CAN CHANGE PREDICTION HELP PRIORITISE REDESIGN WORK IN FUTURE ENGINEERING SYSTEMS?

Future design environments will necessitate improved management of the propagation and impacts of changes. To ascertain whether change prediction can assist in making better work prioritisation decisions, this paper develops a new simulation approach and applies it to a model of a complex aerospace product, which was elicited from industry. We use an accepted technique to generate potential change propagation trees and apply Monte Carlo methods to generate a sample space within which multiple scheduling policies could be evaluated and compared. The experiments reveal that poor coordination of change activity can result in significant process inefficiencies, that the potential for inefficiency increases for larger change networks, and that a modest ability to accurately predict change propagation in the specific case at hand could have a dramatic effect in reducing unnecessary rework. The experiments also suggest that the capability of predicting multiple steps of change propagation would provide only minimal additional improvement.International Design Conference - DESIGN 201

Strategic Risk and Reliability Assessment in the Container Liner Shipping Industry Under High Uncertainties

The container liner shipping industry (CLSI) can be defined as one consisting of a fleet of vessels that provides a fixed service at regular intervals between ports of call. It is noteworthy that the CLSI is remarkably acting as an artery in making contributions to the growth of the global economy. However, in an era of unprecedented global changes, the CLSI faces a variety of internal and external risks. Moreover, the reliability and capability of liner shipping operators (LSOs) vary under different environmental conditions. Consequently, it is important for LSOs to ensure that the safety and reliability of their internal operations as well as external environments through proactive assessment of their reliability and capability are intact. The literature indicates that disruptive events have been assessed and investigated by many researchers and practitioners whilst the root causes arising from external risks have not yet been fully identified. The aim of this research was to develop integrated frameworks for assessing risk and reliability in the CLSI under high uncertainties. As a result, three interlocking levels of analysis have been highlighted in this research: 1) business environment-based risk (BEBR), 2) organisational reliability and capability (ORC) of LSOs, and 3) punctuality of containerships. To achieve the aim, firstly, this research employed a combination of different decision-making methods (i.e. Analytic Hierarchy Process (AHP), Fuzzy Set Theory (FST) and Evidential Reasoning (ER)) for the assessment of the BEBR. The research outcomes are providing LSOs with a powerful decision-making tool to assess the risk value of a country prior to investment and strategic decisions. In addition, LSOs are also able to regularly assess the overall level of existing BEBR in a host country prior to development of mitigation strategies that can help to minimise financial losses. Secondly, this research employs the Fuzzy Bayesian Belief Network (FBBN) method for evaluating the ORC of LSOs. By exploiting the proposed FBBN model, LSOs are able to conduct a self-evaluation of their ORC prior to the selection of a strategy for enhancing their competitive advantages in the CLSI. A significant concern in container liner shipping operations is the punctuality of containerships. Therefore, thirdly, this research concentrated on analysing and predicting the arrival punctuality of a liner vessel under dynamic environments by employing a combination of Fuzzy Rule-Base (FRB) and FBBN methods. Finally, a probabilistic model for analysing and predicting the departure punctuality of a liner vessel was generated. Accordingly, from the outcomes of this research LSOs are able to forecast their vessels’ arrival and departure punctuality and, further, tactical strategies can be implemented if a vessel is expected to be delayed. In addition, both arrival and departure punctuality models are capable of helping academic researchers and industrial practitioners to comprehend the influence of uncertain environments on the service punctuality. In order to demonstrate the practicability of the proposed methodologies and models, several real test cases were conducted by choosing the Malaysian maritime industry as a focus of study. The results obtained from these test cases have provided useful information for recommending preventive measures, improvement strategies and tactical solutions. The frameworks and models that have been proposed in this research for assessing risk and reliability of the CLSI will provide managerial insights for modelling and assessing complex systems dealing with both quantitative and qualitative criteria in a rational, reliable and transparent manner. In addition, these models have been developed in a generic sense so that they can be tailored for application in other industrial sectors

