. Similarly, core scientists, who were assessed through their publication impact, work primarily in North America and Europe. Though they mainly exchange and collaborate across locations of these two continents, the connectivity among them has increased with time. Finally, biodiversity-related research has primarily focused on terrestrial systems, plants, and the species level, and is frequently conducted in Europe and Asia by researchers affiliated with European and North American institutions. The distinct spatial imbalances in biodiversity research, as demonstrated here, must be filled, research capacity built, particularly in the Global South, and spatially-explicit biodiversity data bases improved, curated and shared.

A Contemporary Prostate Biopsy Risk Calculator Based on Multiple Heterogeneous Cohorts

BackgroundProstate cancer prediction tools provide quantitative guidance for doctor-patient decision-making regarding biopsy. The widely used online Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) utilized data from the 1990s based on six-core biopsies and outdated grading systems. ObjectiveWe prospectively gathered data from men undergoing prostate biopsy in multiple diverse North American and European institutions participating in the Prostate Biopsy Collaborative Group (PBCG) in order to build a state-of-the-art risk prediction tool. Design, setting, and participantsWe obtained data from 15 611 men undergoing 16 369 prostate biopsies during 2006–2017 at eight North American institutions for model-building and three European institutions for validation. Outcome measurements and statistical analysisWe used multinomial logistic regression to estimate the risks of high-grade prostate cancer (Gleason score ≥7) on biopsy based on clinical characteristics, including age, prostate-specific antigen, digital rectal exam, African ancestry, first-degree family history, and prior negative biopsy. We compared the PBCG model to the PCPTRC using internal cross-validation and external validation on the European cohorts. Results and limitationsCross-validation on the North American cohorts (5992 biopsies) yielded the PBCG model area under the receiver operating characteristic curve (AUC) as 75.5% (95% confidence interval: 74.2–76.8), a small improvement over the AUC of 72.3% (70.9–73.7) for the PCPTRC (p<0.0001). However, calibration and clinical net benefit were far superior for the PBCG model. Using a risk threshold of 10%, clinical use of the PBCG model would lead to the equivalent of 25 fewer biopsies per 1000 patients without missing any high-grade cancers. Results were similar on external validation on 10 377 European biopsies. ConclusionsThe PBCG model should be used in place of the PCPTRC for prediction of prostate biopsy outcome. Patient summaryA contemporary risk tool for outcomes on prostate biopsy based on the routine clinical risk factors is now available for informed decision-making.

S96. EEG reactivity testing practices for cardiac arrest coma prognostication in North America

Introduction Lack of EEG reactivity is associated with unfavorable functional outcome in hypoxic-ischemic brain injury. Recent literature suggests that EEG reactivity inter-rater agreement between experts is as low as 26–50%. It is unclear if technical procedures, nomenclature variability, and practice patterns might contribute to poor inter-rater agreement rates. Methods We conducted a survey of representatives from North American institutions participating in the Critical Care EEG Monitoring Research Consortium to assess practice patterns involving EEG reactivity testing. The 10-question multiple choice survey evaluated center-specific metrics related to technical, personnel, and procedural aspects of EEG reactivity testing and assessment specific to cardiac arrest prognostication. One response per institution was obtained. Results We received responses from 25 institutions, including seven pediatric hospitals. A standardized EEG reactivity testing protocol was available in 44% of centers and 44% of respondents felt that reactivity assessment was subjective. Electroencephalogram reactivity testing usually started during hypothermia (76%) and tipically happened at least once daily (63%). Auditory stimulation and nail bed pressure were the most frequently used stimulation modalities (83% and 63% respectively). One institution included nipple pinching as part of its testing protocol. Stimulation was performed primarily by EEG Technologists (76%). Video-EEG assessment was the most common review method (92%). Changes in EEG amplitude were not considered consistent with EEG reactivity by 24% of centers. Stimulus induced rhythmic, periodic, or ictal discharges were considered indicative of EEG reactivity in 44% of centers. Conclusion There is substantial variability in EEG reactivity testing practices among North American academic medical centers. Lack of standardization of stimulation protocols, training of EEG Technologists, and ambiguous definitions of EEG reactivity might contribute to subjectivity and variability in EEG reactivity assessment.

