Importance Rating
\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"6132",leadTitle:null,fullTitle:"Advanced Casting Technologies",title:"Advanced Casting Technologies",subtitle:null,reviewType:"peer-reviewed",abstract:"Major casting processing advancements have been made in experimental and simulation areas. Newly developed advanced casting technologies allow foundry researchers to explore detailed phenomena associated with new casting process parameters helping to produce defect-free castings with good quality. Moreover, increased computational power allows foundry technologists to simulate advanced casting processes to reduce casting defects. In view of rapid expansion of knowledge and capability in the exciting field of casting technology, it is possible to develop new casting techniques. This book is intended to discuss many casting processing technologies. It is devoted to advanced casting processing technologies like ductile casting production and thermal analysis, casting of metal matrix composites by vortex stir casting technique, aluminum DC casting, evaporative casting process, and so on. This book entitled Advanced Casting Technologies has been organized into seven chapters and categorized into four sections. Section 1 discusses the production of ductile iron casting and thermal analysis. Section 2 depicts aluminum casting. Section 3 describes the casting manufacturing aspects of functionally graded materials and evaporative casting process. Section 4 explains about the vortex stir casting technique to process metal matrix composite castings. All the chapters discussed in detail the processing steps, process parameters involved in the individual casting technique, and also its applications. The goal of the book is to provide details on the recent casting technologies.",isbn:"978-1-78923-033-8",printIsbn:"978-1-78923-032-1",pdfIsbn:"978-1-83881-297-3",doi:"10.5772/intechopen.68254",price:119,priceEur:129,priceUsd:155,slug:"advanced-casting-technologies",numberOfPages:136,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f2da423c1b74b321e5302adaaf888495",bookSignature:"T.R. Vijayaram",publishedDate:"May 2nd 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6132.jpg",numberOfDownloads:9801,numberOfWosCitations:31,numberOfCrossrefCitations:35,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:53,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:119,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 28th 2017",dateEndSecondStepPublish:"April 18th 2017",dateEndThirdStepPublish:"November 19th 2017",dateEndFourthStepPublish:"December 19th 2017",dateEndFifthStepPublish:"February 19th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"139338",title:"Prof.",name:"Thoguluva",middleName:"Raghavan",surname:"Vijayaram",slug:"thoguluva-vijayaram",fullName:"Thoguluva Vijayaram",profilePictureURL:"https://mts.intechopen.com/storage/users/139338/images/system/139338.jpg",biography:"Dr. T. R. Vijayaram is a senior professor in the Department of Mechanical Engineering, School of Mechanical Engineering, Bharath Institute of Higher Education and Research (BIHER), India. He is an expert in the field of materials and metallurgical, manufacturing, and mechanical engineering. He received his BE in Mechanical Engineering from Madurai Kamaraj University, India, followed by an ME in Industrial Metallurgy from PSG College of Technology, Bharathiyar University, India. He obtained his Ph.D. in Mechanical Engineering from Universiti Putra Malaysia. Later, he worked as a rector researcher in metallurgy at the Department of Chemistry and Industrial Chemistry (DCCI), Genoa University, Italy. His passion for academics, research, and education led him to obtain an MBA in Educational Management and an MA in Sociology from the University of Madras, India. He is also a Chartered Engineer (India) and a member of several professional and scientific bodies in India and abroad, including the Indian Society for Technical Education (ISTE), Institution of Engineers (IEI), Institute of Indian Foundryman (IIF), and Society of Automotive Engineers (SAE). He is also a fellow of IEI. Dr. Vijayaram received the Distinguished Scientist Award in Metallurgical and Materials Engineering for his outstanding contribution to metallurgy. He has published more than 210 papers in international and national journals, conferences, broadsheets, and magazines. His areas of research include materials engineering, metallurgical engineering, manufacturing engineering, and mechanical engineering.",institutionString:"Bharath University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"944",title:"Metallurgy",slug:"metals-and-nonmetals-metallurgy"}],chapters:[{id:"57999",title:"Thin Wall Ductile Iron Castings",doi:"10.5772/intechopen.72117",slug:"thin-wall-ductile-iron-castings",totalDownloads:1023,totalCrossrefCites:2,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The use of austempered ductile iron (ADI) as an alternative material has increased, and it is predicted that it will reach 300,000 tons by the year of 2020 due to its characteristics especially design flexibility. When the reduction in weight is considered as a parameter for energy saving, ADI is presented as thin wall austempered ductile iron (TWADI). To produce a good quality TWADI, a good quality thin wall ductile iron (TWDI) must be used as a raw material. Good quality TWDI is produced by casting design. This chapter discusses the production of thin wall ductile iron, including its characterisation and defect. The discussion includes the background of thin wall casting (TWC) and TWDI, applying TWC in general casting, the problems in producing TWDI, characterisation of the TWDI and specific defects.",signatures:"Rianti Dewi Sulamet-Ariobimo, Johny Wahyuadi Soedarsono and\nTresna Priyana Soemardi",downloadPdfUrl:"/chapter/pdf-download/57999",previewPdfUrl:"/chapter/pdf-preview/57999",authors:[{id:"208291",title:"Dr.",name:"Rianti",surname:"Sulamet-Ariobimo",slug:"rianti-sulamet-ariobimo",fullName:"Rianti Sulamet-Ariobimo"}],corrections:null},{id:"57825",title:"Thermal Analysis of Ductile Iron Casting",doi:"10.5772/intechopen.72030",slug:"thermal-analysis-of-ductile-iron-casting",totalDownloads:1562,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Pure metals solidify with a solidification front that is very well defined and a clearly delineated solid-liquid interface. Ductile cast iron solidification is characterised by a very thin solidified skin and appearance of different phases. The outer skin is formed being very thin in ductile iron; the expansion occurs due to graphite nucleation into the casting forces to the mould walls. With proper care taken while designing and during melt processing stage, quality ductile iron castings can be produced with minimal risering. With recent developments in sensing and storing instruments, it is now possible to see and measure structural transformations within the solidification in ductile iron castings very precisely. The shape of a cooling curve measured by a thermocouple mounted on a thermal analysis sample cup reflects the solidification process of the melted cast alloy for the given solidification conditions. By analysing particular cooling curve, the solidification start, eutectic arrests, recalescence, amount of undercooling and end of freezing temperature temperatures are generated. The thermal analysis data so generated will be used to study composition, soundness, chill and microstructure by analysis of cooling curve. The cooling rates measured in degrees per second at different stages of solidification sequence will be analysed and correlated with the properties of the castings to be produced from the same melt.",signatures:"Vasudev D. Shinde",downloadPdfUrl:"/chapter/pdf-download/57825",previewPdfUrl:"/chapter/pdf-preview/57825",authors:[{id:"208778",title:"Prof.",name:"Vasudev",surname:"Shinde",slug:"vasudev-shinde",fullName:"Vasudev Shinde"}],corrections:null},{id:"57796",title:"Depicting Aluminium DC Casting by Means of Dimensionless Numbers",doi:"10.5772/intechopen.71893",slug:"depicting-aluminium-dc-casting-by-means-of-dimensionless-numbers",totalDownloads:1141,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"DC casting of aluminium and its alloys is a controlled heat removal solidification process. The rate of heat extraction has strong effects on the microstructure and mechanical properties of the solidified alloy ingots. In view of this strict temperature, control over the ingot as it solidifies should be implemented in order to achieve metal with the best possible properties. In situ direct temperature measurements are complicated; so in this report, the use of dimensionless analysis to predict temperature distributions on the ingots as they are casted is proposed. It is reported that the dimensionless groups that better represent the impact of process variables on the solidification of aluminium and its alloys are the Péclet (Pe) and Biot (Bi) numbers.",signatures:"José C. Méndez, Ricardo R. Ambriz, David Jaramillo and Gabriel\nPlascencia",downloadPdfUrl:"/chapter/pdf-download/57796",previewPdfUrl:"/chapter/pdf-preview/57796",authors:[{id:"46960",title:"Prof.",name:"Gabriel",surname:"Plascencia",slug:"gabriel-plascencia",fullName:"Gabriel Plascencia"},{id:"85573",title:"Dr.",name:"Ricardo Rafael",surname:"Ambriz",slug:"ricardo-rafael-ambriz",fullName:"Ricardo Rafael Ambriz"},{id:"170247",title:"Dr.",name:"David",surname:"Jaramillo",slug:"david-jaramillo",fullName:"David Jaramillo"},{id:"208155",title:"Prof.",name:"Claudio",surname:"Méndez",slug:"claudio-mendez",fullName:"Claudio Méndez"}],corrections:null},{id:"58487",title:"Castability and Characteristics of High Cerium Aluminum Alloys",doi:"10.5772/intechopen.72830",slug:"castability-and-characteristics-of-high-cerium-aluminum-alloys",totalDownloads:1010,totalCrossrefCites:6,totalDimensionsCites:13,hasAltmetrics:0,abstract:"This chapter describes the development and the castability of near eutectic aluminum-cerium (Al-Ce) alloy systems. These alloys have good mechanical properties at high temperatures and are very castable. The castability of the binary systems is as good or better than the aluminum-silicon system with some deterioration as additional alloying elements are added. In alloy systems that use cerium in combination with common aluminum alloying elements such as silicon, magnesium, and/or copper, the casting characteristics are generally better than the aluminum-copper system. Alloying with magnesium increases room temperature strength considerably.",signatures:"David Weiss",downloadPdfUrl:"/chapter/pdf-download/58487",previewPdfUrl:"/chapter/pdf-preview/58487",authors:[{id:"206168",title:"Mr.",name:"David",surname:"Weiss",slug:"david-weiss",fullName:"David Weiss"}],corrections:null},{id:"57524",title:"Casting and Applications of Functionally Graded Metal Matrix Composites",doi:"10.5772/intechopen.71225",slug:"casting-and-applications-of-functionally-graded-metal-matrix-composites",totalDownloads:1501,totalCrossrefCites:3,totalDimensionsCites:6,hasAltmetrics:0,abstract:"This chapter discusses the concepts, casting techniques and applications of functionally graded materials metal matrix composites (FGMMCs). Considerations were given to bulk functionally graded aluminium matrix composites (FGAACs) production processes. Liquid-metal forging processes of FGAACs fabrication, such as infiltration process, squeeze casting, friction casting or compocasting, stir, and centrifugal casting were discussed. The chapter provides basic concepts of the processes and overview of their processing parameters, such as mould rotational speed; reinforcement particles size and volume; degassing method; melting and pouring temperatures; pressure; and stirrer. The study notes that functionally graded materials (FGMs) are commonly used in automotive, aircraft, aviation, chemical, medical, engineering, renewable energy, nuclear energy, and optics electronics industries.",signatures:"Williams S. Ebhota and Tien-Chen Jen",downloadPdfUrl:"/chapter/pdf-download/57524",previewPdfUrl:"/chapter/pdf-preview/57524",authors:[{id:"206268",title:"Dr.",name:"Williams",surname:"Ebhota",slug:"williams-ebhota",fullName:"Williams Ebhota"},{id:"214786",title:"Prof.",name:"Tien-Chien",surname:"Jen",slug:"tien-chien-jen",fullName:"Tien-Chien Jen"}],corrections:null},{id:"59140",title:"Evaporative Pattern Casting (EPC) Process",doi:"10.5772/intechopen.73526",slug:"evaporative-pattern-casting-epc-process",totalDownloads:1234,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The chapter provides details of operations and activities in evaporative pattern casting (EPC) Process. The process was developed in the year 1956 to tackle some of the inadequacies of the traditional sand casting processes but has in itself some challenges that should be taken care of if sound castings would be obtained. The challenges come mainly from the evaporative pattern employed as pattern material in the process. The material makes the process to be sensitive to process variables such that proper and adequate control should be ensured to have castings of sound integrity. Some of the known process variables are pouring temperature, refractory coating, vibration and pattern and molding materials. In the whole the EPC is known to have edge over the traditional sand casting methods.",signatures:"Babatunde Victor Omidiji",downloadPdfUrl:"/chapter/pdf-download/59140",previewPdfUrl:"/chapter/pdf-preview/59140",authors:[{id:"228410",title:"Dr.",name:"Victor",surname:"Omidiji",slug:"victor-omidiji",fullName:"Victor Omidiji"}],corrections:null},{id:"58816",title:"Fabrication of Aluminum Matrix Composites by Stir Casting Technique and Stirring Process Parameters Optimization",doi:"10.5772/intechopen.73485",slug:"fabrication-of-aluminum-matrix-composites-by-stir-casting-technique-and-stirring-process-parameters-",totalDownloads:2330,totalCrossrefCites:21,totalDimensionsCites:30,hasAltmetrics:1,abstract:"Aluminum matrix composites (AMCs) and hybrid aluminum matrix composites (HAMCs) becomes choice for automobile and aerospace industries due to its tunable mechanical properties such as very high strength to weight ratio, superior wear resistance, greater stiffness, better fatigue resistance, controlled co-efficient of thermal expansion and good stability at elevated temperature. Stir casting is an appropriate method for composite fabrication and widely used industrial fabrication of AMCs and HAMCs due to flexibility, cost-effectiveness and best suitable for mass production. Distribution of the reinforcement particles in the final prepared composite regulates the anticipated properties of AMCs and HAMCs. However, distribution of reinforcements is governed by stirring process parameters. The study of effect of stirring parameters in the particle distribution and optimal selection of these is still a challenge for the ever-growing industries and research. In this chapter accurate and precise attempts were taken to explore the effect of stirring parameters in stir casting process rigorously. Further, Optimal values of stirring parameters were suggested which may be helpful for the researchers for the development of AMCs and HAMCs. This chapter may also provide a better vision towards the selection of stirring parameters for industrial production of AMCs and HAMCs comprising superior mechanical properties.",signatures:"Mohit Kumar Sahu and Raj Kumar Sahu",downloadPdfUrl:"/chapter/pdf-download/58816",previewPdfUrl:"/chapter/pdf-preview/58816",authors:[{id:"200118",title:"Dr.",name:"Raj",surname:"Sahu",slug:"raj-sahu",fullName:"Raj Sahu"},{id:"225730",title:"Mr.",name:"Mohit",surname:"Sahu",slug:"mohit-sahu",fullName:"Mohit Sahu"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"3817",title:"Developments in Corrosion Protection",subtitle:null,isOpenForSubmission:!1,hash:"8ff86fac7ac8bce142fdc3c0e5a79f30",slug:"developments-in-corrosion-protection",bookSignature:"M. 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Six Sigma is a customer focused continuous improvement strategy and discipline that minimizes defects.It is a philosophy to promote excellence in all business processes with aggressive target goals.Six Sigma is a five phase methodology for continuous improvement which uses a metric based on standard deviation.It is also a statistic which describes the amount of variation in a process.Six Sigma is focused on customer satisfaction and cost reduction by reducing variation in processes.