The Development of a Set of Principles for Through-Life Management of Engineering Information

Corporate business models are shifting away from product delivery paradigms to product-service paradigms, where ongoing through-life service support is preeminent. In the UK, a Grand Challenge project (www.kimproject.org) was established to investigate and develop good practice with regard to the design and use of information, knowledge support systems, and business methods necessary for organisations to succeed and profit within this new environment. A key outcome of this work has been the development of a series of principles for through-life management of engineering information, derived from the research insights and experiences of project members in both academia and industry, and supported by detailed explanations and implementation guidance. This report is an approved version of the Principles and their development.This work was undertaken through the “Immortal Information and Through-Life Knowledge Management: Strategies and Tools for the Emerging Product-Service Paradigm” (KIM) project, funded by the UK Engineering and Physical Sciences Research Council (EPSRC) and the Economic and Social Research Council (ESRC), under grant number EP/C534220/1

Comparative study on cartilage tissue collected from less- and severely-affected region of osteoarthritic knee

Culture expanded chondrocytes isolated from non-load bearing region of osteoarthritic (OA) joint has been used to construct tissue engineered cartilage for treatment purposes. The aim of the study was to compare the histological properties of the cartilage tissue and morphological properties of the chondrocytes isolated from less and severely affected OA knee. Human articular cartilage was obtained as redundant tissue from consented patients with late-stage OA undergoing total knee replacement surgery at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Articular cartilage was graded according to Dougados and Osteoarthritis Research Society International (OARSI) classification. Articular cartilage was classified into less affected (LA; Grade 0-1) and severely affected (SA; Grade 2-3). Cartilage tissue from less and severely affected region was stained with Safranin O staining. Isolated chondrocytes from each group were cultured until passage 4 (P4). Their growth patterns, cell areas, and circularity were compared. LA-cartilage tissue shows uniform spread of safranin O staining indicating intact extracellular matrix (ECM) component. However, SA-cartilage shows significant reduction and unstable staining due to its degraded ECM. LA-chondrocytes showed an aggregated growth compared to SA-chondrocyte that remains monolayer. Moreover, LA-chondrocytes have significantly higher cell area with wider spreading at passage 0 and 4 compared to SA-chondrocytes. It was also found that chondrocyte circularity increased with passage, and circularity of LAchondrocytes was significantly higher than that of the SA-chondrocytes at passage 3. This study demonstrated the considerable difference in the cellular properties for less and severely affected chondrocytes and implication of these differences in cell-based therapy needed to be explored

Utilization of Renewable Biomass and Waste Materials for Production of Environmentally-Friendly, Bio-based Composites

The introduction of renewable biomass into a polymer matrix is an option competing with other possibilities, such as energy recovery and/or re-use in the carbonized state, or production of chemicals, such as, in the case of ligno-cellulosic waste, concentrates on the production of simple sugars, then possibly leading to the development of biopolymers. These competitive applications have also some interest and market, however with a considerable energy, water and materials consumption, due also to the not always high yielding. Other possibilities for renewable biomass are therefore being used as fillers to increase mechanical performance of polymers or to allow e.g., the absorption of toxic chemicals. This review concentrates on the use of biomass as close as possible to the “as received” state, therefore avoiding whenever suitable any thermal treatment. More specifically, it focuses on its introduction into the three categories of oil-based (or bio-based replacement) of engineered polymers, into industrial biopolymers, such as poly(lactic acid) (PLA) and self-developed biopolymers, such as thermoplastic starch (TPS)

Efficiency of Ontario primary care physicians across payment models : a stochastic frontier analysis

Objective The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. Methods Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. Results Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models

How are gender inequalities facing India’s one million ASHAs being addressed? Policy origins and adaptations for the world’s largest all-female community health worker programme

