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Sustainable operational excellence (OPEX) initiatives result in a competitive advantage by optimising the use of resources, contributing to profitability, and leading to expanded growth of organisations. OPEX being a practice-led initiative has no standard framework leading to sustainable OPEX efforts in organisations. In this study, we employ the Design Science Research (DSR) approach to develop a framework to assess the sustainability of OPEX initiatives in an organisation. The proposed framework evaluates OPEX initiatives based on operational, economic, environmental, and social sustainability criteria. Besides, the enablers for the sustainability of OPEX initiatives are identified. The enablers, as well as multidimensional assessment criteria of OPEX initiatives, help the organisation develop a methodological approach for implementing sustainable OPEX solutions. The current success rate for OPEX initiatives in organisations has been dismally poor, and the proposed framework will help improve the success of OPEX efforts. Practitioners can use the proposed framework first to assess their organisational readiness in terms of enablers before implementing OPEX initiatives and evaluate qualitatively and quantitatively to obtain a multidimensional perspective for sustainable solutions. The frameworks proposed in prior studies are predominantly conceptual. This study used the DSR methodology to demonstrate the validity of the proposed framework. [ABSTRACT FROM AUTHOR]

Abstract Background Various causes of malabsorption syndrome (MAS) are associated with intestinal stasis that may cause small intestinal bacterial overgrowth (SIBO). Frequency, nature and antibiotic sensitivity of SIBO in patients with MAS are not well understood. Methods Jejunal aspirates of 50 consecutive patients with MAS were cultured for bacteria and colony counts and antibiotic sensitivity were performed. Twelve patients with irritable bowel syndrome were studied as controls. Results Culture revealed growth of bacteria in 34/50 (68%) patients with MAS and 3/12 controls (p < 0.05). Colony counts ranged from 3 × 102 to 1015 (median 105) in MAS and 100 to 1000 (median 700) CFU/ml in controls (p 0.003). 21/50 (42%) patients had counts ≥105 CFU/ml in MAS and none of controls (p < 0.05). Aerobes were isolated in 34/34 and anaerobe in 1/34. Commonest Gram positive and negative bacteria were Streptococcus species and Escherichia coli respectively. The isolated bacteria were more often sensitive to quinolones than to tetracycline (ciprofloxacin: 39/47 and norfloxacin: 34/47 vs. tetracycline 19/47, Conclusions SIBO is common in patients with MAS due to various causes and quinolones may be the preferred treatment. This needs to be proved further by a randomized controlled trial.

Industry 4.0 symbolizes the fourth industrial revolution and the current trend of automation and data exchange in manufacturing technologies. The purpose of this article is to examine the research question on how to successfully implement Industry 4.0 in organizations. This study through a systematic literature review protocol proposed by Tranfield, Denyer, and Smart analyzed 84 articles in depth. The descriptive, categorical and thematic analysis of the literature is conducted. This study identifies 10 critical success factors which are necessary for the successful implementation of Industry 4.0 in the organization. Based on the 10 critical success factors 10 research directions in this area is further expounded. This study can be used by the organizations as a guiding factor while implementing Industry 4.0 in their organizations. Focussing on these 10 factors will help organizations to be sustainable during the implementation of Industry 4.0. Though there are some literature reviews on Industry 4.0, this study critically analyses the literature for finding the critical factors for the successful implementation of Industry 4.0. [ABSTRACT FROM AUTHOR]

Modern organisations are in search of initiatives which will enable them to be sustainable as well as gain a competitive advantage. Lean, Six Sigma and Green initiatives are some of the widely used tools which aid the organisation to be sustainable. Recent studies have suggested that the integration of Green and Lean Six Sigma (LSS) will create a powerful methodology and help organisations to be sustainable. Yet, many organisations have found it difficult due to the lack of a generic implementation framework, which can be used for any processes and cultural context. The purpose of this study is to answer the research question: how to implement a sustainable Green LSS initiative in the organisation. Through a critical analysis of previous literature, an implementation framework is developed and practically implemented through a case study to reduce the graphite and dust pollution in a mine in India. Within case analysis, it is conducted to develop propositions, future research directions and managerial implications. This is a first study to develop and practically test a generic implementation Green LSS framework. [ABSTRACT FROM AUTHOR]