At the core of the method, Six Sigma utilizes a discipline that strives to minimize defects and variation of critical variables towards an achievement of 3.4 defects per million opportunities in product design, production, and administrative processes. Customer satisfaction and cost reduction can be realized by reducing variation in processes that produce products and services which they use. While focused on reducing variation, the Six Sigma methodology uses a well-defined problem solving approach with the application of statistical tools. The methodology uses five phases including Define-Measure-Analyze-Improve-Control (DMAIC). The purpose of the five phases are to define the problem, measure the process performance, analyze the process for root causes, improve the process by eliminating or reducing root causes, and control the improved process to hold the gains.
The goals of Six Sigma include developing a world-class culture, developing leaders, and supporting long-range objectives.There are numerous benefits of Six Sigma including a stronger knowledge of products and processes, a reduction in defects, an increased customer satisfaction level that generates business growth and improves profitability, an increased communication and teamwork, and a common set of tools.Six Sigma is commonly credited to Bill Smith, an engineer at Motorola, who coined the term in 1984.The concept was originally developed as a safety margin of fifty percent in design for product performance specifications.This safety margin was equivalent to a Six Sigma level of capability.Since it’s first introduction, Six Sigma has continued to evolve over time and has been adopted throughout the world as a standard business practice.
In order to achieve Six Sigma, an organization must understand the customer’s wants and needs, also known as the voice of the customer (VOC). The voice of the customer is defined as the identification, structuring, and prioritization of customer needs. Within the Six Sigma DMAIC methodology, gathering the voice of the customer falls within the define phase. This enables the team to fully understand the customer’s expectations at the beginning of the project.Prior to initiating any project or process improvement initiative, the organization or team must determine how the customer defines quality. The customer is typically surveyed or interviewed (among other techniques) to determine their expectations and these are then analyzed using quality function deployment (QFD). A critical aspect of a QFD analysis is gathering the voice of the customer to assess how a product or service measures against what the customer wants or expects.
Customers continually want more reliable, durable products and services in a timely manner.In order to remain competitive, all organizations must become more responsive to customers, strive for Six Sigma capability, and operate at world class level.
Quality function deployment has been widely used to capture the voice of the customer and translate it into technical requirements in the development of products and services. It is a link between product or service development and technical specifications to achieve customer satisfaction. Applications of QFD range from product development, service development, and product re-projecting (Miguel & Carnevalli, 2008).
QFD was developed by Yogi Akao in 1966 and was initially introduced in Japan in the late 1960s and early 1970s. QFD was first implemented in Mitsubishi’s Kobe shipyard in 1972. Following QFD’s introduction in Japan, it was then implemented primarily in manufacturing settings in the United States. Since then, it has been successfully used in many industries and various functional areas, including product development, quality management, customer needs analysis, product design, planning, engineering decision making, management, teamwork, timing, costing and other areas (Chan and Wu, 2002).
Assessing customer requirements is a complex task. Traditional approaches have focused on present customer needs; however, Wu, Liao, and Wang (2005) have concluded that, since customer needs are dynamic and may vary drastically over time, analyzing future customer needs is critical to an organization’s long-term competitiveness. Customer needs may vary depending on various factors, the most important and complex of which is human nature. Other factors may include cultural setting, work environment, age, sex, etc. The most common way to determine customer requirements is through direct customer interaction, but surveyors must consider what a customer means rather than what he or she says.
Quality function deployment is a systematic process to integrate customer requirements into every aspect of the design and delivery of products and services. Understanding the customers wants or needs from a product or service is crucial to the successful design and development of new products and services. QFD is a system that utilizes customer demands to meet client missions by outlining what the customer wants in a service or product. QFD involves the construction of one or more matrices, called quality tables, which ensure customer satisfaction and improved quality servicesat every level of the service and product development process. QFD is a planning process that translates customer needs into appropriate company requirements at each stage, from research and product/service development to engineering, manufacturing, marketing/sales, and distribution.
It is crucial for any organization to understand their customers’ requirements and service expectations as they represent implicit performance standards used by the customers in the assessment of service and product quality. A significant relationship between the relative quality, as perceived by the customers, and the organization’s profitability has been shown. The opportunities to apply QFD in service and business sectors are rapidly expanding. QFD has been used to enhance a wide range of service aspects in healthcare, chemical, and telecommunications industries as well as the typical product design applications. It is vital for companies to identify the exact needs of the customers and to measure their satisfaction toward a Six Sigma level to survive in the current competitive market. QFD focuses on designing in quality rather than inspecting in quality which reduces development times, lowers startup costs, and promotes the use of teams.
QFD maintains the integrity of the VOC and generates innovative strategies to achieve an organization’s vision. In addition, it leads directly to policy deployment for implementation and performance management.Overall, QFD is a service planning and development tool, that facilitates service providers with an organized way to assure quality and customer satisfaction while maintaining a sustainable competitive advantage (Akao, 1990). QFD aims at enhanced customer satisfaction, organizational integration of expressed customer wants and needs, and higher profit levels (Griffin and Hauser, 1991).
QFD is a comprehensive quality system aimed specifically at satisfying the customer. It concentrates on maximizing customer satisfaction by seeking out both spoken and unspoken needs (Helper and Mazur, 2006). QFD displays the notation of customer orientation for designing products and services. Its purpose is to listen to the customer and translate their requirements back in any business process so that the end product or service will satisfy their needs and demands (Chan et al., 2006).
Since its introduction, QFD has been used in conjunction with various techniques such as the Kano model (Sauerwein, Bailom, Matzler, & Hinterhuber, 1996), SERVQUAL (Parasuraman, Zeithaml, & Berry, 1988), analytical hierarchy process (AHP), and maximum difference (MaxDiff), among others.
The mission of this chapter is to provide an overview of QFD, the various approaches, goals/purpose of QFD, a step-by-step procedure for performing QFD, and interpreting QFD.
The opportunities to apply QFD in service and business sectors are rapidly expanding. QFD has been used to enhance a wide range of service aspects in healthcare, chemical, and telecommunications industries as well as the typical product design applications. It is vital for companies to identify the exact needs of the customers and to measure their satisfaction to survive in the current competitive market. QFD focuses on designing in quality rather than inspecting in quality which reduces development times, lowers startup costs, and promotes the use of teams (Fisher and Schutta, 2003).
QFD is a planning process that translates customer needs into appropriate company requirements at each stage, from research and product/service development to engineering, manufacturing, marketing/sales, and distribution (Pawitra and Tan, 2003). The quality function deployment method was first originated in Japan and is used to select the design features of a product to satisfy the expressed needs and preferences of the customer as well as to prioritize those features and select the most important for special attention further down the design process (Fisher and Schutta, 2003).Maritan and Panizzolo (2009) proposed that when used in the strategic planning process, QFD maintains the integrity of the VOC and generates innovative strategies to achieve an organization’s vision. They also argue that it leads directly to policy deployment for implementation and performance management.Overall, QFD is a service planning and development tool, that facilitates service providers with an organized way to assure quality and customer satisfaction while maintaining a sustainable competitive advantage (Akao, 1990). QFD aims at enhanced customer satisfaction, organizational integration of expressed customer wants and needs, and higher profit levels (Griffin, 1992).
QFD differs from traditional quality systems that aim to minimize negative quality such as poor service (Mazur, 1993). QFD provides an organized, systematic approach to bringing customer requirements into product and service design (Helper and Mazur, 2006). QFD focuses on delivering “value” by seeking out both spoken and unspoken customer requirements, translating them into actionable service features and communicating them throughout an organization (Mazur, 1993, 1997; Pun et al., 2000). It is driven by the voice of the customer and because of that, it helps service providers to address gaps between specific and holistic components of customer expectations and actual service experience. In addition, it helps managers to adopt a more customer-driven perspective, pointing out the differences between what managers visualize as customer expectations and the actual customer expectations. It provides a way to more objectively address subjective needs yet demonstrates the belief in customer focus and employee involvement for every party involved in the supply chain.
QFD is developed by a cross-functional team and provides an interdepartmental means of communication that creates a common quality focus across all functions/operations in an organization (Stuart and Tax, 1996). The unique approach of QFD is its ability to integrate customer demands with the technical aspects of a service. It helps the cross-functional team make the key tradeoffs between the customers’ needs and the technical requirements so as to develop a service of high quality. Hence, QFD is not only a methodological tool but also a concept that provides a means of translating customer requirements in each stage of service development (Chan and Wu, 2002).
A critical aspect of a QFD analysis is gathering the voice of the customer to assess how a product or service measures against what the customer wants or expects.The voice of the customer is defined as the identification, structuring, and prioritization of customer needs (Griffin and Hauser, 1991). Customer needs are measured in terms of consequences, which are determined by asking customers directly what they are looking for in a product or service. Then, the customer consequences are assessed and technical requirements are developed by knowledgeable professionals associated with the specific field of the product or service being assessed.The technical requirements are design dimensions that are specifically made to meet the customer consequences developed from the VOC.For example, if a customer consequence was better fuel economy (associated with a vehicle), perhaps a technical requirement would be the fuel type or weight of the vehicle that would directly be associated with the customer consequence.
The VOC is obtained primarily by two methods, namely through interviews or focus groups, which are then used to develop a survey questionnaire to distribute to potential and/or existing customers. Griffin and Hauser (1991) suggest that interviews with 20-30 customers should identify 90% or more of the customer needs in a relatively homogeneous customer segment. Multiple analysts (4-6) should review the transcripts of the focus groups to identify group synergies.Once the interviews and/or focus groups are conducted, an affinity diagram can be used to group the similarities in responses from the participants to develop a questionnaire that addresses all the topics important to the participant.The survey then asks the participant to rate an existing product or service on a scale of 1 to 5 on how well they view the product or service performs on each customer consequence.The participant is also asked to weight how important each customer consequence is to them for the product or service.A weighted rating can then be obtained by multiplying the rating and weight assigned to each customer consequence so that prioritization can be assessed.For example, a customer consequence could be discovered to be very important to a participant, but they view the product or service as performing poorly.This consequence would have priority to address over a consequence that the participant viewed as having a high rating on performance yet it was not seen as important.The next discussion refers to the House of Quality, which is the tool used for organizing the customer consequences and subsequent technical requirements developed to address those consequences.
Olewnik and Lewis (2008) report that the HOQ is a design tool that supports information processing and decision making in the engineering design process. They note that for companies just implementing QFD and the HOQ, there is undoubtedly an improvement in information structure, flow, and direction. Hauser and Clausing (1988) state that the principal benefit of the HOQ is increasing the quality focus of the organization. That is, the HOQ gets people within an organization thinking in the right direction and thinking together.