Background: India’s accredited social health activist (ASHA) programme consists of almost one million female community health workers (CHWs). Launched in 2005, there is now an ASHA in almost every village and across many urban centres who support health system linkages and provide basic health education and care. This paper examines how the programme is seeking to address gender inequalities facing ASHAs, from the programme's policy origins to recent adaptations. Methods: We reviewed all publically available government documents (n = 96) as well as published academic literature (n = 122) on the ASHA programme. We also drew from the embedded knowledge of this paper’s government-affiliated co-authors, triangulated with key informant interviews (n = 12). Data were analysed thematically through a gender lens. Results: Given that the initial impetus for the ASHA programme was to address reproductive and child health issues, policymakers viewed volunteer female health workers embedded in communities as best positioned to engage with beneficiaries. From these instrumentalist origins, where the programme was designed to meet health system demands, policy evolved to consider how the health system could better support ASHAs. Policy reforms included an increase in the number and regularity of incentivized tasks, social security measures, and government scholarships for higher education. Residential trainings were initiated to build empowering knowledge and facilitate ASHA solidarity. ASHAs were designated as secretaries of their village health committees, encouraging them to move beyond an all-female sphere and increasing their role in accountability initiatives. Measures to address gender based violence were also recently recommended. Despite these well-intended reforms and the positive gains realized, ongoing tensions and challenges related to their gendered social and employment status remain, requiring continued policy attention and adaptation

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Identifying ‘win-win-win’ futures from inequitable value chain trade-offs: A system dynamics approach

Context There is growing recognition that food systems must adapt to become more sustainable and equitable. Consequently, in developing country contexts, there is increasing momentum away from traditional producer-facing value chain upgrades towards efforts to increase both the availability and affordability of nutritious foods at the consumer level. However, such goals must navigate the inherent complexities of agricultural value chains, which involve multiple interactions, feedbacks and unintended consequences, including important but often surprising trade-offs between producers and consumers. Objective and methods Based around the 'Loop' horticultural aggregation scheme of Digital Green in Bihar, India, we develop a system dynamics modelling framework to survey the value chain trade-offs emerging from upgrades that aim to improve the availability of fruits and vegetables in small retail-oriented markets. We model the processes of horticultural production, aggregation, marketing, and retailing – searching for futures that are ‘win-win-win’ for: (i) the availability of fruits and vegetables in small retail markets, (ii) the profits of farmers participating in aggregation, and (iii) the sustainability of the initial scheme for Digital Green as an organisation. We simulate two internal upgrades to aggregation and two upgrades to the wider enabling environment through a series of 5000 Monte Carlo trajectories – designed to explore the plausible future dynamics of the three outcome dimensions relative to the baseline. Results We find that ‘win-win-win’ futures cannot be achieved by internal changes to the aggregation scheme alone, emerging under a narrow range of scenarios that boost supplies to the small retail market whilst simultaneously supporting the financial takeaways of farmers. In contrast, undesirable producer versus consumer trade-offs emerge as unintended consequences of scaling-up aggregation and the introduction of market-based cold storage. Significance This approach furthers ongoing efforts to capture complex value chain processes, outcomes and upgrades within system dynamics modelling frameworks, before scanning the horizon of plausible external scenarios, internal dynamics and unintended trade-offs to identify ‘win-win-win’ futures for all

