Green Lean Six Sigma for sustainability improvement: a systematic review and future research agenda

Design/ Methodology/ Approach: To do a systematic analysis of the literature, a systematic literature review methodology has been used in this research work. 140 articles from the reputed databases were identified to explore hidden aspects of GLSS. Exploration of articles in different continents, year-wise, approach-wise, and journal-wise, were also done to find the execution status of GLSS. Purpose: The main purpose of this article is to explore different aspects of the Green Lean Six Sigma approach, application status, and potential benefits from a comprehensive review of the literature and provides an avenue for future research work. The study also provides a conceptual framework for GLSS. Findings: The study depicts that GLSS implementation is increasing year by year, and it leads to considerable improvement in all dimensions of sustainability. Enablers, barriers, tools, and potential benefits that foster the execution of GLSS in industrial organizations are also identified based on a systematic review of the literature. Originality: The study's uniqueness lies in that study is the first of its kind that depicts the execution status of GLSS, and its different facets, explores different available frameworks and provides avenues for potential research in this area for potential researchers and practitioners

Post-Operative Outcome in Patients Who Have Undergone Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Abstract: AIM-To assess the benefit of Lateral Pancreaticojejunostomy (LPJ) in patients wit

Exploration and Mitigation of Green Lean Six Sigma Barriers: A Higher Education Institutions perspective

Purpose-The study aims to identify Green Lean Six Sigma (GLSS) barriers in the context of Higher Education Institutions (HEIs) and prioritize them for executing the GLSS approach. Design/methodology/approach-A systematic literature review (SLR) was used to identify a total of fourteen barriers, which were then verified for greater relevance by the professional judgments of industrial personnel. Moreover, many removal measures strategies are also recommended in this study. Furthermore, this work also utilizes Gray Relational Analysis (GRA) to prioritize the identified GLSS barriers. Findings-The study reveals that Training and education, continuous assessment of SDG, organizational culture, resources and skills to facilitate implementation, and assessment of satisfaction and welfare of the employee are the most significant barriers to implementing this approach. Research limitations/implications-The present study provides an impetus for practitioners and managers to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers. In this case, the outcomes of this research, and in particular the GRA technique presented by this work, can be used by managers and professionals to rank the GLSS barriers and take appropriate action to eliminate them. Practical implications-The ranking of GLSS barriers gives top officials of higher education institutes a very clear view to effectively and efficiently implementing GLSS initiatives. The outcomes also show training and education, sustainable development goals, and organizational culture as critical barriers. The findings of this study provide an impetus for managers, policymakers, and consultants to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers. Societal implications-The GLSS barriers in HEIs may significantly affect the society. HEIs can lessen their environmental effect by using GLSS practices, which can support sustainability initiatives and foster social responsibility. Taking steps to reduce environmental effect can benefit society as a whole. GLSS techniques in HEIs can also result in increased operational effectiveness and cost savings, which can free up resources to be employed in other areas, like boosting student services and improving educational programs. However, failing to implement GLSS procedures in HEIs could have societal repercussions as well. As a result, it's critical for HEIs to identify and remove GLSS barriers in order to advance sustainability, social responsibility, and operational effectiveness. Originality/value-GLSS is a comprehensive methodology that facilitates the optimum utilization of resources, reduces waste, and provides the pathway for sustainable development so, the novelty of this study stands in the inclusion of its barriers and HEIs to prioritize them for effective implementation

The evolutionary dynamics of variant antigen genes in Babesia reveal a history of genomic innovation underlying host-parasite interaction

Babesia spp. are tick-borne, intraerythrocytic hemoparasites that use antigenic variation to resist host immunity, through sequential modification of the parasite-derived variant erythrocyte surface antigen (VESA) expressed on the infected red blood cell surface. We identified the genomic processes driving antigenic diversity in genes encoding VESA (ves1) through comparative analysis within and between three Babesia species, (B. bigemina, B. divergens and B. bovis). Ves1 structure diverges rapidly after speciation, notably through the evolution of shortened forms (ves2) from 5′ ends of canonical ves1 genes. Phylogenetic analyses show that ves1 genes are transposed between loci routinely, whereas ves2 genes are not. Similarly, analysis of sequence mosaicism shows that recombination drives variation in ves1 sequences, but less so for ves2, indicating the adoption of different mechanisms for variation of the two families. Proteomic analysis of the B. bigemina PR isolate shows that two dominant VESA1 proteins are expressed in the population, whereas numerous VESA2 proteins are co-expressed, consistent with differential transcriptional regulation of each family. Hence, VESA2 proteins are abundant and previously unrecognized elements of Babesia biology, with evolutionary dynamics consistently different to those of VESA1, suggesting that their functions are distinct

Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Purpose: The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon’s geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results: A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion: More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries