Class of 2015 Abstract / Objectives: To determine if using three-factor prothrombin complex concentrate (PCC) immediately prior to heart transplantation reduces blood product transfusions in patients bridged to heart transplantation by mechanical circulatory support (MCS) devices who are treated with warfarin. Methods: This study retrospectively reviewed patients that either received PCC or received usual care (i.e. fresh frozen plasma – FFP) prior to heart transplantation. Outcomes that were evaluated included packed red blood cell (RBC), FFP, platelet and cryoprecipitate transfusions intra and five days post-operatively, Cell Saver autologous blood volume administered intra-operatively, chest tube output for the five days post-operatively, and thromboembolic events post-operatively. Results: There were 24 patients included in the study, 12 from each group. The PCC group showed significantly less intra-operative RBC transfusion (2.60 ± 1.49 units vs. 5.09 ± 2.42 units, p=0.018), Cell Saver autologous blood usage (2.60 ± 1.49 units vs. 4.02 ± 1.55 units, p=0.032), and FFP transfusion (2.14 ± 2.30 units vs. 10.94 ± 5.96 units, p=0.0005) than the usual care group. There was no difference in amount of vitamin K given, change in INR, platelets administered, cryoprecipitate administered, chest tube output, or thromboembolic events between the groups. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. Conclusions: We propose that the use of PCC prior to heart transplant surgery for patients on MCS devices anticoagulated with warfarin may result in the reduction for the need of RBC’s, autologous blood use and FFP during surgery.

Procurement of copper concentrate is becoming increasingly more challenging as the general quality of concentrates are decreasing. Concentrates are now coming with higher shares of impurities and secondary materials, which makes them harder to process. These concentrates are refereed to as complex concentrates and has historically been purchased by refineries pursuing a high margin strategy, as it is cheaper for refineries to buy. As the global copper concentrate quality decreases, traditional smelters may have to revisit their procurement strategy in order to continue to be competitive and cost efficient, gradually moving towards a strategy which today is considered a niche. This notion raises several questions as to what situation future refineries might find them selves in, when treating increasing shares of complex copper concentrates. On that perceptive, this study addresses this topic from a holistic business perspective by investigating managerial challenges which may occur from procurement of complex copper concentrates. We did this through an exploratory investigation on two smelter facilities within Boliden Group, operating on with this procurement strategy. Our aim was to identify important aspects within the procurement itself, inventory management and processing. We conducted eight interviews with company representatives and analysed data on purchasing behaviour, inventory holdings and process quantities in order to understand critical aspects emerging from this strategy. From there, we identified one general challenge containing three sub challenges. We concluded that the management of risk and productivity balance was essential for the whole business, as complex concentrates aggravates already present supply chain and industry risks. Furthermore we saw challenges with maintaining sufficient and balanced inventory levels, due to arrival uncertainties and vague shipping agreements. Also, aligning goals and priorities was identified as a challenge. As complex concentrates have both attractive margin figures and complex processing requirements, differences in prioritisation surrounding profitability and process stability was evident. Lastly, we uncovered potential productivity losses when treating both clean and complex concentrates. / Inköp av kopparkoncentrat blir alltmer utmanande i takt med att koncentratens allmänna kvalitet minskar. Koncentrat kommer nu med större andelar av orenheter och sekundära material, vilket gör dem svårare att bearbeta. Dessa koncentrat betecknas som komplexa koncentrat och har historiskt bearbetats av raffinaderier som bedriver en högmarginalstrategi, eftersom dessa är billigare för raffinaderier att köpa. Då den globala kopparkoncentratkvaliteten minskar kan traditionella smältverk behöva se över sin inköpsstrategiför att fortsätta vara konkurrenskraftiga och kostnadseffektiva. Denna uppfattning väcker flera frågor om vilken situation framtida raffinaderier kan komma att befinna sig i, med ökande andelar av komplexa kopparkoncentrat. Med barkund i detta undersöker denna studie frågan ur ett helhetsperspektiv, genom att utforska operativa utmaningar som kan uppstå till följd av inköp av komplexa kopparkoncentrat. Vi genomförde en fallstudie på två smältverk inom Boliden Group, som förvärvar en hög andel komplexa kopparkoncentrat. Vårt mål var att identifiera viktiga aspekter inom själva upphandlingen, lagerhanteringen och bearbetning av koncentraten samt att identifiera utmaningar som beslutsfattare står inför. Vi genomförde åtta intervjuer med företagsrepresentanter och analyserade data om inköpsbeteende, lagerhållning och processkvantiteter för att förstå kritiska aspekter som framgår av denna strategi. Därifrån identifierade vi en allmän utmaning innehållande tre underutmaningar. Resultatet visade på att hantering av risk- och produktivitetsbalans var väsentlig för hela verksamheten, eftersom komplexa koncentrat förvärrar redan närvarande utmaningar med försörjningskedjan och industririsker. Därtill identifierade vi utmaningar med att upprätthålla en tillräcklig och balanserad lagernivå, på grund av osäkerheter om ankomst och vaga sjöfartsavtal. Gemensamma mål och prioriteringar identifierades också som en utmaning. Eftersom komplexa koncentrat både har attraktiva marginaler och komplexa bearbetningskrav var skillnader i prioritering kring lönsamhet och process-stabilitet uppenbara. Slutligen upptäckte vi potentiella produktivitetsförluster vid behandling av både rena och komplexa koncentrat.