Os EUA, a exportação e a expansão do ensino de Management no Brasil nas décadas de 1950 e 1960

Resumo Estudos a respeito da história do ensino de Administração têm ganhado destaque no campo, recentemente, em nosso país. Neste artigo, discutimos como instituições dos EUA atuaram na exportação e expansão do ensino de Management no Brasil durante os anos de 1950 e 1960. Argumentamos que a representação diplomática dos EUA, a Universidade do Michigan e a Fundação Ford formaram uma rede que possibilitou a exportação e expansão do ensino do Management no País. Este artigo contribui por aprofundar a discussão sobre a exportação e expansão do ensino do Management para o Brasil, e por contextualizar essa ação dentro das relações Brasil-EUA da época. Além disso, mostramos detalhadamente o papel das instituições norte-americanas nesse processo e colocamos ainda a expansão do ensino do Management no Sul e no Nordeste do Brasil como resultado de apoio e pressões por parte dos EUA.

Ecological regional analysis applied to campus sustainability performance

PurposeSustainability performance in higher education is often evaluated at a generalized large scale. It remains unknown to what extent campus efforts address regional sustainability needs. This study begins to address this gap by evaluating trends in performance through the lens of regional environmental characteristics.Design/methodology/approachFour sustainability metrics across 300 North American institutions are analyzed between 2005 and 2014. The study applies two established regional frameworks to group and assess the institutions: Commission on Environmental Cooperation Ecoregions and WaterStat (water scarcity status). Standard t-tests were used to assess significant differences between the groupings of institutions as compared to the North American study population as a whole.FindingsResults indicate that all institutions perform statistically uniformly for most variables when grouped at the broadest (Level I) ecoregional scale. One exception is the Marine West Coast Forest ecoregion where institutions outperformed the North American average for several variables. Only when institutions are grouped at a smaller scale of (Level III) ecoregions do the majority of significant performance patterns emerge.Research limitations/implicationsThis paper demonstrates an ecoregions-based analytical approach to evaluating sustainability performance that contrasts with common evaluation methods in the implementation field. This research also identifies a gap in the literature explicitly linking ecological sub-regions with their associated environmental challenges and identifies next research steps in developing defensible regional targets for applied sustainability efforts.Practical implicationsThe practical implications of this research include the following: substantive changes to methodologies for rating sustainability leadership and performance, a framework that incentivizes institutions to frame sustainability efforts in terms of collaborative or collective impact, a framework within which institutions can meaningfully prioritize efforts, and a potential shift toward regional impact metrics rather than those focused solely on campus-based or generalized targets.Originality/valueThe authors believe this to be the first effort to analyze North American higher education sustainability performance using regional frameworks.

Updated clinical guidelines experience major reporting limitations

BackgroundThe Checklist for the Reporting of Updated Guidelines (CheckUp) was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs) exists. We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of CheckUp.MethodsWe conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items). We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC) and 95% confidence interval (95% CI) for domains and overall score.ResultsWe included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10), for editorial independence 8.3 (range 3.3 to 10), and for methodology 5.7 (range 0 to 10). The median overall score on a 10-point scale was 6.3 (range 3.1 to 10). Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs). CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014). Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95).ConclusionsThe reporting of updated CGs varies considerably with significant room for improvement. We recommend using CheckUp to assess the updating process in updated CGs and as a blueprint to inform methods and reporting strategies in updating.

Oncology research in late twentieth century and turn of the century Portugal: a scientometric approach to its institutional and semantic dimensions

This paper analyses the developmental dynamics of oncology research in Portugal during the second half of the twentieth century and early twenty first century. Grounding its conclusions in a scientometric analysis of a database of publications covering the period 1976–2015, the paper shows how the expansion of oncology research from the end of the 1990s through the 2000s is closely related to science and technology policy decisions in the country. The main actors of the institutional evolution of the field are public organizations, both hospital and academia/research-based, frequently working together. Portuguese oncology research focused especially on organ-based cancers, underlining the strong link between the laboratory and the clinic. Accordingly, translational research is a major trend in oncology research, as evidenced by the analysis of publications in major journals and inter-citation maps. Networks of institutional co-authorships show the importance of regional and international collaborations. The collaboration patterns over time reveal the importance of national and European collaborations during the initial years covered by our publication database, in line with the major impact of Portugal’s integration into the European Union, and a growing importance of regional collaborations, as well as with North and South American institutions in more recent years. Portugal provides a case study of how twentieth century policies at the national and European levels have impacted on the evolution of oncology research in countries from southern Europe.