Conducting Action Research to Improve Operational Efficiency in Manufacturing: The Case of a First-Tier Automotive Supplier.

Optimising available resources and minimising production costs and throughput time is vital for first-tier suppliers in the worldwide automotive sector. To develop this type of optimisation and efficiency, MAHLE applied Action Research (AR) in one of its factories located in Spain. A multidisciplinary collaborative work team was created with the aim of deploying the AR initiative in combination with Lean Manufacturing and Six Sigma tools. Four improvement and learning cycles were deployed and key performance metrics were defined to collect and measure data in order to analyse the improvements achieved. The application of the AR initiative in the production line of a power filter device enabled improvements in both production times and quality indicators in the manufacturing process. The most outstanding results were the improvements made in the decrease in initial throughput time (34.78%) and in average daily rejections (73.53%). In addition, the AR initiative generated practical and theoretical contributions for business and academia, allowing the AR initiative to be applied in other areas of the company, and contributing to the current state of the art in the industrial application of this methodology.

Diverse mutations and structural variations contribute to Notch signaling deregulation in paediatric T-cell lymphoblastic lymphoma.

BACKGROUND: T-cell lymphoblastic lymphoma (T-LBL) is an aggressive neoplasm closely related to T-cell acute lymphoblastic leukaemia (T-ALL). Despite their similarities, and contrary to T-ALL, studies on paediatric T-LBL are scarce and, therefore, its molecular landscape has not yet been fully elucidated. Thus, the aims of this study were to characterize the genetic and molecular heterogeneity of paediatric T-LBL and to evaluate novel molecular markers differentiating this entity from T-ALL. PROCEDURE: Thirty-three paediatric T-LBL patients were analyzed using an integrated approach, including targeted next-generation sequencing, RNA-sequencing transcriptome analysis and copy-number arrays. RESULTS: Copy number and mutational analyses allowed the detection of recurrent homozygous deletions of 9p/CDKN2A (78%), trisomy 20 (19%) and gains of 17q24-q25 (16%), as well as frequent mutations of NOTCH1 (62%), followed by the BCL11B (23%), WT1 (19%) and FBXW7, PHF6 and RPL10 genes (15%, respectively). This genetic profile did not differ from that described in T-ALL in terms of mutation incidence and global genomic complexity level, but unveiled virtually exclusive 17q25 gains and trisomy 20 in T-LBL. Additionally, we identified novel gene fusions in paediatric T-LBL, including NOTCH1-IKZF2, RNGTT-SNAP91 and DDX3X-MLLT10, the last being the only one previously described in T-ALL. Moreover, clinical correlations highlighted the presence of Notch pathway alterations as a factor related to favourable outcome. CONCLUSIONS: In summary, the genomic landscape of paediatric T-LBL is similar to that observed in T-ALL, and Notch signaling pathway deregulation remains the cornerstone in its pathogenesis, including not only mutations but fusion genes targeting NOTCH1.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013 / Immunisation schedule of the Spanish Association of Paediatrics: 2013 Recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de seguridad, efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo. El CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España. Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, el CAV-AEP mantiene las novedades propuestas la temporada anterior, como la administración de las primeras dosis de las vacunas triple vírica y varicela a los 12 meses y las segundas dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años, siempre acompañada de otra dosis a los 11-14 años, con preferencia a los 11-12 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas de 11 a 14 años, con preferencia a los 11-12 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y, por tanto, un objetivo deseable. La vacunación frente al rotavirus, dadas la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y a la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule (AU)

Permeabilización de catéteres venosos periféricos de uso intermitente: con y sin heparina / Permeabilisation of peripheral venous catheters of intermittent use: with and without heparin

Algunos estudios sugieren que el uso de Heparinasódica (HepNa) para la permeabilización delos catéteres venosos de uso intermitente (CVPI),no presenta más efectividad en la prevención deoclusiones o flebitis, que el ClNa 0,9% puro.Aunque su uso es generalizado, desconocemossi es realmente efectiva y cuál es la dosis deHepNa necesaria. El objetivo del estudio fue determinarla eficacia de la HepNa a concentraciónde 100 UI/ml frente al uso de ClNa 0,9% puro,comparando la incidencia de aparición de oclusionesy flebitis con ambas.Se diseñó un estudio experimental, aleatorio ydoble ciego. Se crearon dos grupos, en uno sepermeabilizó con HepNa, “Grupo de Control” oMétodo A; en el otro, “Grupo de intervención”o Método B se usó SF 0,9%.El tamaño de la muestra se calculó en 235 y serecogieron datos de un total de 383 catéteresperiféricos.El número de oclusiones fue de 17 (4,43%),6/190 método A (3,15%) y 11/193 método B(5,69%), sin diferencia significativa (p=0,227).La incidencia de flebitis fue de 72 casos(18,79%), 27/190 método A (14,21%) y 45/193método B (23,31%), existiendo una diferenciasignificativa (p=0,023) entre ambos métodos.Basándonos en los estudios revisados y en nuestrosresultados, concluimos, con todas las precauciones,que la dosis de heparina necesariapara que ésta muestre beneficios en la disminuciónde las flebitis sería mayor de 10 UI/ml y quecon 100 UI/ml el beneficio es evidente

Some studies suggest that the use of sodium heparin(HepNa) for permeabilisation of venouscatheters of intermittent use does not presentany higher effectiveness in the prevention of occlusionsor phlebitis than 0,9% pure ClNa. Eventhough it is generally used, we are yet unclear onwhether it is really effective and on what thenecessary dose of HepNa is. The objective of thestudy was to determine the efficacy of HepNa ata concentration of 100 U.I./ml compared to theuse of 0,9% pure ClNa, comparing the incidenceof occlusion and phlebitis with both regimens.An experimental, randomised, double blindstudy was designed. Two groups were created.One group was permeabilised with HepNa,“control group” or method A; the other groupwas called the “intervention group” or methodB and was permeabilised using 0,9% ClNa.The sample size was 235 and data from a totalof 383 peripheral catheters was collected.There were 17 occlusions (4,43%), 6/190method A (3,15%) and 11/193 method B(5,69%), with no significant difference(p=0,227). Phlebitis developed in 72 cases(18,79%), 27/190 method A (14,21%) and45/193 method B (23,31%), with a significantdifference (p=0,023) between both methods.Based on a review of the literature and on ourown results, we are able to conclude that thedose of heparin necessary to show a benefit anddecrease phlebitis would have to be higher than10 UI/ml and that with 100 UI/ml provides anevident benefit