A systemic framework based on Soft OR approaches to support teamwork strategy: an aviation manufacturer Brazilian company case

The paper reports on the application of a combination of Operational Research (OR) approaches to a real-world case of re-designing the strategy of a department management team, in an aircraft manufacturing organization in Brazil. We combine approaches from ‘Soft’ OR Problem Structuring Methods in a multi-methodological framework arguing that this helps to discuss, develop and implement a new departmental strategy. The proposed framework uses elements of Soft Systems Methodology; Strategic Options Development and Analysis to understand and structure the situation; Value-Focused Thinking to define the means and objectives; and Value-Focused Brainstorming to highlight the potential solutions. We conceptualize a four-phased systemic framework linking elements of the above four ‘Soft’ OR approaches and apply it to a real-world case in a department where a new team leader was appointed with the specific brief to improve the departmental strategy and its performance in general. Findings suggest that combining the approaches into a framework encourages trust and participation from stakeholders which, in practice, is translated into an improved strategy for the organization. A reflection on the multi-methodological approach is proposed. Conclusions and points for further research are suggested

Lupinus mutabilis oil obtained by expeller press: Yield, physicochemical characterization, antioxidant capacity, fatty acids and oxidative stability analyses

The oil of debittered and dehulled grains from two Andean lupins (Lupinus mutabilis) from Peru, Andenes and Común, was extracted by expellerpress. The extraction yield and the proximal composition of both varieties were assessed. The oil and the cake, as well as the defatted flour from thevariety with the highest extraction yield, werecharacterised for physico-chemical properties, total polyphenol content andantioxidant capacity. Theoil shelf-life at 25 °C was extrapolated by Rancimat test. Andenes presented an oil yield of 22.1% (vs. 18.4% of Común), CIELAB colour coordinates ofL* = 36.5, a* = 2.2, b* = 20, refractive index and density at 25 ºC of 1.469 and 0.903 g/mL, acid number of 3.2 mg KOH/g, free fatty acids content of1.6%, peroxide number of 2.7 meqO2/kg, p-anisidine number of 1.3, unsaponificable content of 58%, total antioxidant capacity 21.4 μmol TE/g and total polyphenol content of 7.0 mg AGE/100 g. The predominant fatty acid, tocopherol and phytosterol in the oil were oleic acid (56.2%), γ-tocopherol (555 mg/kg) and β-sitosterol (41900 mg/100 g), respectively. The oil shelf-life at 25 ºC was 2.7 years. The Lupinus mutabilis oil extracted by expeller presented an acceptable quality with a lower environmental negative impact than the oils obtained by solvent extraction

Consumers’ values and behaviour in the Brazilian coffee-in-capsules market: Promoting circular economy

Coffee consumption is changing. Monodose, flavoured coffee capsules provide new experiences beyond the traditional custom of brewing coffee. While these pods mean access to a selection of premium coffee worldwide, they create huge quantities of plastic-aluminium packaging waste. This paper examines the novelty of coffee capsule consumption in Brazil in terms of consumers’ perspectives about ethical enterprise and environmental stewardship. We argue for ‘waste to resource’ management and applying reverse logistics to the coffee production supply chain. Based on Circular Economy principles and fuelled by the ‘green’ awareness of Brazilian coffee consumers themselves, we propose a conceptual framework to support business decision-making by adopting a systemic intervention from the consumer viewpoint. To structure and scope the problematic situation, we conducted over 40 interviews, using purposive sampling. Analytic Hierarchy Process (AHP), Value Focused Thinking (VFT) and Rich Picture Technique also informed our problem structuring approach. Findings illustrate that the ambition for a reverse supply chain in coffee capsule manufacturing presents real challenges to achieving circular practice. Yet, the eco-values of Brazilian coffee enthusiasts may be partly considered a ‘wealth of information flow’ and a potential driving force for change. This paper should be of interest to researchers and practitioners exploring how consumers may contribute to behavioural change, towards more circular business

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Tenacidad a la fractura de compuestos cermets 3Al2O3*2SiO2/Ag manufacturados por molienda de alta energía

La fabricación de materiales compuestos de matriz cerámica reforzados con partículas metálicas han propiciado la formación de nuevos materiales conocidos como compuestos CERMETS, materiales que debido a sus elementos precursores poseen propiedades distintas a las de los materiales convencionales. En este trabajo se establece la ruta de fabricación de materiales compuestos cermets base 3Al2O3*2SiO2 reforzados con partículas metálicas de Ag a partir de la formación de la composición química en peso de polvos de 3Al2O3*2SiO2 / 1% Ag en busca de un aumento en la tenacidad a la fractura con respecto al cerámico base. La composición química de polvos es sometida a un proceso de mezcla molienda de alta energía en seco en un molino tipo planetario por 2 horas a 200 rpm. Los polvos posteriormente son conformados en muestras cilíndricas de 20 mm de diámetro y 3 mm de espesor mediante la aplicación de carga uniaxial en frío de 200 MPa. Las muestras son sinterizadas a 1500°C y 1600°C por una y dos horas en un horno de resistencia eléctrica en atmósfera controlada de gas nitrógeno. Los compuestos fabricados son analizados microestructuralmente por microscopia óptica y electrónica de barrido. Se determina la densidad y las propiedades mecánicas de dureza y tenacidad a la fractura, las dos últimas por el método de indentación. Los resultados muestran la viabilidad de fabricación de materiales compuestos cermets así como los cambios en la densidad, la dureza y la tenacidad a la fractura, con respecto al cerámico 3Al2O3*2SiO2 sin refuerzo metálico