The role of small extracelllular vesicles in endometriosis

Endometriosis, defined as endometrial-like tissue outside the uterus, causes pain and/ or subfertility in 10% of reproductive-age women (Zondervan, Becker and Missmer, 2020). To date, the cause is unknown, resulting in inadequate diagnostic methods and treatment options (E. Liu et al., 2015; Gupta et al., 2016; Nisenblat, Bossuyt, et al., 2016; Nisenblat, Prentice, et al., 2016). I propose an aetiology similar to cancer’s ‘seed and soil’ hypothesis (Hoshino et al., 2015), requiring interaction between eutopic endometrium, the peritoneal fluid (PF) and the prospective lesion site, mediated by small extracellular vesicles (sEVs). SEVs are cell-derived vesicles 30-150 nm in size that contain genetic material (RNA, DNA) and protein (Colombo, Raposo and Théry, 2014) and influence gene expression and behaviour in target cells (Zomer et al., 2015). Their cargo and surface proteins mirror the expression within their cell of origin. This DPhil thesis attempts to demonstrate the presence of PF-derived sEVs in endometriosis and control samples, to characterise their protein content and to understand the function of PF-derived sEVs in the pathophysiology of endometriosis. This involved an initial feasibility study (Nazri et al., 2020), an optimisation of sEV isolation methods, and a larger study which employed the optimised sEV isolation methods to investigate the differences between PF-derived sEVs in women with and without endometriosis. Methods: Samples and data were collected according to WERF EPHect protocols (Becker et al., 2014; Fassbender et al., 2014; Rahmioglu et al., 2014; Vitonis et al., 2014) from women who consented to be part of ENDOX, a study into the biology of Endometriosis at Oxford study (Rahmioglu et al., 2017). In the pilot (feasibility) study, PF-derived sEVs were isolated from 28 women and were pooled into six groups according to disease stage and cycle phase (control, rASRM stages I-II and III-IV endometriosis in proliferative and secretory phases). Following the optimisation of protocols for the isolation and characterisation of PF-derived sEVs, no pooling of PF samples occurred in the larger, main study involving 63 women. With the addition of the menstrual phase, PF-derived sEVs from these 63 women were analysed in nine groups according to disease stage and cycle phase (control, rASRM stages I-II and III-IV endometriosis, each in proliferative, secretory, and menstrual phases). PF-derived sEVs were purified using size exclusion chromatography (SEC) and analysed by nanoparticle tracking analysis (NTA), immunoblotting and mass spectrometry. TEM imaging was done for samples in the pilot study. Results: SEVs are present in PF of women with and without endometriosis in both pilot and main studies. PF-derived SEVs are positive for marker proteins programmed cell death 6-interacting protein (ALIX), CD9 and syntenin. Differences in concentration of PF-derived sEVs and protein content were observed in different disease stages and cycle phases in both studies, though the results found in the pilot study were not replicated in the main study. Notably, this could be due to the pooling of samples and the smaller sample size in the pilot study. Therefore, higher weightage is ascribed to the results of the main study when in doubt, as PF samples were not pooled, and an additional cycle phase was added to the analysis. In the main study, higher sEV concentrations were found in endometriosis versus control. PF-derived sEV concentrations were highest in stage III-IV endometriosis, followed by stage I-II endometriosis and control, irrespective of the cycle phase (P = 0.0210). The mode size of PF particles in women with endometriosis was 130 ± 8.7 nm, whereas in women without endometriosis, it was 134 ± 2.12 nm. A gradual decrease of sEV concentration in stage III-IV endometriosis was observed as these samples experienced the transition from proliferative to secretory cycle phases. The reverse was seen with stage I-II endometriosis as these samples transitioned from proliferative to secretory cycle phases. Proteomic analysis showed distinct distribution patterns of proteins within endometriosis PF-derived sEVs compared to controls. CD44, complement C1q, and leucine-rich repeat neuronal protein 4 (LRRN4) are sEV proteins with the top three highest VIP scores (variable importance projection, as per PLS-DA plot) uniquely found within the endometriosis population. Unfortunately, functional assays for understanding the role of these PF-derived sEVs in endometriosis need further optimisation. I hypothesise that endometriosis-specific PF-derived sEVs taken up by mesothelial cells in the peritoneal cavity induce epithelial-mesenchymal transition (EMT), thus allowing endometrial cells in PF to adhere and invade the PMC and establish an endometrial lesion. This follows several studies investigating the role of CD44, complement C1q and LRRN4 in endometriosis and cancer metastases. The presence of endometriosis-specific PF-derived sEV CD44, complement C1q, and LRRN4 needs to be validated via ELISA or immunoblotting. Conclusion: PF-derived sEVs differ between endometriosis and control patients. Concentrations vary regardless of cycle phase and disease stage, and this difference appears to be reflected in the proteomics analysis. Correlating PF-derived sEVs in endometriosis versus control groups will aid our understanding of endometriosis and biomarker identification to diagnose endometriosis.</p