Lean Six Sigma (LSS) is one of the most widely used business improvement initiatives in both manufacturing and service organizations. For a modern organization to sustainably exist in society, the impact of business initiatives such as LSS should affect social dimensions. This study analyzes the impact of LSS on different dimensions of social performance. A systematic literature review was conducted using the method suggested by Tranfield, Denyer, and Smart (2003) to collect, analyze, and integrate previous literature to study the impact of LSS on social performance. The authors conducted a descriptive and thematic analysis of the literature. Their study determined that LSS has an impact on decent work, the health and well-being of society, public services and infrastructure, quality education for society, and climate action. In addition, the authors studied the various challenges related to the impact of LSS on social performance. This is the first systematic literature review that has focused on the impact of LSS on different dimensions of social performance. [ABSTRACT FROM AUTHOR]

Industry 4.0, commonly referred as the fourth industrial revolution, has the potential to transform the modern organization in the way the products are designed, manufactured, delivered, and serviced. The implementation of Industry 4.0 is a challenge for the organizations because there is hardly any universally accepted framework. Therefore, it is difficult for the managers to plan its implementation methodology. The purpose of this study is to answer the question what are the important lessons for managers while implementing Industry 4.0? A literature review is carried out on the implementation of Industry 4.0. This paper is based on the primary data from academic articles. This study finds ten lessons that managers can keep in mind while implementing Industry 4.0 in the organizations. Besides, some limitations and issues are also identified. This study will help the practising managers and practitioners while implementing Industry 4.0 [ABSTRACT FROM AUTHOR]

Background: Various causes of malabsorption syndrome (MAS) are associated with intestinal stasis that may cause small intestinal bacterial overgrowth (SIBO). Frequency, nature and antibiotic sensitivity of SIBO in patients with MAS are not well understood. Methods: Jejunal aspirates of 50 consecutive patients with MAS were cultured for bacteria and colony counts and antibiotic sensitivity were performed. Twelve patients with irritable bowel syndrome were studied as controls. Results: Culture revealed growth of bacteria in 34/50 (68%) patients with MAS and 3/12 controls (p < 0.05). Colony counts ranged from 3 x 10² to 1015 (median 105) in MAS and 100 to 1000 (median 700) CFU/ml in controls (p 0.003). 21/50 (42%) patients had counts ≥105 CFU/ml in MAS and none of controls (p < 0.05). Aerobes were isolated in 34/34 and anaerobe in 1/34. Commonest Gram positive and negative bacteria were Streptococcus species and Escherichia coli respectively. The isolated bacteria were more often sensitive to quinolones than to tetracycline (ciprofloxacin: 39/47 and norfloxacin: 34/47 vs. tetracycline 19/47, <0.01), ampicillin, erythromycin and cotrimoxazole (21/44, 14/22 and 24/47 respectively vs. tetracycline, p = ns). Conclusions: SIBO is common in patients with MAS due to various causes and quinolones may be the preferred treatment. This needs to be proved further by a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Objectives: Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction. Though hypercoagulable states are implicated in the causation of BCS, the etiology remains unknown in most cases. Presence of anticardiolipin antibodies (aCL) is a known cause of hypercoagulable state. We therefore studied the frequency of IgG aCL in BCS. Methods: Sera were obtained from 19 patients with BCS, 50 healthy controls, 18 age- and gender-matched patients with cirrhosis, and 15 patients with acute viral hepatitis. IgG aCL levels were measured using a solid-phase enzyme immunoassay. Values exceeding mean + 2 SD of healthy controls were taken as abnormal. Results: Mean ± SD IgG aCL levels (GPL units) in the four groups were: healthy controls, 6.3 ± 4.4; BCS, 13.8 ± 13.3 (p < 0.05, compared with healthy controls); cirrhosis, 15.1 ± 14.9 (p < 0.05, compared with healthy controls and p = ns, compared with BCS patients); and acute viral hepatitis, 5.0 ± 2.5 (p = ns, compared with healthy controls). The levels in BCS and cirrhosis patients were similar (p = ns). The number of patients with elevated aCL was: healthy controls, 3/50; BCS, 6/19; cirrhosis, 7/18; and acute viral hepatitis, 0/15. The number of patients with elevated IgG aCL was significantly higher among patients with BCS and cirrhosis, compared with controls (p = 0.03 and p = 0.002, respectively). Conclusions: Patients with BCS had higher IgG aCL levels than healthy controls. However, as aCL levels were also elevated in patients with cirrhosis, the pathogenetic role of IgG aCL in the causation of BCS is doubtful. [ABSTRACT FROM AUTHOR]