QFD uses a set of interrelated matrix diagrams. The first matrix is the HOQ, which converts the customer consequences into technical requirements that must be fulfilled throughout the supply chain. The starting point on the left of the house is the identification of basic customer consequences. The next step is the definition of the priority levels that customers assign to these needs. These priorities are translated into numeric values that indicate relative importance, as discussed earlier. Customer ratings, shown on the right side of the house, enable benchmarking with competitors’ services. The section just below the roof states the technical requirements used to meet the customer consequences. The relationship between the customer consequences and technical requirements constitutes the main body of the HOQ, called the relationship matrix. This matrix helps identify certain technical requirements that should be given priority if one addresses multiple customer consequences.The correlation matrix defines the relationships among technical requirements, which is represented by the roof of the HOQ.The bottom of the house evaluates the competition in terms of technical requirements in which the target values are defined by the researcher in this matrix (Tan and Pawitra, 2001). The construction of each of the sections in the HOQ is discussed in the following sections. Figure 1 depicts a standard HOQ.
The following section of this paper will outline a standard generic methodology for conducting a QFD analysis, which includes obtaining the VOC and translating it into meaningful data using an HOQ.
HOQ Model (
QFD involves the construction of one or more matrices, called quality tables, which ensure customer satisfaction and improved quality services at every level of the service development process. The House of Quality, one of the most commonly used matrices in the QFD methodology, is a toolbox of decision matrices and the customer requirements and competitive benchmarks are utilized for decision-making (Andronikidis et al., 2009).
TheQFD methodology requires the development of a survey to understand the customer consequences for a product’s or service’s potential, current, or past customers regarding its functions to these demographics, and translates these consequences using quality function deployment into technical requirements to improve service offerings. The final deliverable of the methodology is an HOQ that is constructed by integrating customer consequences gathered via a survey, developing technical requirements to address each customer consequence, benchmarking competitors on similar design structures, and comparing the product or service to its competitors and prioritizing actions based on customer wants and competitors’ successes and/or failures. The step-by-step process for the development of the HOQ is discussed in detail in the following sections.
One of the essential strategies for successful functioning of any organization is delivering superior service or product quality to their customers. Understanding what exactly the customer’s needs and wants (voice of the customer)are is a key criterion in total quality management (Griffin and Hauser, 1991). The first step towards understanding customer needs is to identify attributes and customer consequences. Attributes are defined as the physical or abstract characteristics of a service or product. They are objective, measurable, and reflect the provider’s perspective. Consequences are a result of using attributes; basically, an end result in what a customer “gets” from using a service or product. Customers judge services and products based on their consequences, not their attributes. In other words, customers judge a service or product on its outcome, or affect of use on them.A service or product has many attributes, and each may have more than one consequence (Fisher and Schutta, 2003).
To gather the VOC, a cross-functional team must conduct focus groups or interviews with a select group of potential, existing, or past customers and ask them what is important to them in the service or product being offered.“Why” is asked numerous times until the respondent responds with the same answer each time.This is the fundamental customer consequence that the customer wants from using the service or product. These responses are grouped using an affinity diagram and used to develop a meaningful survey questionnaire that captures all things important to the customers.To ensure that the appropriate number of responses is gathered (90%), a standard sample size calculation can be performed.
During the survey, the respondents are asked to evaluate the particular product or service provider on each customer consequence on a standard 5 point Likert scale.The respondent is also asked to weight each consequence on how important it is to them on a 5 point Likert scale.These ratings and weightings will be multiplied to derive a weighted rating to encompass both the performance rating and the importance for each consequence.With this information, the team can determine which of the consequences are the most important and also the worst in performance and assign priorities.
If respondents for other similar types of products or services are available, the same survey can gather data regarding customer consequences for those competitors.If respondents are not available, the team will use available data (i.e., website published information, annual reports, technical reports, financial statements) to determine which competitor being evaluated is “best” and assign it a value of “5”. The team will also identify which competitor is “worst” at each consequence and sign them a value of “1”.All competitors will be assigned a value relative to “best” and “worst” using team or industry expertise in the subject area.This information will be used to “benchmark” the product or service being directly evaluated by the team to see how they compare to similar competitors.
After the customer consequences are analyzed, the next step in the construction of the HOQ is the development of the technical requirements. The technical requirements are the design specifications that satisfy customer consequences.These technical requirements are on the top of the HOQ and are referred to as the “how” of the HOQ.They describe “how” to meet the customer consequences and improve a product or service.The technical requirements must be within the control of the product or service provider and must be measurable (i.e., quantitative measurements, “yes/no”).Each customer consequence can have more than one technical requirement, and each technical requirement may fulfill the need of more than one customer consequence.
The development of technical requirements often requires expertise in the area regarding the service or product and requires creativity to develop.This area of the HOQ is the “thinking outside the box” aspect and there is no definite “right or wrong” answer.Any reasonable technical requirement should be considered.Often times ambiguous research and information collected from many sources (i.e., experts, websites, technical reports) may be used to spark brainstorming and creativity to develop technical requirements.
Once the customer consequences are developed, survey results are gathered, and the technical requirements are developed, a matrix to highlight relationships between the customer consequences and the technical requirements is constructed.This matrix is the “body” of the House of Quality. The matrix defines the correlations between the customer consequences and technical requirements as strong, moderate, or weak using a 9-3-1 scale. For this scale the following notations are used Strong (H) = 9, Moderate (M) = 3, and Weak (S) = 1. Each customer consequence is matched with any applicable technical requirement; make note that relationships should not be forced, leaving a blank if no relationship is determined.Here again, this assignment of relationships requires the expertise of the researchers or industry members.Normally only the strongest relationships are specified leaving approximately 60-70% of the matrix blank (Griffin and Hauser, 1991). Although some indicate that ideally in the QFD analysis, no more than 50% of the relationship matrix should be filled, and a random pattern should result (Fisher and Schutta, 2003). This matrix identifies the technical requirements that satisfy most customer consequences. The technical requirements that address the most customer consequences should be a main priority in the design process to ensure a product or service that satisfies the stated customer expectations.
After the completion of the relationship matrix, the focus of the analysis shifts to the construction of the planning matrix. The planning matrix defines how each customer consequence has been addressed by the competition. It provides market data, facilitates strategic goal setting for the new product, and permits comparison of the customer desires and needs. It also compares the service to its key competitors. For the competitive analysis, research should be conducted regarding similar products or services.Researchers may have to assert a level of expertise in drawing meaningful information from the information available, as many competitors will not openly aid their competition by providing market data and design specifications.The researchers will use available data (i.e., website published information, annual reports, technical reports, financial statements) to determine which competitor being evaluated is “best” and assign it a value of “5”.The researchers will also identify which competitor is “worst” at each consequence and sign them a value of “1”.All competitors will be assigned a value relative to “best” and “worst” using researcher or industry expertise in the subject area.This information will be used to “benchmark” the product or service being directly evaluated by the researcher to see how they compare to similar competitors.
Following the completion of the relationship and planning matrices, the technical correlations are determined. These correlations are depicted in the roof of the HOQ. The roof maps the relationships and interdependencies among the technical requirements. The analysis of which informs the development process, revealing the existence and nature of service or product design bottlenecks. The relationships among technical requirements are plotted and given a value. Relationships among the technical requirements are important to evaluate, as one technical requirement could either aid or hinder the success of another crucial technical requirement in meeting customer consequences.Past experience and publicly available data (i.e., website information, technical reports, financial reports) can be used to complete the roof of the HOQ. Symbols are used to represent the strength of the relationship between the technical requirements and are assigned by the team.
The last step in the formation of the HOQ is the foundation or bottom of the house.This foundation is referred to as the technical matrix. This matrix depicts the values assigned by the team of the direction of improvement and/or standard values of each technical requirement needed to be competitive in the industry. Often times, if a numerical value cannot be absolutely determined, the team and/or industry experts use judgment based on expertise in the subject area to assign “targets.”The direction of improvement indicates the type of action needed to ensure that the technical requirements are sufficient to make the product or service competitive for each entity evaluated. For example, if a technical requirement’s target value is 5, and a product or service provider’s mean for that requirement is 4, the direction of improvement would be up to aim for the higher target value.
The collected information from the above methods enables the development of strategic decisions, one of which is the allocation of resources. An importance-performance grid can be developed to prioritize the usage of resources to improve the most critical customer benefits. The mean importance ratings (gathered from the survey) can be plotted on the vertical axis (importance) and the mean customer competitive ratings (gathered from the survey) on the horizontal axis (performance). Using the importance rating values, the mean importance rating (for all consequences) should be calculated.The consequences with an importance rating higher than that of the mean importance rating should be placed above the horizontal line and those lower should be placed below this line. After these values are plotted, the focus can shift to the distribution of consequences on either the left or right side of the vertical line. For this purpose, the mean performance rating is used and labeled for the vertical axis. Each consequence with a lower mean should be plotted to the left of the axis, and each consequence with a performance mean higher than the mean should be plotted to the right of the vertical axis.Using this grid, the level of priority can be assigned to each consequence from the customer’s point of view, and subsequently resource allocation decisions can be influenced.
There are two main tools utilized in quality function deployment: the Kano model and SERVQUAL. This section describes each of these tools in detail.
The Kano model is a theory of customer satisfaction developed in the 1980s by Noriaki Kano (Kano et al., 1984). During interviews and focus groups, it can be difficult to elicit from customers clear expressions of the consequences that are important to them. Attributes are the physical or abstract characteristics of the product or service where as consequences are the results of using the service. Sometimes customers are not even aware of important consequences (Fisher and Schutta, 2003).
The Kano model is a theory of product development and customer satisfaction. Kano et al. (1984) distinguish three types of product or service requirements that influence customer satisfaction in various ways: ‘‘must be,” ‘‘one-dimensional,’’ and ‘‘attractive’’ quality requirements. Must be requirements can be defined as the basic attributes of quality in terms of customer satisfaction. In other words, they are a necessary but insufficient condition for customer satisfaction (Busacca and Padula, 2005).
One-dimensional requirements are related to product or service performance; they create customer satisfaction when present and dissatisfaction when absent (Redfern and Davey, 2003). The higher the perceived product or service quality, the higher the customer’s satisfaction and vice versa. One-dimensional requirements are both a necessary and sufficient condition for customer satisfaction (Busacca and Padula, 2005).
Attractive requirements can be defined as the product or service attributes that satisfy or even excite customers when present but do not dissatisfy when absent (Berger et al., 1993). Such attributes have the greatest influence on customer satisfaction with a given service (Matzler et al., 1996). They are a sufficient, but unnecessary condition for satisfaction (Busacca and Padula, 2005). Attractive attributes can be used as an element of an aggressive marketing strategy to attract competitors’ customers. QFD normally deals with satisfiers not delighters. Zhao and Dholakia (2009) have reported that although one-dimensional (i.e., linear) relationships are common, other relationships between attribute-level performance and customer satisfaction also exist that change dynamically over time and with user experience.Figure 2 illustrates the three different consequences and indicates the extent to which they can affect customer satisfaction.
Kano Model
Berry, Parasuraman, and Zeithaml developed SERVQUAL in 1988. It is a service quality tool based on the customer’s perceptions of and expected performance. It is one of the most widely used models for the evolution of service quality (Pawitra & Tan, 2003). Initially, Parasuraman et al. (1985) proposed ten service quality attributes: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, understanding/knowing the customer, and tangibles. However, in the early 1990s, these were condensed into five. The five dimensions of service quality, commonly known as RATER, include (Lim, Tang, & Jackson, 2003):
With the help of SERVQUAL, customer satisfaction can be measured in terms of the difference, or gap, between the expected and perceived level of performance. This approach can be applied to any service organization to evaluate the standards of quality for the services provided. “Services are different from goods in many ways: they are intangible, require participation of the customer, simultaneous production and consumption” (Oliveira et al., 2009).
Research conducted by Baki et al. (2008) concluded that the integration of SERVQUAL, the Kano model, and QFD could serve as an effective tool in assessing quality of services provided by an organization. The linearity assumption in SERVQUAL can be eliminated by integrating SERVQUAL with the Kano model and QFD to develop a way to satisfy customer needs, thus leading to increased customer satisfaction and higher profits.
SERVQUAL is a reliable and valid scale used to measure the perceived and expected levels of performance in any service organizations and thus results in improved service offerings. SERVQUAL is most effective when administered periodically to monitor new trends in the service quality. By calculating the average of the differences between the scores on the questions that make up a given dimension, and by calculating an average across all dimensions, an organization’s quality standards can be administered (Parasuraman et al., 1988).
SERVQUAL has also been used in the house of quality design process to evaluate customer satisfaction with an organization’s services. It can be used to identify and analyze customer requirements and thus forms the first stage in the construction of an HOQ. As noted by Parasuraman et at. (1988), the SERVQUAL dimensions can be modified based on the requirements and needs of an organization to make them more relevant to the context in which they are used (Paryani et al., 2010).
The following sections present two case studies for the Kano model and SERVQUAL methodology.
This case study integrates quality function deployment and the Kano model to examine the application of quality function deployment in the new product development process by using the production of a fuel efficient vehicle. An integrated team of marketers, design engineers, and business experts developed a House of Quality for the fuel efficient vehicle that provided an insight into the customer preferences to be concentrated on and the technical requirements that helped achieve desired results in the prototyping of a Hydrogen Fuel Cell Vehicle (HFCV).
The product that was being developed was a plug-in hybrid. The vehicle’s power source consists of a battery and a hydrogen fuel cell. The first step in obtaining the VOC for this case study was to conduct interviews, which was used to derive a customer survey. The interviews were one-on-one conversations conducted with customers to determine their expectations from a vehicle. Only 30 interviews were conducted, as past research has shown that this captures 90% of customer consequences for the general customer base (Griffin and Hauser, 1991).
The interview questions included:
The purpose of the interview process was not to ask each customer all ten questions, but to promote the customer to talk. When the subject stopped talking, the next question would get the conversation flowing again. To elicit consequences from a customer, the interviewer used a probing technique repeatedly by asking “why” to determine the attributes responsible for making a specific feature appealing to them. Seventeen customer consequences were developed from the interview data.
After the VOC had been gathered via the interview process, the collected data was organized using affinity diagrams. Affinity diagrams group the consequences gathered based on similarity to clarify customer input. The 17 consequences were grouped into six similar categories, and each category was given a title. The left side of the HOQ was completed with customer consequences and attributes. The affinity diagram is shown in Table 1.
The next step was to obtain the importance rating and rankings of each consequence from the customer base. A survey was conducted of 104 customers regarding the relative importance of the 17 consequences. The reason behind this was to avoid misinterpretation of the customer’s overall attitude or satisfaction towards the product that could lead to poor prediction of the customer’s purchase behavior. Customers do not place equal importance on all consequences. Three vehicles were chosen for this purpose including a Toyota Prius (Vehicle A), a BMW 335 advanced diesel (Vehicle B), and the HFCV (Vehicle C). In addition, the survey respondent’s current car was used to allow comparison. The identities of the three vehicles were not disclosed to the survey respondents. A brief description of each vehicle was provided however, to allow them to make a nonbiased decision on ratings and rankings of each consequence, relative to each vehicle. Each respondent was asked to read the descriptions and provide rating and rankings for each vehicle.
Affinity Diagram
The survey was conducted in two parts. First, the respondents were asked to identify the most important consequence to them and label it as “10”. All other consequences were to be assigned a value (rank) between 1 and 10, relative to the consequence labelled as most important.Therefore, some consequences may be just as important as the first consequence assigned a value of “10”, and they too would be assigned a value of “10.”Consequences that were almost as important as the first consequence assigned a value of “10” may be assigned values of “9” or below, relative to how important the customer felt they were in relation to the first “10” consequence.The mean of the rankings was calculated for the results of each consequence that constituted the importance column in Table 2.
The second part of the survey involved rating each consequence as it applies to each of the four vehicles on a Likert scale from 1 to 5. The mean of the ratings was calculated for each consequence and noted in the rating column in Table 2. The weighted rating values were obtained by multiplication of the importance (rank) and rating together. The weighted rating is a means of obtaining an optimal solution by evaluating both what is important to a customer and how well the customer thinks each product is doing on what is important to them.This is also used as a means to evaluate resource allocations, as if the customer base feels that a company is lacking on a consequence that they deem very important, more focus can be applied to improving this, which may ultimately improve market share.Conversely, if a customer base feels that a product excels on consequences that are of no importance to them, resources can be directed away from these areas and applied to areas needing improvement.The survey’s main purpose was to gather more specific information on potential customer desires and needs. The results of the survey are tabulated in Table 2.
1 | This vehicle is climate controlled. | 6.6 | 4.2 | 27.51 | 4.2 | 27.51 | 3.6 | 23.58 | 4.0 | 26.20 | |
2 | This vehicle has a quality audio system. | 6.7 | 3.4 | 22.64 | 3.5 | 23.31 | 3.3 | 21.98 | 3.7 | 24.64 | |
3 | This vehicle provides a comfortable ride. | 7.5 | 3.3 | 24.65 | 3.9 | 29.13 | 3.6 | 26.89 | 3.7 | 27.64 | |
4 | This vehicle gets good gas mileage. | 7.6 | 4.4 | 33.44 | 3.9 | 29.64 | 4.4 | 33.44 | 3.3 | 25.08 | |
5 | This vehicle has low emissions. | 4.7 | 4.2 | 19.57 | 3.5 | 16.31 | 4.4 | 20.50 | 2.9 | 13.51 | |
6 | This vehicle has low emissions. | 5.4 | 4.2 | 22.64 | 3.5 | 18.87 | 4.4 | 23.72 | 2.9 | 15.63 | |
7 | This vehicle is good for the enviro-nment. | 5.1 | 4.1 | 20.87 | 3.6 | 18.32 | 4.3 | 21.89 | 2.8 | 14.25 | |
8 | This vehicle has a lot of horsepo-wer. | 6.5 | 2.3 | 15.04 | 3.8 | 24.85 | 2.9 | 18.97 | 3.0 | 19.62 | |
9 | This vehicle has towing capabilities. | 5.2 | 1.9 | 9.79 | 3.1 | 15.97 | 2.5 | 12.88 | 2.7 | 13.91 | |
10 | This vehicle does not compromise speed and handling. | 7.1 | 2.9 | 20.51 | 3.4 | 24.42 | 2.9 | 20.58 | 3.5 | 24.78 | |
11 | This vehicle is affordable. | 8.0 | 3.7 | 29.77 | 2.5 | 19.87 | 2.3 | 18.03 | 3.7 | 29.77 | |
12 | This vehicle has an extensive warranty. | 6.2 | 3.2 | 20.06 | 3.3 | 20.49 | 3.0 | 18.69 | 2.9 | 17.70 | |
13 | This vehicle can drive for long distances ("/>400 miles). | 7.1 | 3.7 | 26.66 | 3.6 | 25.60 | 3.0 | 21.68 | 3.7 | 26.52 | |
14 | This vehicle has a high safety and standard rating. | 7.0 | 3.8 | 26.63 | 3.8 | 26.56 | 3.7 | 25.65 | 3.5 | 24.12 | |
15 | This vehicle provides accurate safety warnings. | 5.7 | 3.6 | 20.51 | 3.7 | 21.13 | 3.6 | 20.51 | 3.5 | 19.78 | |
16 | The vehicle is a hybrid (split powers between electric and gas). | 3.2 | 3.6 | 11.70 | 2.1 | 6.74 | 3.8 | 12.21 | 1.7 | 5.44 | |
17 | This vehicle comfortably fits a family of all sizes. | 4.7 | 2.4 | 10.95 | 3.7 | 17.06 | 3.3 | 15.56 | 2.8 | 13.23 | |
18 | Overall, I am satisfied with this type of vehicle. | 3.2 | 3.6 | 3.4 | 3.9 | ||||||
Sum | 104.07 | 62.15 | 362.93 | 62.74 | 365.77 | 62.39 | 356.76 | 58.16 | 341.82 | ||
Average | 3.49 | 3.51 | 3.43 | 3.28 |
Importance Rating
After the customer consequences were analyzed, the next step in the construction of the HOQ was the development of technical requirements. The technical requirements are the design specifications that satisfy customer needs. This aspect of QFD is directly in the organization’s control, and focuses on designing specific, measurable design aspects that ensure the end product meets the customer wants and needs. The technical requirements are called the ‘hows’ and are placed on the top of the house. Each consequence can have one or more technical requirement. Technical requirements must be within the control of the manufacturer. It must also be measurable to enable designers to determine if the customer’s needs are fulfilled. Brainstorming among marketers and product designers was used to develop the technical requirements, along with various Internet sources for references to industry standards. Thirty technical requirements were developed and organized using tree diagrams. One of the seven management tools, the tree diagram is a hierarchical structure of ideas built from the top down using a logic and analytical thought process.
A customer design matrix log was then developed that created a product development log that provided a history of the design process. It contained the design concepts derived from the customer’s voice and the corresponding technical requirements that were designed, their measurement units and values. The column ‘Measurement units’ in Table 3 was placed at the bottom of the HOQ indicating how each technical requirement would be measured. Table 3 shows the customer design matrix log.
Once the customer consequences and the technical requirements were developed, a relationship matrix was constructed. The matrix defines the correlations between customer attributes and technical attributes as weak, moderate, or strong using a standard 9-3-1 scale. For this scale the following notations are used Strong (H) = 9, Moderate (M) = 3, and Weak (S) = 1.
Each customer consequence was matched with each technical requirement. The relationship between them was then determined and placed in the relationship matrix that constitutes the of the HOQ. This matrix identifies the technical requirements that satisfy most customer consequences and determines the appropriate investment of resources for each. The technical requirements that addressed the most customer consequences should be dealt into the design process to ensure a customer-approved product.Ideally in the QFD analysis, no more than 50% of the relationship matrix should be filled, and a random pattern should result (Fisher and Schutta, 2003). Relationships were determined here on the basis of research conducted using resources available on the Internet. Appendix A displays the relationship matrix developed for the HOQ.
No | Customer’s Voice | Technical Requirements | Measurement | Measurement Units |
1 | Climate control | Level of temperature change | Boolean Value | Yes/No |
Time taken to attain the changed temperature | Time | Minutes/Seconds | ||
2 | Audio System | Power of speakers | Power | Watts |
No. of operability modes in an audio system | Number | Integer value | ||
3 | Comfort | Seating Capacity | Capacity | Integer value |
Distance between front and rear seat | Length | Inches | ||
4 | Fuel Efficiency | Engine Power | Power | Horsepower |
Air compression ration | Volume | Cubic cms (cc) | ||
Size of exhaust pipes | Diameter | Inches | ||
5 | Environmental friendly | Lower Emissions (Nitrogen, Carbon- dioxide, Carbon-monoxide) | Weight/Distance | Grams/Km |
Hybrid | Boolean Value | Yes/No | ||
6 | Safety | Size of side & rear view mirror | Ratio | Ratio |
Size of damping sheets | ||||
Suspension/steering stability | Spring frequency | Cycles/minute (cpm) | ||
No. of airbags | Number | Integer value | ||
Air bag response time | Time | Seconds | ||
Alignment of tires | Toe-in (Distance) | Fractions of an inch | ||
Crash warning system | Boolean Value | Yes/No | ||
7 | Long distance travel | Tank capacity | Capacity | Gallons |
Tire quality | UTQG standards | Grades | ||
8 | Warranty | No. of parts covered under warranty | Number | Integer value |
Validity of warranty | Time | Years | ||
Cost of extended warranty | Boolean Value | Yes/No | ||
9 | Performance | Torque transmission | Force | Foot-pounds |
Cylinder size | Volume | Liters | ||
No. of valves/cylinder | Number | Integer value | ||
Weight of engine | Weight | Grams |
Customer Design Matrix
After completion of the relationship matrix, the focus of the project shifted to the construction of the planning matrix. This matrix defines how each customer consequence has been addressed by the competition. It provides market data, facilitates strategic goal setting for the new product, and permits prioritization of the customer desires and needs. It also compares the product to its key competitors. A standard 5-point Likert scale was used. Each vehicle was represented by different symbol. A square symbol was used for the Toyota Prius, a circle for the BMW 335d, and a triangle for the HFCV. The ratings were based from the customer survey. Customers rated the three vehicles for each of the 17 customer consequences included in the planning matrix. Appendix A shows the planning matrix in the HOQ.
Following completion of the planning matrix, technical correlations were determined. These form the roof of the HOQ. The roof maps the relationships and interdependencies among the technical requirements. The analysis of which informs the development process, revealing the existence and nature of design bottlenecks. The relationships among technical requirements were plotted and given a value. Past experience and test data were used to complete the roof of the HOQ. Symbols are used to represent the level of the relationship between technical requirements. Appendix A shows the completed roof of the HOQ, with all relationships identified between the technical requirements.
Next, a technical matrix was constructed to form the foundation of the HOQ. This matrix addresses the direction of improvement, standard values, units of measurement, the relative importance of technical requirements, and technical evaluation.
