Frugal innovation: doing more with less for more

The global economy will face significant challenges over the next few decades. On the one hand, it must meet the needs of 7 billion consumers (growing to 9 billion by 2050), including the currently unmet basic needs of large numbers in developing countries in areas such as food, energy, housing and health. On the other hand, it must achieve this growth without exceeding the resources available on the planet or causing environmental devastation. This paper argues that such change is possible through a systemic shift to a frugal economy that involves radical, frugal innovation across sectors. Such a transformation will involve the participation of large and small firms, consumers and governments alike. The paper introduces the notion of frugal innovation—the creation of faster, better and cheaper solutions for more people that employ minimal resources—and discusses strategies and examples of such change already taking place in core sectors like manufacturing, food, automotive and energy in developing and developed economies. It also outlines the role of the interaction between large and small firms as well as between firms and consumers in making change possible, as well as the role of governments in driving change where market mechanisms alone will not suffice. This article is part of the themed issue ‘Material demand reduction’

Advanced demand and a critical analysis of revenue management

Pre-print; author's draftThis paper presents a theoretical framework of advanced demand through six propositions. The framework introduces the concept of acquisition and valuation risks and suggests that advanced demand distribution is rooted in the trade off between them. Furthermore, since advanced buyers may not consume, firms may be able to re-sell capacity relinquished. The study then proposes how refunds could provide additional revenue to firms. The study further suggests theoretical reasons why and when service firms are able to practice revenue management, suggesting that RM tools such as overbooking and demand forecasting may not be the only tools for higher revenue

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Technological Revolution, Sustainability and Development in Africa: Overview, Emerging Issues and Challenges

The paper examines the silent technological revolution in sub‐Saharan Africa focusing on emerging issues and challenges. In view of the centrality of technology diffusion in fostering local innovations and economic development in developing countries, it is surprising that our understanding of the challenges and opportunities in scaling‐up technologies remains limited. This paper capitalises on the ongoing silent technological revolution in sub‐Saharan Africa to present an overview of how new technologies have been adopted and utilised to achieve sustainability. The study identified a host of factors such as weak regulatory enforcement systems, lack of financial credit availability, and limited banking services, which have created conditions for technological innovations such as mobile phone‐based banking, mPedigree, “cardiopad,” and M‐PEPEA to emerge. The public policy implications and directions for future research are identified and examined

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Frugal Innovation for Supply Chain Sustainability in SMEs: Multi-method Research Design

In this study we attempt to establish the missing links between supply chain sustainability and frugal innovation. Our study motivations stem from two facets of the emerging markets: firstly, the institutional barriers and secondly, the resource constraints. We argue that there is a synergy in the concepts of frugal innovation and sustainability in supply chains and there is a need to further explore this synergy. Furthermore, we claim that even in the wake of many success stories in the frugal innovative supply chain management practices from emerging markets such as India, there are very few, if any, attempts made to understand the implications of a sustainability oriented frugal innovations in the particular context. To address this gap we develop a model to establish the linkage between sustainable supply chains and frugal innovations. Our proposed conceptual framework depicts the hierarchy and interlinks of the identified enablers in developing sustainability oriented frugal innovative capabilities in supply chains. Furthermore, we have empirically validated our theoretical framework using survey data. We observed that most of the interpretive links are supported. These findings extend the understanding of frugal innovation for supply chain sustainability using multi-method research design, while also providing theoretically guidance to managers in the development of frugal innovation capability to achieve sustainability in supply chain in resource constrained environment

Institutional Legitimacy, Cross-Border Trade and Institutional Voids: Insights from the Cocoa Industry in Ghana

In spite of a growing body of literature on market opportunism in emerging markets, it remains unclear how supply chain partners abuse the institutional voids emanating from weak markets and legal enforcement mechanisms. This study attempts to integrate the concept of ‘institutional voids’ with that of ‘opportunism in inter-firm relationship’ literature to examine how they create space and conditions for illegitimate activities to occur in a supply chain. Using insights from cocoa production and distribution in Ghana, we uncovered activities such as tampering, adjustment of weighing scales and smuggling as examples of illegitimate activities and abuses in the supply chain. The study revealed that these activities are manifestations of institutional voids arising from weak markets and legal enforcement mechanisms. An analysis of the supply chain partners’ activities illuminates our understanding of the underlying processes inherent in market opportunism. Taken together, the study demonstrates how smuggling and theft-to-smuggle have taken on new prominence as an escape response to the institutional voids in the country. The implications for future research are examined

A Quantitative Approach to Innovation in Agricultural Value Chains: Evidence from Kenyan Horticulture

In less developed countries such as Kenya, trade is increasingly occurring through, and employment is found within, global and local value chains. Yet, although innovation is widely recognised as crucial for development, the endogenous relationship between small-scale innovations and participation in global value chains (GVCs) has yet to be explored sufficiently. This endogeneity is highlighted using the 3L’s of labels, linkages and learnings as key overlapping factors that affect both the processes of innovation as well as GVC participation. Drawing on a survey of 320 fresh fruit farmers and 55 interviews in Kenya, we develop a novel method to quantify small-scale agricultural innovations, which are categorised into two overarching types. The first, formal, emanate from meeting standard requirements; the second, informal, evolve from local contexts and are less codified. We find that GVC farmers perform more formal innovations, while local farmers perform similar levels of informal innovation to GVC farmers

Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. © 2019 The Author(s)