To achieve positive economic, environmental, and social benefits, many incumbent manufacturing firms attempt to apply circular economy principles to their business practices. However, these firms ...often struggle to change their existing linear business models to circular models because the steps required for successful transformation are still poorly understood. Based on a multiple case study of eight business model transformation journeys, this article proposes a roadmap for circular business model transformation. It provides a step-by-step process to enable circular transition, allowing companies to meet environmental, social, and financial objectives and proactively address sustainability.
The lessons learned during the development of PennOpen Pass — an early warning system to detect symptoms and exposures concerning for Covid-19 — will help advance innovations in health care long ...after the pandemic.
To open campuses safely, the University of Pennsylvania (Penn) and its health system (UPHS), with six hospitals and hundreds of outpatient practices, needed to develop an early warning system to identify the infected and exposed among Penn and UPHS campus members — 70,000 faculty, staff, and students who were at risk of transmitting severe acute respiratory syndrome coronavirus 2, or Covid-19. This warning system would help to minimize future spread by preventing individuals with concerning symptoms or recent exposures from coming into contact with others and, when necessary, streamline access to testing, self-isolation guidance, contact tracing, and medical care. The authors describe the challenges in designing, implementing, and continuously improving PennOpen Pass and the Red Pass Management System, a part-digital, part-human screening system. The lessons learned while developing and implementing PennOpen Pass provide key insights for the future of innovations in health care as we move toward improving the health of communities long after the pandemic.
A multidisciplinary team of physicians, physicists, and optical engineers conceived, deployed, and scaled up an operational, financial, and educational solution to address the limited supply of a ...critical component of safety during the Covid-19 pandemic at 21 hospitals in low- and middle-income countries.
The Covid-19 pandemic has caused worldwide shortages in N95 respirators, surgical masks, and other respiratory personal protective equipment, particularly for hospitals in low-income settings. Treatment with ultraviolet-C (UV-C) light is an affordable technology for the decontamination and reuse of N95 respirators in times of critical shortage. Optical engineers, physicists, and clinicians collaborated to develop an affordable, enclosed cabinet to decontaminate N95 respirators with UV-C irradiation in hospital sterile processing areas; units were constructed and implemented locally at 21 hospitals in low- and middle-income countries. Along with this practical grassroots approach to deliver a simple and locally accessible technology, the team’s experience in developing relevant clinical workflows resulted in a rapid and effective implementation of a decontamination process that provided hundreds of thousands of additional N95 respirators for health care provider protection.
The teaching case discusses a number of organizational challenges faced by a German vegetable producer. Two business consultants were hired to assist and to explore the situation in the new ...production facility at Peppers & More. While the CEO assumed the employees were not motivated, the consultants uncovered that various employees’ behavior, as well as a structural problem contributed to the tense situation in the production facility. During the period of analysis, it becomes apparent that there is a communication problem between the production manager and the foremen. The setup of the job rotation system and conflicts between two foremen caused further irritation at the facility. At the end of each consulting day, the consultants and the readers have to link the challenges to motivation theory and provide recommendations how Peppers & More can cope with these challenges.
We present a case of a 22-year-old male diagnosed with B-cell acute lymphoblastic leukemia who received intrathecal (IT) methotrexate (MTX) in addition to his systemic chemotherapy regime. During ...induction treatment, he presented with a rapidly progressive bilateral paresis, anarthria, and respiratory insufficiency requiring intubation. The brain magnetic resonance imaging showed bilateral lesions with diffusion restriction of the corona radiata/centrum semi-ovale without other abnormalities. He recovered spontaneously without neurological sequelae. The clinical course combined with the radiological findings is suspect for an IT-MTX-induced leukoencephalopathy.
Although neurological deficits after IT-MTX are rare and in most cases self-limiting, it should be recognized as a cause for rapid neurological decline after excluding other causes.
Primary spinal cord glioblastoma multiforme (GBM) is a rare clinical condition and is often associated with a dismal prognosis. The standard treatment is maximal safe surgery followed by adjuvant ...radiotherapy and chemotherapy. Despite such aggressive treatments, the median survival is estimated to be around 15 months in several studies. We report three patients with primary spinal GBM who received treatment in our institute from 2012 to 2019. Among the three, one patient is on long-term follow-up with no evidence of disease, another patient succumbed to the illness and the third patient is having stable disease.
Although primary spinal GBM is usually associated with a dismal prognosis, our case series shows a subset of patients will have a favorable outcome with the protocol treatment.
Melasma is a common pigmentation disorder with few satisfactory treatment options. The hyperpigmentation has both an epidermal and dermal component. To date, combination therapies have been observed ...to yield greater improvements in melasma compared to monotherapies. Cysteamine has been tested and shown to improve epidermal melasma. In this case series, we examined the efficacy of nightly applications of cysteamine cream, washed off after 15 minutes, with monthly in-office laser treatment sessions using a 650-microsecond neodymium-doped yttrium aluminium garnet 1,064-nm laser. The patients all reported satisfaction with the results of this combination therapy. None of the patients experienced irritation with the product nor did they experience discomfort/downtime with the laser sessions. Evaluation of the patients two months after the treatment indicated persisting effects. Our small case series suggests high levels of satisfaction can be achieved using this combined topical and laser approach.
A team at the University of Pennsylvania Health System devised the I-READI conceptual framework — for Integration, Root Cause Analysis, Evidence Review, Adaptation, Dissemination, and Implementation ...— to help health care organizations respond to quality and safety challenges during crises, such as emerging infectious diseases or periods of capacity strain.
Health care institutions responding to quality and safety challenges during times of crisis, such as emerging infectious diseases or natural disasters, can follow the I-READI conceptual framework: Integration, Root Cause Analysis, Evidence Review, Adaptation, Dissemination, and Implementation. The University of Pennsylvania Health System developed this approach by drawing on lessons learned from rapidly coordinating changes to their ventilator management practices. They modified their practices to improve patient safety after recognizing high rates of airway complications among mechanically ventilated patients with Covid-19. Vertical and horizontal integration of their quality and safety teams helped streamline problem solving, enrich collaboration, and coordinate implementation. Root cause analysis and evidence review framed their practice adaptation, ensuring that they prioritized patient and health care worker safety. Daily safety huddles engaged frontline providers and promoted dissemination of the revised interventions. Telemedicine oversight and real-time ICU dashboards enabled system-wide implementation, goal setting, and continuous performance feedback. Under their revised guidelines, the rate of endotracheal tube obstruction among mechanically ventilated patients with Covid-19 decreased from 9.2% to less than 1%, and reintubation rates decreased from 36% to 9%.
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