The customer design provides information regarding consequences, technical requirements, and their units and values. It contains design concepts derived from the VOC and detailed design considerations. The column ‘Measurement Units’ from Table 3 was placed at the bottom of the HOQ, indicating the units of measurement for each technical requirement. The relative importance of each technical requirement was calculated by multiplying the value assigned to its relationship with a specific consequence (9, 3, 1) multiplied by the importance of that consequence; the values of all consequences were then added to yield the final weight. These weights were placed in a row at the bottom of the HOQ. A final weight is a comprehensive measure that indicates the degree to which the specific technical requirement relates to the customer consequences.
The technical evaluation of the competition and the product to be developed is carried out by the engineering and technical staff who would design the product. The process establishes strategic goals for the product development process to ensure the satisfaction of the customer. For each technical requirement, the product was compared to its competitors and a technical evaluation was performed. Thus, the construction of the HOQ was completed. Appendix A shows the completed HOQ with the roof.
The collected information from the above methods helped in the development of strategic decisions, one of them being the allocation of resources. An importance-performance grid was developed to prioritize the usage of resources for improvement on the most critical customer benefits. The relative importance ratings were plotted on the vertical axis (importance) and the median importance rating on the horizontal axis (performance). Using the values from the column ‘Importance’ from Table 2, the median importance rating was found out to be 6.5. Consequences with rating higher than that of the median importance rating were placed above the horizontal line and the others below the median. After this decision was made, the focus shifted to the distribution of consequences on either the left or right side of the vertical line. For this purpose, the median was calculated for each consequence and if the mean brand rating was higher than that value it was placed on the right side of the vertical line otherwise on the left side. Using this grid, the level of priority was assigned to each consequence from the customers point of view. Figure 3 shows the Importance-Performance grid for Vehicle C (HFCV).
Importance-Performance Grid
Recommendations and Conclusions
This study has illustrated how QFD can successfully be applied to new product development efforts via the application to the prototyping of a fuel-efficient vehicle. This study was deemed a success, as the results were reasonable per the design team that is currently in progress prototyping the product.For this particular application, the results showed that the first and utmost priority should be given to the following customer benefits/consequences: climate control, quality audio control, high safety and standard rating, long distance travel, high speed and handling, comfortable ride, good gas mileage, substantial horsepower, and affordability. These benefits are ones that must be accomplished in order to appeal to the customers in the market, and thereby give the new product a chance for success as a sellable product. The consequences were identified as priority because they are of high importance to the customer, but have poor performance according to the prototype description given to the respondent group in the study.These are the areas of design that must be addressed so as to create a product that appeals to the consumer.If resources are limited, consideration should be given to shifting resources to these priorities in the design phase.Conversely, the fourth priority benefits include low emissions, environment-friendly, and power split between electric and gas. These benefits are performing well and not of high importance, so no improvement needs to be made with these benefits currently.In fact, resources can actually be shifted away from these aspects and reinvested elsewhere where the design needs improvement to meet customer expectations.
The results presented in this study aided the design team of the HFCV and provided them with an insight into what customers were really looking for in an environmentally friendly vehicle. The application of QFD to the prototyping of a HFCV proved to be beneficial, as the voice of the customer was gathered, analyzed, and factored into the design process to ensure a product that will meet customer expectations.
It has been demonstrated that the QFD methodology can be successfully applied in a new product development process. It also aided the HFCV design team in developing a proprietary knowledge base about their customers’ needs and wants which allowed them to make the best design efforts in the early development stages that lowered the development costs and increased profit levels. Although this study focused on the production of HFCV, the QFD methodology presented could serve as a powerful reference to the development of a new product of any kind. The authors hope that this study could attract more new product development teams and organizations to adopt QFD in the NPD process and develop better and successful products and achieve high customer satisfaction with increased profit levels.
This case study integrates quality function deployment and SERVQUAL to evaluate a university career opportunities center (COC)and recommends service standards to increase its benefits to students. A university COC seeks to bridge the gap between students and employers. It equips students with the professional skills they need to find employment. The staff keeps the students regularly informed about various events such as the career fair, and it can help them make major career decisions. A COC should maintain high standards of quality and serve students efficiently. To do so, its staff must understand student needs and constantly monitor feedback to improve their performance.
The mentioned methodology has been applied to a COC at a university. Detailed steps are listed for the construction of the HOQ, with SERVQUAL being incorporated into QFD in this application. A step-by-step procedure for this case is discussed in this section.
The main goal of applying QFD to a university COC was to identify how the COC could better serve students. This work sought to identify expectations of the students and the measures necessary to meet them. Here, SERVQUAL was applied to identify the key customer needs and requirements. Table 4 presents the SERVQUAL dimensions and their definitions as they relate to their application to the COC case study.
To make the dimensions more relevant to a COC, a few SERVQUAL items were modified or removed based on the responses obtained through student interviews. A total of 15 customer requirements were identified. Table 5 provides the modified SERVQUAL dimensions and customer requirements.
SERVQUAL: Five Dimensions
SERVQUAL Adjusted Items Description
These SERVQUAL items are the customer consequences that were obtained by conducting interviews with 30 students. The intention behind interviewing these students was to keep the conversation flowing. To elicit the consequences from a customer, the interviewer used a probing technique repeatedly by asking “why” to determine the reason responsible for making a specific aspect appealing to them. When the student stopped talking, the next question would get the conversation flowing again.
A survey of 99 students was the primary source of information for this study. The survey asked the students to express their thoughts on various aspects of the COC and to indicate what changes would increase their satisfaction. Customers do not assign equal importance to all requirements. The survey was administered in two sections. First, the students were asked to identify the most important consequence, assigning to each a rank from 1 to 10, with 10 indicating the highest level of importance. The mean rank was calculated for each customer consequence. To determine the quality of COC services, respondents were also asked if they would recommend the service to other students. In the second part of the survey, students were asked to indicate the degree to which each of the consequences was true of an ideal COC and of the specific university COC on a scale from 1 to 5, where 5 indicated strongly agree and 1 indicated strongly disagree. The mean ratings were calculated for each consequence as shown in Table 6. The survey results obtained were analyzed using SERVQUAL by performing a gap analysis that is discussed in the following section. The questionnaire developed for this study is included in Appendix B.
Survey Results (Averages of all the ratings)
The five SERVQUAL dimensions: reliability, assurance, tangibles, empathy, and responsiveness were prioritized based on the gap score calculated for each dimension. There were four items under reliability, three under assurance, two under tangibles, four under empathy, and two under responsiveness for a COC. For each customer requirement, the perceived level (P) and expected level (E) of service were obtained from the survey data. The difference (gap score) between them was calculated, as was the average gap score for each of the five dimensions. The five RATER dimensions for a COC were prioritized based on the value of the average gap scores; i.e. the dimension with the highest average gap score was the one given the highest priority for improvement. Empathy had the highest average gap score (-1.25), making it the highest priority. The dimensions were prioritized in the following order starting with the highest priority: reliability (-1.12), responsiveness (-1.1), and assurance (-1.1), and tangibles (-0.95).
Based on the gap scores calculated for each customer requirement, the importance ratings obtained from the survey data, and the priority level of each SERVQUAL dimension, the customer requirements were prioritized. When two consequences have the same gap score, their mean importance ratings obtained from the survey results could be used to determine their priority level. The results showed that students identified the following requirements, listed in priority order from the highest to lowest:
After analyzing the survey results using SERVQUAL, the focus shifted to the development of service characteristics that are the design specifications that would satisfy customer needs. Each customer consequence can have one or more service characteristic. Various strategies were developed to reduce or eliminate low customer satisfaction and increase the quality of service. The service characteristics are called the how’s. These characteristics appear on top of the HOQ and constitute the technical response matrix. They are the measurable steps to ensure that all customer requirements are met. The service characteristics defined in QFD are within the organization’s direct control. These characteristics focus on specific, measurable aspects of service.
Brainstorming was used to develop the service characteristics using various Internet sources which provided references to industry standards. Tree diagrams were used to organizethese service characteristics. Tree diagrams are hierarchical structures of ideas built from the top down using logic and analytical thought. A customer design matrix log was then developed to create a service process development log that provided a history of the development process. This log contained the design concepts derived from the VOC, along with the corresponding service characteristics and their values. Twenty service characteristics were developed which are listed in Appendix C.
Dimension | No. | Customer Requirements | Expectation Score (E) | Perception Score (P) | Gap Score (P-E) | Average for Dimension |
Tangibles | 1 | I have a professional appearance for an interview | 4.5 | 3.6 | -0.9 | -0.95 |
2 | I have a professional resume | 4.6 | 3.6 | -1.0 | ||
Reliability | 3 | I get opportunities with potential employers | 4.6 | 3.5 | -1.1 | -1.12 |
4 | I have my resume easily accessible to companies | 4.6 | 3.7 | -0.9 | ||
5 | I get a job that pays well | 4.6 | 3.5 | -1.1 | ||
6 | I get job offers | 4.7 | 3.3 | -1.4 | ||
Responsiveness | 7 | I get a resume evaluation | 4.5 | 3.4 | -1.1 | -1.1 |
8 | I have interviewing experience | 4.6 | 3.5 | -1.1 | ||
Assurance | 9 | I am comfortable during an interview | 4.6 | 3.5 | -1.1 | -1.1 |
10 | I stand out to a potential employer | 4.7 | 3.5 | -1.2 | ||
11 | I am prepared for an interview | 4.5 | 3.5 | -1.0 | ||
Empathy | 12 | I can work overseas | 3.7 | 2.5 | -1.2 | -1.25 |
Calculation of Unweighted SERVQUAL Scores
Prioritizing Customer Requirements
Once the customer consequences and the service characteristics were developed, a relationship matrix was constructed. This matrix defines the correlations between customer attributes and technical attributes/service characteristics as strong, moderate, or weak using a 9-3-1 scale. For this scale the following notations are used: Strong (H) = 9, Moderate (M) = 3, and Weak (S) = 1. Each of the fifteen customer consequences was matched with each of the twenty service characteristics for a COC. The relationship between them was then determined and placed in the relationship matrix that constitutes the center of the HOQ. This matrix identifies the technical requirements that satisfy most customer consequences and determines the appropriate investment of resources for each. The technical requirements that addressed the most customer consequences should be addressed in the design process to ensure a product that satisfies the stated customer expectations. Ideally in the QFD analysis, no more than 50% of the relationship matrix should be filled, and a random pattern should result (Fisher and Schutta, 2003). Relationships were determined here on the basis of research conducted using resources available on the Internet. Appendix C displays the relationship matrix developed as a part of the HOQ for a COC.
After completion of the relationship matrix, the focus of this study shifted to the construction of the planning matrix, which defines how each customer consequence has been addressed by the competition. This matrix provides market data, facilitates strategic goal setting for the new service, and permits prioritization of customer desires and needs. In this methodology, where we incorporated SERVQUAL into the HOQ, the competitive analysis is done between the current COC and an ideal COC. For the competitive analysis, a survey was conducted to determine the characteristics of an ideal COC, and this ideal COC was compared to a university COC. The survey respondents judged the ideal COC and the current COC against each of the fifteen consequences on a scale of 1 to 5, where ‘5’ indicated strongly agree and ‘1’ indicated strongly disagree. The mean for each consequence was calculated and placed in the columns to the right of the HOQ. A triangle was used for the ideal COC, and a square was used for a university COC. Appendix C shows the planning matrix in the HOQ.
Next, the technical correlations were determined after the completion of the planning matrix. These form the roof of the HOQ. The roof maps the relationships and interdependencies among the service characteristics. The analysis of these characteristics informs the development process, revealing the existence and nature of service design bottlenecks for a COC. The relationships among service characteristics were plotted and given a value. Past experience and test data were used to complete the roof of the HOQ. Appendix C shows the correlations developed for the roof of the HOQ for a COC.
A technical matrix was constructed to form the foundation of the HOQ. This matrix addresses the direction of improvement, target values, the final weights of service and quality characteristics, and the level of difficulty to reach the target values. The direction ofimprovement indicates the type of action needed to ensure that the service characteristics are sufficient to make the service competitive; this direction is typically indicated below the roof of the HOQ.