Background: The etiology of malabsorption syndrome (MAS) may differ in different geographical regions. Limited data are available on the etiological spectrum of MAS among Indian adults., Methods: Ninety-nine consecutive adult patients with MAS (urine d-xylose <1 g/5 g/5 h with or without increased fecal fat (> or =7 g/24 h) were evaluated for cause of MAS using standard criteria. Past medical records were examined to know the nature of treatment received., Results: The etiology of MAS was: tropical sprue 39, celiac disease 9, Crohn's disease 9, giardiasis 8, small intestinal bacterial overgrowth in absence of another cause of MAS 8, panhypogammaglobulinemia 2 (one with strongyloidiasis), intestinal lymphangiectasia 1, intestinal tuberculosis 4, idiopathic 15, acquired immunodeficiency syndrome 2, and amyloidosis 2. Twenty-eight patients had received anti-tubercular treatment earlier., Conclusions: Tropical sprue, celiac disease and Crohn's disease are common causes of MAS in Indian adults. Inappropriate anti-tubercular treatment is common in them and needs to be discouraged.

Background: Serological tests may fail to identify hepatitis B virus (HBV) infection as a cause of liver cirrhosis in a proportion of patients. The frequency of such occult infection in regions with intermediate HBV endemicity is not known. Such cases may be diagnosed by incremental testing for IgG anti-HBc, serum HBV DNA, and HBV DNA in liver tissue., Methods: We tested sera of 111 patients with cirrhosis, including 39 with history of significant alcohol ingestion, for HBsAg, anti-HBc and serum HBV DNA. In addition, in a subset of 14 patients, HBV DNA was looked for in liver tissue., Results: On HBsAg and anti-HBc testing, 66 patients had HBV infection. Serum HBV DNA testing identified HBV infection in 13 additional cases. Of 18 patients labeled as 'cryptogenic' on serological testing, HBV DNA was detected in the serum in 7 patients. Of 14 patients in whom paired liver tissue and serum specimens were tested, 4 additional patients with HBV infection were detected after liver biopsy analysis., Conclusions: Serological tests for HBsAg and anti-HBc antibody are insensitive in identifying HBV infection in patients with liver cirrhosis. HBV DNA testing in serum and liver can help in establishing HBV infection as etiology, either alone or in addition to another cause.

Introduction: Although acute hepatitis E virus (HEV) infection is known to induce IgM and IgG humoral host immune responses, little is known about occurrence of cellular responses in this infection. We looked for evidence of lymphocyte sensitization to HEV peptides in patients with acute HEV infection., Methods: peripheral blood lymphocytes were obtained from patients with acute hepatitis E and healthy controls. Proliferation of these lymphocytes in the presence of each of seven peptides with amino acid sequences corresponding to open reading frames 2 and 3 proteins of HEV (3 and 4 peptides, respectively) were studied; no peptide was added to control wells. Proliferative responses with stimulation indices exceeding 3.0 were taken as positive., Results: More patients showed reactivity to two or more HEV peptides than did controls (11/21 vs 5/22, p<0.05). Reactivity to one peptide corresponding to open reading frame 2 of HEV was more frequent in patients than in controls (7/21 vs 1/22, p<0.05)., Conclusion: Our results show that lymphocytes of patients with acute hepatitis E show sensitization to HEV peptides. This may have significance in understanding the pathogenetic mechanisms of liver injury in this infection.