Abstract
In this paper, we propose an innovative approach to integrate the wastewater treatment (WWT) that is carried out in a set of plants and the anaerobic digestion (AD) that is carried out in a different set of plants, all from the same system. The aim is to contribute to sustainability improvements (e.g., cost reduction and environmental and social benefits) within the system. The main drivers that support this approach are the existence of unutilized capacity in some digesters and the possibility of reducing the process sludge age to maintain its biogas potential during the aerobic treatment in the plants without AD facilities. Furthermore, the effect of co-digestion as a means of enhancing the amount of biogas that can be produced through the sludge is also considered. This innovative approach leads to a mixed-integer linear programming (MILP) model to optimize the sludge flows that connect the plants without AD facilities to the ones with anaerobic digesters. The developed approach was applied to a Portuguese water utility and the results provide new insights for an optimized sludge management process of WWTPs, also indicating that the economic benefit obtained from the proposed strategy for sludge management can lead to a reduction of up to 23.5% in terms of current energy costs.

Abstract

Abstract
This paper investigates the relationship between students' performance and the type of school attended during upper secondary education. The performance of three different types of schools (Liceo, Technical and Professional schools) in four Italian macroregions (North West, North East, Centre, South & Islands) is investigated. A benchmarking analysis of the variability in students' performance among regions (within macroregions) for cohorts of students attending Liceo is also conducted. The data was collected at the student level from the Italian Institute for the Evaluation of Education System (INVALSI), for the academic year 2017/18. Families with higher socio-economic status may self-select into Liceo, so a direct comparison with vocational schools could lead to biased conclusions regarding the impact of school type on student performance. To overcome this limitation, we used a Propensity Score Matching approach prior to the estimation of efficiency. A pseudo-Malmquist index, based on a metafrontier and satisfying the circular property, is developed. It enables comparing the location of the best-practice frontier for each type of school and the spread in the educational efficiency of the students attending each type of school. Thus, best performance of a given school type corresponds to the combined effect of these two aspects. This study is an interesting starting point to challenge the stereotypes that persist in Italy, especially concerning general and vocational studies and geographic differences in educational achievements.

Abstract
Economic efficiency assessments based on Data Envelopment Analysis are scarce compared to technical efficiency studies, even in for-profit firms. Some aspects justify this scarcity, such as the difficulty to estimate accurate prices, given their variability over time. In many situations, external benchmarking is hindered due to organizations' unique nature and the barriers to sharing information considered critical to competitiveness. The use of internal benchmarking can overcome some of these difficulties. This study conducted an internal benchmarking analysis of a broiler production system, focusing on cost efficiency. We conducted longitudinal case-based research over six years (2014-2019). The concepts of throughput accounting of the Theory of Constraints were applied to structure the DEA model (inputs, prices, and output). The Critical Incident Technique was used to explore the effects of interventions on the production system's cost efficiency. The results show that the broiler production system could reduce 32% of the total cost per unit of production if the balance of inputs suggested by the DEA evaluation was used. This work contributes to the literature by showing the potential of internal benchmarking to explore the evolution of cost efficiency over time. From a practical perspective, this study is important for managers by showing how to measure the impact of management actions on performance, providing valuable information to guide continuous improvement.

Abstract
This paper proposes two new measures to assess performance of surgical practice based on observed mortality: reliability, measured as the area under the ROC curve and a living score, the sum of individual risk among surviving patients, divided by the total number of patients. A Monte Carlo simulation of surgeons' practice was used for conceptual validation and an analysis of a real-world hospital department was used for managerial validation. We modelled surgical practice as a bivariate distribution function of risk and final state. We sampled 250 distributions, varying the maximum risk each surgeon faced, the distribution of risk among dead patients, the mortality rate and the number of surgeries performed yearly. We applied the measures developed to a Portuguese cardiothoracic department. We found that the joint use of the reliability and living score measures overcomes the limitations of risk adjustedmortality rates, as it enables a different valuation of deaths, according to their risk levels. Reliability favours surgeons with casualties, predominantly, in high values of risk and penalizes surgeons with deaths in relatively low levels of risk. The living score is positively influenced by the maximum risk for which a surgeon yields surviving patients. These measures enable a deeper understanding of surgical practice and, as risk adjusted mortality rates, they rely only on mortality and risk scores data. The case study revealed that the performance of the department analysed could be improved with enhanced policies of risk management, involving the assignment of surgeries based on surgeon's reliability and living score.

Abstract
This study proposes a benchmarking approach to assess water supply and sanitation services' performance in Brazilian municipalities from an integrated perspective of efficiency and access. The regional differences and the impact of the governance models adopted by different municipalities (local public entities, regional public entities, and private entities) on efficiency levels are also explored. The results revealed significant heterogeneity in the efficiency levels of Brazilian municipalities, as the average efficiency score is relatively low (45%). The Southeast and Center-west regions stand out both in terms of efficiency and access dimensions. There is evidence that municipalities with services provided by local public entities have higher efficiency than those with regional providers. On the other hand, efficiency differences between municipalities with public and private providers are statistically significant. Finally, regulatory strategies are suggested based on the outcome of the integrated analysis.