Dimension | No. | Customer Requirements | Service Requirements | Measuring Units | Values |
Tangibles | 1 | I have a professional appearance for an interview | No. of workshops conducted on professionalism | Number | Integer value |
No. of formal outfits that could be rented | Number | Integer value | |||
2 | I have a professional resume | No. of workshops conducted on resume and cover letter writing | Number | Integer value | |
Reliability | 3 | I get opportunities with potential employers | No. of career fairs held | Number | Integer value |
No. of companies participating in the career fairs | Number | Integer value | |||
Number of companies invited to hold seminars | Number | Integer value | |||
Number of alumni invited to be connected to the university | Percentage | Percentage | |||
4 | I have my resume easily accessible to companies | Provide companies with online access to resumes of all students | Boolean value | Yes/No | |
5 | I get a job that pays well | Expected salary amount | Money | Dollars | |
6 | I get job offers | No. of interview calls received | Number | Integer value | |
Responsiveness | 7 | I get a resume evaluation | No. of staff members appointed for resume evaluation | Number | Integer value |
Waiting time to get an appointment for resume evaluation | Time | Days | |||
8 | I have interviewing experience | No. of mock interviews conducted | Number | Integer value |
Customer Design Matrix
The quality and service characteristics were analyzed and a standard or limit value was determined for each. These are the industry standard values. These values were established based on well-informed assumptions, and they are believed to be within reach for a university COC. The final weight of each service characteristic was calculated by multiplying the value assigned to its relationship with a specific consequence (9, 3, 1) multiplied by the importance of that consequence (obtained from the survey results); thevalues of all consequences were then added to yield the final weight, that is a comprehensive measure that indicates the degree to which the specific service characteristic relates to the customer consequences. These final weights are shown in a row along the bottom of the HOQ.
The engineering and technical staff that would design the service process evaluates the level of difficulty involved in achieving each service characteristic. This evaluation becomes the basis for development of strategic goals for the development of the service process to ensure customer satisfaction. The level of difficulty involved in reaching the target values for each service characteristic was determined on a scale of 0 (easy) to 10 (difficult). Thus, the HOQ was completed for a COC; it is shown in Appendix C. Twenty service characteristics were developed that would fulfill customer requirements
With the help of QFD and SERVQUAL methodologies, the SERVQUAL dimensions, customer consequences/requirements and the service characteristics were prioritized. The priority order of the five RATER dimensions based on their gap scores were determined as: Empathy (-1.25) followed by reliability (-1.12), responsiveness (-1.1), and assurance (-1.1), and tangibles (-0.95). The overall gap score for the five dimensions was -1.1 indicating a scope for improvement for a COC. A few of the customer requirements that ranked higher than the others were: I get a job that fits me, I have a job that I enjoy, I know what different jobs are available, I can work overseas, I get a job that pays well, I get opportunities with potential employers, etc.
Establishing a team for career guidance and counseling team to provide students with individual attention and care would increase the performance of the COC. Hosting more career fairs with the participation of a large number of companies would provide students with more opportunities to interact with employers and to secure suitable jobs. Establishment of a resume evaluation team with sufficient staff would increase student confidence and help them face interviews. Conducting periodic workshops on writing resumes and cover letters, interviewing, business ethics, and professionalism would increase student knowledge and improve their professional skills. Conducting frequent mock interviews would equip students with practical experience that could help them to perform better in interviews.
The service characteristics were also prioritized that help the design team in development of better services and reduce the service development costs. The number of mock interviews conducted received the highest priority along with number of staff appointed for conducting mock interviews, followed by the number of staff members on the career guidance and counseling team, the number of interview calls received, the number of staff members appointed for resume evaluation, the number of workshops conducted on setting up, and accessing online job accounts. Also important were expected salary amount, employer access to online resumes, number of workshops on interviewing and business ethics, the number of international companies participating in the career fair, and the number of formal outfits that could be rented. A focus on implementing these service characteristics in order of their priority would improve the function of the COC.
Prioritizing Service Characteristic
Appendix A.
Part A – Questionnaire
Find the benefit of using the Career Opportunities Center in the list below that is most important to you. Assign it 10 points. Then, assign from 0 to 10 points to the other benefits to indicate how important they are to you in comparison to the most important one. You may assign the same number of points to more than one benefit._____ I have a professional appearance for an interview_____ I am comfortable during an interview_____ I stand out to a potential employer_____ I am prepared for an interview_____ I have interviewing experience_____ I get opportunities with potential employers_____ I can work overseas_____ I know what different jobs are available_____ I have a professional résumé_____ I get a résumé evaluation_____ I have my résumé easily accessible to companies_____ I get a job that fits me_____ I get a job that pays well_____ I have a job that I enjoy_____ I get job offers
Part B - Questionnaire
Please rate how well the university’s Career Opportunities Center delivers each of these benefits when you use it. Circle the number below that best indicates how well you feel the university’s COC satisfies each of the benefits. For comparison purposes, please rate your ideal career center on the same benefits. Use a scale of:
1= Strongly Disagree2= Disagree3= Neutral4= Agree5= Strongly Agree
Appendix B
Appendix C
Acute kidney injury is the deterioration of the renal function over hours or days, resulting in the accumulation of toxic wastes and the loss of internal homeostasis. It can be caused by numerous etiologies [1, 2], and medications are a relatively common cause of kidney injury among these injuries [3]. Drug-induced nephrotoxicity is a renal dysfunction that occurs as a result of direct or indirect exposure to nephrotoxic prescribed drugs, over-the-counter products, diagnostic agents, or alternative/complementary products (herbal remedies, natural products, nutritional supplements) that are widely available at most health food stores [3, 4]. Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys [4]. Nephrotoxicity most commonly affects tubulointerstitial compartment and manifests either acute tubular injury (ATI) or acute interstitial nephritis (AIN). There is a growing incidence of drug-induced glomerular disease, including direct cellular injury and immune-mediated injury [5]. However, kidney disease does not develop in all patients exposed to the various potential nephrotoxins [3]. The nephrotoxicity of medications, drugs, or other ingested substances is a complicated process that involves a combination of factors.
Potential nephrotoxic effect of the drug, comorbid diseases or conditions (underlying renal dysfunction, cardiovascular disease, diabetes, immunologic diseases, sepsis, etc.), genetic determinants of drug metabolism and transport, immune response genes, drug dose and duration of therapy, drug characteristics (solubility, structure and charge), combinations of potential nephrotoxic drugs, urine pH, metabolic disturbances, older age (>65 year), and female sex are the common risk factors for drug-induced nephrotoxicity [1, 2, 3, 4, 5].
Basic renal functions should be evaluated and patient’s renal functions should be considered when prescribing a new drug.
Dosage adjustments of the drugs should be done according to the patient’s basic renal functions.
Risk factors for nephrotoxicity must be corrected before initiation of therapy.
Nephrotoxic drug combination should be avoided.
Adequate hydration before and during therapy must be ensured.
Whenever possible, equally effective nonnephrotoxic drugs should be used [4].
Early detection of drug-induced kidney injury is vital. Traditional biomarkers such as creatinine (Cr) and blood urea nitrogen (BUN) are insensitive for monitoring renal safety. Thus, new biomarkers have been investigated for accurate diagnosis, risk assessment, adopting therapy, and improvement of clinical outcome. [4, 6, 7, 8, 9] Serum Cr can raise in prerenal azotemia without tubular injury, and some factors such as muscle mass, total body weight, fluid status, age, gender, race, and drugs influence serum Cr levels [8]. There are novel biomarkers that are more sensitive and can detect renal damage earlier than serum BUN and Cr levels [4, 6, 7, 8, 9]. It is clear that which marker indicates kidney damage, but it is not yet clear when they should be measured. Also it is not clear if these biomarkers should be used for clinical decision-making or what should be done when the levels are elevated. Further studies are required for the routine clinical use of these biomarkers [8]. Table 1 lists common novel biomarkers that are under investigation.
Biomarker | Source | Region specificity | Clinical application |
---|---|---|---|
NGAL | Plasma/urine | Proximal tubule/distal tubule | AKI/CKD |
Cyclophilins | Urine | Glomerulus/proximal tubule | AKI |
KIM-1 | Urine | Proximal tubule | AKI/CKD |
IL-18 | Urine | Proximal tubule | AKI |
L-FABP | Urine | Proximal tubule | AKI |
H-FABP | Plasma/urine | Distal tubule | AKI |
NAG | Urine | Proximal tubule | AKI |
α-GST | Urine | Proximal tubule | AKI |
π-GST | Urine | Distal tubule | AKI |
γ-GT | Urine | Proximal tubule | AKI |
Low-molecular-weight proteins | |||
Urine | Glomerulus/proximal tubule | AKI | |
Urine | Proximal tubule/glomerulus | AKI/CKD | |
Urine | Proximal tubule | AKI/CKD | |
Urine | Proximal tubule | AKI | |
Cell cycle arrest proteins | |||
Urine | Proximal tubule | AKI | |
Urine | Proximal tubule | AKI | |
Clusterin | Urine | Proximal tubule/distal tubule | AKI/CKD |
TFF-3 | Urine | Proximal tubule/distal tubule | AKI/CKD |
Summary of novel nephrotoxicity biomarkers.
NGAL is an acute phase reactant, and it can raise in inflammatory conditions. It is expressed by tubular epithelial cells in response to injury and tubulointerstitial damage. It can be measured in both plasma and urine [8, 9, 10, 11, 12, 13], but for early detection of acute kidney injury (AKI), increase in urine NGAL is more specific than increase in plasma NGAL [9]. Baseline renal functions, severity of AKI, and age influence the level of NGAL. Studies showed that plasma and urine NGAL levels rise 2 hours after the injury; thus, it is the strongest predictor of AKI [8, 9]. It is more sensitive in ischemic and toxic (tacrolimus, cisplatin, cyclosporine A, radiographic contrast agent) AKI. [9] NGAL levels can be a predictor of clinical outcomes of AKI (need for dialysis and mortality) [9, 11] and progression of chronic kidney disease (CKD) in adults [8, 10, 12, 13]. Urine excretion of NGAL may be increased by albuminuria [9].
Cys-C is a protein that synthesized in all nucleated cells. It is freely filtered in the glomerulus and reabsorbed and catabolized completely in the proximal tubules without tubular secretion. It is an alternative parameter of serum Cr in the measurement of renal function [8, 9, 10, 11, 13]. Serum Cys-C levels are not influenced by gender, age, total body weight, muscle mass, or race, but tubular reabsorption is decreased by marked albuminuria [9, 10, 11]. It is thought to be the best biomarker for early kidney injury and more reliable marker of renal function [8, 10, 11].
They are structural proteins and measured in urine and plasma. Elevated levels of cyclophilins indicate AKI [11].
KIM-1 is a transmembrane glycoprotein. After ischemic or toxic injury, its levels elevate and it helps to distinguish acute tubular nephritis (ATN) from prerenal azotemia and CKD. Elevated urine KIM-1 levels are highly specific for kidney injury, because it is only expressed in injured kidney [8, 9, 10, 11, 12, 13]. Some studies suggest KIM-1 as an indicator of AKI transition to CKD, because high levels of KIM-1 are maintained during CKD progression [12].
It is also known as interferon-γ (IFN-γ)-inducing factor and its urinary levels rise in ischemic and toxic AKI [9]. It predicts renal parenchymal injury [10]. Its levels are higher in patients with ATN. Increased urinary levels of IL-18 are a predictor of poor outcome such as death and the need for short-term dialysis [8, 9]. According to some studies, urine IL-18 levels increase in contrast-induced AKI [12], 6–12 hours after administration of the radiocontrast agent [9].
Insulin-like growth factor-binding protein 7 (IGFBP-7) and tissue inhibitor of metalloproteinase-2 (TIMP-2) are the two biomarkers included in this group. They are measured in urine and can be used for risk stratification of AKI [8, 9]. According to some studies, the most important advantage of these biomarkers is that their levels are not affected by comorbid diseases such as CKD, diabetes, and sepsis [8].
FABP is a cytoplasmic protein found in all tissues with fatty acid metabolism. In kidneys, liver-type (in proximal tubule) and heart-type (in distal tubule) FABP present. Studies showed that urinary L-FABP is a useful biomarker in ischemic and toxic (especially cisplatin toxicity and contrast-induced nephropathy) AKI [9, 10, 12]. Elevated urinary and plasma H-FABP levels are indicator of distal tubular injury [10].
It is an enzyme produced by the proximal tubular cells. It can be found in the urine in very small amounts in healthy people. It cannot be filtered by glomerulus; thus, elevated levels of urine NAG indicate tubular damage [9, 10, 12]. Studies showed that NAG is a useful, sensitive, and early biomarker of contrast-induced AKI and high urinary levels correlate with poor outcome [9]. Also, high urinary NAG levels have been showed to be an indicator of clinical and subclinical tubular damage after chemotherapy [10] and are a sensitive biomarker of acute oxidative stress [11].
It is a heparin-binding growth factor. Although not studied well, it may increase in contrast-induced AKI [9].
They are cytosolic, microsomal, and membrane-bound enzymes. They are detoxification enzymes that present in kidney and many other organs. Some studies showed elevation in urine α-GST indicating epithelial necrosis in the proximal tubules and π-GST indicating epithelial necrosis in the distal tubules [9, 10, 11]. α-GST is thought to be a biomarker of proximal tubular necrosis of cisplatin-induced injury. α-GST and KIM-1 are sensitive biomarkers for predicting polymyxin-induced nephrotoxicity [10].
They are two enzymes that may increase in urine in proximal tubular epithelial damage [9, 10, 11]. Some studies showed increased levels of γGT, 24 hours after contrast administration [9], and some showed that it may be a sensitive biomarker of acute paracetamol nephrotoxicity [11].
Alanine amino peptidase (AAP), lactate dehydrogenase (LDH), β-galactosidase, β-glucuronidase, and leucine aminopeptidase are the other enzymes that are used for nephrotoxicity biomarkers [10, 11].
It is a low-molecular-weight protein. It is normally found in urine but increases in tubular injury secondary to antibiotic, analgesic, solvent, heavy metal, or pesticide poisoning. In these conditions, it has been proved to be a sensitive biomarker of renal tubular damage [9, 10, 11, 12, 13]. But it rapidly degrades in room temperature and urine pH < 6; therefore, its utility as a urinary biomarker is limited [12].
It is a low-molecular-weight protein, and elevated urinary levels can be used as a biomarker of tubular injury [10, 11, 12]. It is resistant to pH changes; thus, it is a sensitive biomarker of proximal tubular dysfunction [12].
It is a low-molecular-weight protein that functions in vitamin A transportation from the liver to other tissues. It is a sensitive biomarker in proximal tubular damage [9, 10, 11].
Although not demonstrated well, some subgroups of miRNA (miRNA-30a, -30c, and -30e) may rise in serum and urine in the states of contrast-induced AKI [9].
It is a glycoprotein and may be used as a biomarker for cisplatin-induced nephrotoxicity [10]. Urinary clusterin levels may increase following drug-induced nephrotoxicity [13].
It is another new biomarker of nephrotoxicity that is mainly expressed in kidneys. Studies showed marked decrease in urinary TFF3 after nephrotoxic AKI [13].
β-Lactam antibiotics include penicillins, cephalosporins, cephamycins, carbapenems, monobactams, and β-lactamase inhibitors, and these are among the most commonly prescribed antibiotics [14]. β-Lactam antibiotics, especially penicillins and cephalosporins, frequently cause hypersensitivity reactions. Methicillin and nafcillin are the prototypical drugs for hypersensitivity reactions associated with AIN. It is generally characterized by acute and severe renal failure. Hematuria, proteinuria, leucocyturia, and pyuria are seen in urinary sediment of affected patients. Hypersensitivity reactions such as fever, rush, and peripheral eosinophilia are commonly seen [5, 14].
Piperacillin-tazobactam and vancomycin must not be used concurrently; they may cause AKI. Cephalosporins may exacerbate the renal toxicity of aminoglycosides [14].
They can cause AIN. Rifampicin-induced AIN is dose dependent and is commonly associated with oliguric acute renal failure, hemolytic anemia, thrombocytopenia, and hepatitis. Approximately two-thirds of patients affected by rifampin-induced AIN require renal transplantation [5].
Aminoglycosides are antibiotics used in the treatment of Gram-negative and
Tubular uptake of aminoglycosides is a saturable process; thus, a single daily high dose is preferable to divided low doses. Administration of aminoglycosides by this way will cause less nephrotoxic effect [4, 15, 16].
Aminoglycosides primarily affect proximal tubules [1, 16], and patients present with acute tubular necrosis, showing features such as nonoliguric acute renal failure [4]. Proximal dysfunction leads to loss of enzymes, proteins, glucose, calcium, potassium, and magnesium [1]. In some patients, distal tubular segments can be affected and this manifests as polyuria and hypomagnesemia. Most patients may recover but some progress to irreversible kidney damage, especially if the patient is hypovolemic, septic, or catabolic. Aminoglycoside nephrotoxicity risk factors are nearly the same as other nephrotoxic agents. In addition to common factors, higher creatinine clearances and hypoalbuminemia are also independent risk factors for aminoglycoside nephrotoxicity [9].
Polymyxins are a group of antibiotics that are used for pan-resistant nosocomial infections, especially for
According to data, colistin appears more nephrotoxic than polymyxin B. Colistin-induced nephrotoxicity may exacerbate by older age, preexisting renal insufficiency, hypoalbuminemia, and concomitant use of NSAIDs. There are limited data on the risk factors for polymyxin-B associated nephrotoxicity. Methoxyflurane and cefazedone may enhance the nephrotoxic effect of polymyxin-B. Methoxyflurane-polymyxin-B combination should be avoided, but polymyxin-B-cefazedone combination may be used by close monitoring renal functions. Also, polymyxin-B may enhance the nephrotoxic effect of bacitracin [17, 18].
Analgesic nephropathy is a CKD characterized by papillary necrosis and chronic interstitial nephritis. It is caused by prolonged consumption of analgesic agents. Hypertension is a common clinical finding. The major laboratory manifestations are hematuria, sterile pyuria, elevation in serum Cr levels, and anemia [19, 20].
NSAIDs lead to AIN, chronic interstitial nephritis and finally CKD [20, 21]. Risk factors that may increase the nephrotoxic effect of NSAIDs are congestive heart failure, age > 65 years, and preexisting renal disease [4, 21].
When used alone, even if prolonged, acetylsalicylic acid is not thought to cause kidney damage. It aggravates the nephrotoxic effects of both phenacetin and acetaminophen; thus, it should not be used simultaneously with these drugs. Acetylsalicylic acid and acetaminophen combination leads to papillary necrosis and calcification. Acetylsalicylic acid and NSAID combination leads to ischemic injury [20].
Oral and rectal forms of acetaminophen may cause nephrotoxicity with chronic overdose [12]. The incidence of renal dysfunction is related to the severity of the acetaminophen ingestion [22]. IV forms may cause oliguria in neonates, infants, children, and adults [23]. AKI, which is primarily ATN, is manifested by elevations of BUN and Cr along with proteinuria, hematuria, and granular and epithelial cell casts on urine analyses. Also vascular endothelial damage can occur. It may be used in severe renal impairment with caution and dosing must be adjusted. Renal functions spontaneously return to baseline within 1–4 weeks. Rarely dialysis may be required. There is no evidence that N-acetylcysteine has any protective effect on nephrotoxicity [22, 23].
5-ASAs are used to treat inflammatory bowel diseases. They lead hypersensitivity reactions in multiple organs, especially in kidneys, leading to acute interstitial nephritis [5, 24, 25]. During 5-ASA therapy, regular monitoring of renal functions is recommended [24]. AIN occurs most commonly during the initial year of therapy and it is non-dose-dependent. But in some patients with inflammatory bowel disease, AIN may occur as a complication of the disease [5].
Proton pump inhibitors are used to treat acid-related gastrointestinal disorders. According to recent studies, many side effects of proton pump inhibitors have been reported. One of the side effects of the drug is nephrotoxicity, especially acute interstitial nephritis. PPI is thought to be associated with increased chronic kidney disease and its progression [5].
Recently, more concerns have been raised for proton pump inhibitors about the risks of acute interstitial nephritis, chronic kidney disease, and end-stage renal disease, and similar adverse kidney effects, such as interstitial nephritis and acute renal failure, have been attributed to histamine-2 receptor antagonists [26]. But according to a newly published review, these potential adverse effects of PPIs must be proven by demonstrable evidence [27].
Interferons are cytokines that protect body against viral infections. Exogenous interferons are used to treat hepatitis B, hepatitis C and various malignancies (IFN-α), multiple sclerosis (IFN-β), and chronic granulomatous disease and malignant osteoporosis (IFN-γ). They may cause nephrotic syndrome with histological finding of minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) [5, 28, 29], and renal vascular injury [28].
Bisphosphonates are used to prevent bone absorption. The oral forms are used to treat osteoporosis and are thought to be nonnephrotoxic. But IV forms (pamidronate and zoledronic acid) can cause nephrotoxicity. Some reports reveal MCD and FSGS—not otherwise specified (FSGS-NOS) after pamidronate therapy and some reveal collapsing—FSGS (C-FSGS) after IV zoledronate therapy [5, 30]. According to some reports, zoledronic acid mainly leads to ATN [29]. The severity of nephrotoxicity depends on dosing, infusion time, and total number of infusion. Ibandronate is thought to be safe for kidneys [30].
Lithium carbonate is generally used to treat bipolar disorder. It causes multiple renal side effects, most commonly nephrogenic diabetes insipidus. Acute lithium toxicity causes ATN. Chronic lithium toxicity occurs after more than 10 years of therapy and most commonly causes chronic tubulointerstitial nephritis with distal tubular cysts and sometimes secondary glomerulosclerosis. Lithium also causes nephrotic syndrome and histological findings of MCD or FSGS. Rarely it leads to end-stage renal disease secondary to lithium-associated chronic tubulointerstitial nephropathy. Lithium may also lead to renal tubular acidosis and hypercalcemia [5, 29, 31].
AADs are used for treatment of cancers and neovascular eye disorders such as diabetic retinopathy, macular degeneration, and retinal vein occlusion. They cause nephrotoxicity by endothelial cell injury and thrombotic microangiopathy (TMA) [5, 29]. Clinical manifestations of AAD-associated TMA are proteinuria and hypertension [29].
Mitomycin-C is an alkylating agent used for treatment of malignancies. It can lead to TMA and AKI. AKI is dose-dependent, and the risk of TMA significantly increases with the cumulative doses of >60 mg [5, 29]. While TMA can occur during therapy, it usually occurs several week, average 75 days, after last dosage [29].
Gemcitabine is a pyrimidine antagonist that is used to treat a variety of malignancies. AKI is dose-dependent. Higher cumulative dose and prior exposure to other chemotherapeutic drugs increase the risk of TMA [5, 29]. AKI occurs almost in all patients treated with gemcitabine. TMA most commonly occurs weeks to months after initiation of therapy [29].
Oral-extended release formulation of oxymorphone-hydrochloride is a long-acting opioid that is used to treat moderate to severe pain. Some data reveal AKI and TMA secondary to IV abuse of the drug [5, 32].
Levamisole has been used in treatment of pediatric nephrotic syndrome, colon cancer, inflammatory bowel disease, and rheumatoid arthritis. It was removed from the market due to agranulocytosis side effect. But it is still available in illegal form mixed with cocaine. Levamisole may cause antineutrophil cytoplasmic autoantibodies (ANCAs)-associated vasculitis (AAV) [5]. It may also rarely lead to hyponatremia, Wegener’s granulomatosis, and renal failure [33].
Also antithyroid drugs such as propylthiouracil, carbimazole, and methimazole, and an antihypertensive drug hydralazine may lead to AAV [5].
Captopril is an ACE inhibitor that is used for treatment of hypertension and proteinuria. Kaptopril may be the only ACE-I leading to nephrotic syndrome [5].
Anabolic androgenic steroids like testosterone and illicitly used forms may lead to CKD [34].
TNF-α inhibitors are biologic agents. Based on renal biopsy and clinical findings, glomerulonephritis associated with systemic vasculitis (GNSV), glomerulonephritis in lupus-like syndrome, and isolated autoimmune renal disorder are the subgroups of autoimmune renal diseases that may be caused by TNF-α inhibitors [5].
Gold compounds have been used for treatment of rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. Because of side effects, low efficacy, and high cost, newer medications take place of gold salts. Parenteral use 0f gold leads to proteinuria, and gold-induced proteinuria is an indication of gold discontinuation. With oral gold therapy, proteinuria is rare. Renal pathology shows membranous glomerulonephritis. This may progress to nephrotic syndrome in patients continuing gold therapy [5, 35, 36].
Amphotericin-B is an antifungal agent that is the choice in immunocompromised patients. It causes AKI via the tubular cell toxicity [1].
Amphotericin-B damages membrane integrity by causing pores and increases membrane permeability, and this leads to distal renal tubular acidosis [16]. Risk factors for nephrotoxicity are similar as any toxic nephropathy, but sodium deficiency is important especially in patients taking diuretic therapy [4]. Preventive procedures of amphotericin-B nephrotoxicity include saline hydration before and after drug administration, use of liposomal formulations, limiting the duration of therapy, and considering a continuous low-dose infusion over a 24 hours\' period [1].
Cyclosporine and tacrolimus cause reversible AKI by inducing afferent and efferent arteriolar vasoconstrictions. Persistent injury can lead to interstitial fibrosis and glomerulosclerosis, and this leads to irreversible chronic nephrotoxicity. Tacrolimus may cause TMA [16, 37].
Cisplatin may affect glomeruli and distal tubule, but it primarily affects proximal tubules. It leads to tubular necrosis or tubulointerstitial disease. It may increase serum creatinine and decrease GFR and lead to hypomagnesaemia, hyponatremia, hypocalcemia, and hypokalemia. When administered with hypertonic saline, cisplatin is better tolerated [1, 4, 16].
Cyclosporin-A leads to acute reversible and chronic irreversible nephrotoxicity. Acute reversible form is seen most commonly in renal transplant recipients and manifests as acute renal failure. Chronic form typically manifests after 1-year therapy. Clinical features are marked decline in glomerular filtration rate (GFR), hypertension, mild proteinuria, and rarely hematuria [4].
Ifosfamide is an analog of cyclophosphamide [16] and is used in the treatment of solid tumors in both children and adults [1] Cyclophosphamide is not nephrotoxic, but ifosfamide is toxic to the tubular cell. It prefers proximal tubular toxicity and leads to Fanconi’s syndrome [1, 16]. It may also affect glomerulus and decreases GFR. These impairments may lead to clinical manifestations including hypophosphatemic rickets, proximal and distal renal tubular acidosis, diabetes insipidus, and hypokalemia [1].
Foscarnet is used for treatment of resistant cytomegalovirus (CMV) infections. It causes acute interstitial nephritis and intratubular crystal formation. Foscarnet may chelate with calcium and cause hypocalcemia [16].
Methotrexate is an antiproliferative and immunomodulating agent that is widely used. Its high-dose regimen leads to AKI. It may cause cellular damage or crystal nephropathy. Hydration therapy and urine alkalinization can prevent the concentration of MTX to become too high in the tubules. Also toxic systemic concentrations caused by AKI can be prevented by leucovorin administered 24–48 hours after MTX [1].
mTOR inhibitors such as sirolimus or everolimus can worsen any significant underlying proteinuria in liver recipients with preexisting chronic renal disease [1].
Vancomycin is an antimicrobial agent used in the treatment of Gram-positive infections. Vancomycin use is associated with nephrotoxicity. Nephrotoxicity range was as high as 50% in the past, but now it ranges about 1.0–42.6% by newer formulations. In addition to common nephrotoxicity risk factors, patients weight exceeding 101.4 kg, daily vancomycin dose over 4 g are also risk factors for vancomycin nephrotoxicity [38].
The selective BRAF inhibitors vemurafenib and dabrafenib are used to treat metastatic melanomas. There are no data reported dabrafenib use causing acute kidney injury, but there are a few case series with vemurafenib. The Food and Drug Administration Adverse Event Reporting System (FAERS) reports renal toxic effect of both agents. Vemurafenib appears more nephrotoxic than dabrafenib. Although not clear, they are thought to cause tubular interstitial injury with hypokalemia and hyponatremia [39].
Dekstrans are used for volume replacement therapy and may cause acute kidney injury. Therefore, fluid status and urine output should be monitored closely [39].
It is a chelating agent used to get rid of iron from the body. It may produce toxic effect that may be fatal. Genitourinary effects of EDTA are nephrosis, nephrotoxicity, occult blood in urine, and proteinuria [40].
Contrast-induced nephropathy is defined as an increase in serum Cr level of greater than 0.5 mg/dL or 25% over baseline during a period of 12–48 hours after contrast administration and the exclusion of other causes of AKI [2, 41].
Contrast agents generally lead to reversible AKI. Histopathologic evidence generally shows ATN. Compared with other types of ATN, contrast nephropathy is usually characterized by relatively rapid recovery of renal function. Most patients are nonoliguric. If occurs, oliguria occurs immediately after the procedure. Other manifestations of acute kidney injury, such as hyperkalemia, acidosis, and hyperphosphatemia, may be present. The urinary sediment may show classical findings of ATN. Proteinuria is absent or mild [41].
Underlying chronic renal disease, diabetes, and nephrotoxic medications predispose patients to renal injury from contrast. If IV contrast is necessary, patients can be pretreated with N-acetylcysteine (600 mg twice daily for two doses before study and after study) and alkalinized IV hydration (three ampules of 50 mEq sodium bicarbonate in 1000 mL D5W solution). In most cases, Cr usually starts to decline within 3–7 days. Dialysis is rarely required for contrast-induced AKI [37].
Crystal nephropathies cause mechanical obstruction, local intrarenal inflammation, and tissue injury. There are three subgroups of crystal nephropathies: renal ischemic, tubular injury, and obstructive nephropathy [42].
Crystal-induced acute kidney injury commonly occurs following the administration of drugs or toxins that are poorly soluble or have metabolites that are poorly soluble in the urine [3, 43]. Especially in volume depletion status, glomerular ultrafiltrate can be enriched with minerals, proteins, or drug metabolites. Acute accumulation can induce a sudden onset of crystal formation leading to AKI, and long-term accumulation can lead to CKD [3, 42].
Patiens with drug- related crystal- induced AKI are usually asymptomatic. Kidney injury usually manifests with increased serum Cr, accompanying with hematuria, pyuria, and crystalluria. Crystal-induced AKI is generally reversible by discontinuation of the drug. It may rarely progress to CKD and dialysis may be required.
Risk factors for crystal-induced nephropathies are intravascular volume depletion, underlying kidney or liver disease, and metabolic disturbances that change urinary pH [3, 43].
Sulfadiazine and sulfamethoxazole are relatively insoluble in acid urine. Alkalinization of urine to a pH > 7.15 increases sulfadiazine solubility.
High-dose methotrexate can both precipitate in the tubules and cause direct tubular injury. Alkalinization of urine to a pH > 7 increases methotrexate solubility. Methotrexate-induced acute kidney injury is typically nonoliguric and often reversible.
It is a protease inhibitor used in the treatment of human immunodeficiency virus infection. Acidic urine pH (<6) increases indinavir solubility, but acidification of urine may be harmful; thus, it is not recommended.
It is a fluoroquinolone antibiotic and causes acute interstitial nephritis and crystal-induced nephropathy. Crystals precipitate in alkaline pH [43].
The other drugs that may lead to crystal-induced nephropathy are acyclovir; protease inhibitors such as indinavir, atazanavir; foskarnet; megadose vitamin C; orlistat; oral sodium phosphate; purgatives; triamterene; and high-dose amoxicillin [2, 3, 16, 43].
It is used in the treatment of herpes infections and sepsis in neonates. It can most commonly lead to crystal-induced nephrotoxicity and also to nephrotoxicity by direct tubular injury [21].
Many drugs both prescribed or over-the counter have potential to cause kidney damage. Therefore, some basic items such as past medical history, age and weight of the patient, drug-related risk factors, and nephrotoxic drug combinations should be taken into consideration before starting the treatment. If a nephrotoxic drug use is mandatory, patients should be followed up closely and frequently with appropriate biomarkers. Basic renal functions should be evaluated before treatment. The early detection of drug-induced nephropathies and application of the appropriate treatment methods are critical, because many patients recover when the drug is discontinued.
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Placenta-derived MSC have been used to treat a variety of disorders, such as, cancer, liver and cardiac diseases, ulcers, bone repair, and neurological diseases. Placenta-derived MSC are relatively new types of MSC with specific immunomodulatory properties and whose mechanisms are still unknown. Placenta-derived MSC secrete some soluble factors that seem to be responsible for their therapeutic effects, i.e., they have paracrine effects. On the other hand, Placenta-derived MSC can also serve as cellular vehicles and/or delivery systems for medications due to their migration capacity and their tropism for injury sites. Nanotechnology is an important field, which has undergone rapid development in recent years for the treatment of injured organs. 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These cells remain in a quiescent state until they are activated by different factors, usually those generated by an alteration in the parenchymal tissue. These cells have characteristic membrane markers such as CD73, CD90, and CD105. Those are a receptor, which in response to their ligand induces strong changes in different metabolic pathways that lead to these cells, both to generate molecules with different activities and to leave their stationary phase to reproduce and even differentiate. This review describes the metabolic pathways dependent on these membrane markers and how they influence on parenchymal tissue and other stromal cells.",book:{id:"6658",slug:"stromal-cells-structure-function-and-therapeutic-implications",title:"Stromal Cells",fullTitle:"Stromal Cells - Structure, Function, and Therapeutic Implications"},signatures:"Maria Teresa Gonzalez Garza",authors:[{id:"181389",title:"Ph.D.",name:"Maria Teresa",middleName:null,surname:"Gonzalez Garza",slug:"maria-teresa-gonzalez-garza",fullName:"Maria Teresa Gonzalez Garza"}]},{id:"63044",title:"Stromal-Epithelial Interactions during Mammary Gland Development",slug:"stromal-epithelial-interactions-during-mammary-gland-development",totalDownloads:1439,totalCrossrefCites:2,totalDimensionsCites:7,abstract:"Mammary gland is an organ, which undergoes the majority of its development in the postnatal life of mammals. The complex structure of the mammary gland comprises epithelial and myoepithelial cells forming the parenchymal tissue and adipocytes, fibroblasts, vascular endothelial cells, and infiltrating immune cell composing the stromal compartment. During puberty and in adulthood, circulating hormones released from the pituitary and ovaries regulate the rate of development and functional differentiation of the mammary epithelium. In addition, growing body of evidence shows that interactions between the stromal and parenchymal compartments of the mammary gland play a crucial role in mammogenesis. This regulation takes place on a paracrine level, by locally synthesized growth factors, adipokines, and cytokines, as well as via direct cell-cell interactions. This chapter summarizes the current knowledge about the complex nature of interactions between the mammary epithelium and stroma during mammary gland development in different mammalian species.",book:{id:"6658",slug:"stromal-cells-structure-function-and-therapeutic-implications",title:"Stromal Cells",fullTitle:"Stromal Cells - Structure, Function, and Therapeutic Implications"},signatures:"Żaneta Dzięgelewska and Małgorzata Gajewska",authors:[{id:"165068",title:"Dr.",name:"Malgorzata",middleName:null,surname:"Gajewska",slug:"malgorzata-gajewska",fullName:"Malgorzata Gajewska"},{id:"249847",title:"Ms.",name:"Żaneta",middleName:null,surname:"Dzięgelewska",slug:"zaneta-dziegelewska",fullName:"Żaneta Dzięgelewska"}]},{id:"69757",title:"Flow Cytometry Applied to the Diagnosis of Primary Immunodeficiencies",slug:"flow-cytometry-applied-to-the-diagnosis-of-primary-immunodeficiencies",totalDownloads:1084,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Primary immunodeficiencies are the result of biological defects associated with functional immune abnormalities. It consists of a group of disorders showing a higher incidence and severity of infections, expression of immunological dysregulation such as inflammation and lymphoproliferation. The immunophenotyping and in vitro functional characterization of immunodeficient patients contribute, together with the clinical aspects, to define the underlying immune defect particularities. Flow cytometry applications in primary immunodeficiency assessment are multiple and include the study of a wide range of specific cell lymphocyte subpopulations. This chapter describes the main techniques used in the diagnosis of a wide variety of primary immunodeficiencies, in which intracellular proteins or activation markers involved in immunity are evaluated, as well as functional proliferation, cytokine production, phosphorylation of transcription factors, cytotoxic and degranulation capacity. Flow cytometry is a tool that allows rapid and accurate evaluation of multiple lymphocyte populations and immunological function, and this information is essential for the diagnosis and evaluation of patients with primary immunodeficiencies.",book:{id:"6913",slug:"innovations-in-cell-research-and-therapy",title:"Innovations in Cell Research and Therapy",fullTitle:"Innovations in Cell Research and Therapy"},signatures:"Mónica Martínez-Gallo and Marina García-Prat",authors:[{id:"286242",title:"Ph.D.",name:"Mónica",middleName:null,surname:"Martínez Gallo",slug:"monica-martinez-gallo",fullName:"Mónica Martínez Gallo"},{id:"286704",title:"BSc.",name:"Marina",middleName:null,surname:"García-Prat",slug:"marina-garcia-prat",fullName:"Marina García-Prat"}]},{id:"50685",title:"States of Pluripotency: Naïve and Primed Pluripotent Stem Cells",slug:"states-of-pluripotency-na-ve-and-primed-pluripotent-stem-cells",totalDownloads:4084,totalCrossrefCites:4,totalDimensionsCites:12,abstract:"Pluripotent stem cells are classified into naïve and primed based on their growth characteristics in vitro and their potential to give rise to all somatic lineages and the germ line in chimeras. In this chapter, I describe the similarities and differences between the naïve and primed pluripotent states as exemplified by mouse embryonic stem cells (mESCs), mouse epiblast stem cells (mEpiSCs), human embryonic stem cells (hESCs), and human induced pluripotent stem cells (hiPSCs). I also review the efforts for derivation of naïve human pluripotent stem cells by manipulating culture conditions during reprogramming of somatic cells and attempts to revert primed hESCs to the naïve state. Understanding the requirements for induction and maintenance of the naïve pluripotent state will facilitate studies on early human embryonic development and understanding the mechanisms involved in X inactivation in vitro. 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