Order Picking in Narrow-Aisle Warehouses: A Fast Approach to Minimize Waiting Times

Mail order companies like Zalando or Amazon reported a significant increase regarding the number of incoming customer orders in recent years. Customers are served from a central distribution center (warehouse) where requested items of the orders have to be retrieved (picked) from their storage locations. The picking process is performed by human operators (order pickers) who are employed on a large scale in order to enable a fast processing of the orders. However, due to limited space, aisles are often very narrow in warehouses, and order pickers cannot pass or overtake each other. Thus, an order picker may have to wait until another picker has performed his/her operations. The arising waiting times may significantly increase the processing times of the orders, implying that a large number of pickers does not guarantee for small processing times. Therefore, in this paper, the impact of several problem parameters on the amount of waiting time is investigated first and situations are identified where the consideration of waiting times is inevitable for an efficient organization of the picking process. In the second part of the paper, a solution approach, namely a truncated branch-and-bound algorithm, is proposed which aims for the minimization of the waiting times. By means of extensive numerical experiments, it is demonstrated that this approach provides high-quality solutions within a very small amount of computing time

Restraint practice in the somatic acute care hospital: A participant observation study

Aims and Objectives We aimed to describe daily restraint practices and the factors which influence their use, from an outsider's perspective. Background A reduction in restraint use is recommended in health care. However, somatic acute care hospital settings currently lack effective reduction strategies. Thus far, hospital restraint practice is described in terms of quantitative assessments and the ‘insider’ view of healthcare professionals. However, as factors such as routine or personal beliefs seem to play a relevant role in restraint use, these approaches might be incomplete and biased. Design A qualitative observation study design was employed. Methods Fieldwork with unstructured participant observation was conducted at a department of geriatrics and a department of intensive care in Switzerland between November 2019 and January 2020. Data were recorded as field notes. The analysis was conducted iteratively in two coding cycles using descriptive coding followed by pattern coding. We adhered to the Standards for Reporting Qualitative Research (SRQR). Results A total of 67 hours of observation were conducted. We found that daily restraint practice can be described in three categories: the context in which restraints are used, the decision-making process on the use and continued use of restraints, and the avoidance of restraint use. Most processes and decisions seem to take place unconsciously, and their standardisation is weak. Conclusions The lack of standardisation favours intuitive and unreflective action, which is prompted by what is also known as heuristic decision-making. To transform daily restraint practice, a technical solution that leads restraint management in line with ethical and legal requirements might be useful. Relevance to clinical practice The outsider perspective has allowed daily restraint practice to be described independently of existing routines, departmental cultures and personal attitudes. This is important to comprehensively describe restrictive practices, which is a prerequisite for the development of effective restraint reduction strategies

Breastfeeding woman are at higher risk of vitamin D deficiency than non-breastfeeding women - insights from the German VitaMinFemin study

Background: Despite increased awareness of the adverse health effects of vitamin D deficiency, only a few studies have evaluated the vitamin D status (25-hydroxyvitamin D [25(OHD)]) of breastfeeding women and up to now, no information exits for German breastfeeding women. Therefore, the aim of study was to determine the vitamin D status of breastfeeding women compared to non-pregnant and non-breastfeeding (NPNB) women. Methods: This cross-sectional study investigated 124 breastfeeding women and 124 age and season matched NPNB women from the German "Vitamin and mineral status among German women" study. The study participants were recruited from April 2013 to March 2015 and did not take vitamin D supplements. Serum 25(OH)D was analyzed by chemiluminescent immunoassay. Results: Vitamin D deficiency (<25.0 nmol/L) was prevalent in 26.6% of the breastfeeding women. The majority of women (49.2%) showed 25(OH)D concentration between 25.0 and 49.9 nmol/L. In multiple binary logistic regression analysis, breastfeeding women had a 4.0-fold higher odds ratio (OR) (95% confidence interval [CI] 1.8, 8.7) for vitamin D deficiency than NPNB women. For breastfeeding women, the risk of vitamin D deficiency was higher in the winter and spring months (OR: 2.6, 95% CI 1.1, 6.3) and increased with lower longitude per one unit (OR 0.7, 95% CI 0.6, 0.9). Conclusion: Breastfeeding women in Germany had a higher risk of deficient vitamin D levels than NPNB women. In further studies, the optimal vitamin D status for breastfeeding women should be investigated and also the required vitamin D doses to ensure this vitamin D status. Trial registration: German Clinical Trial Register (identification number: DRKS00004789 ).Rottapharm Madaus GmbHMeda A

Merging scalar magnetometer and fluxgate gradiometer data - an alternative method

Combining the records of different types of magnetometers to one magnetogram can be onerous. We introduce an alternative way to merge magnetograms of diverse magnetometers. The application of a high-pass filter on scalar magnetometer data resembles gradiometer data. This can be a fast and easy way to merge scalar magnetometer and fluxgate gradiometer data

Content Validation of a Questionnaire to Measure Digital Competence of Nurses in Clinical Practice

Clinical practice nurses need adequate digital competence to use technologies appropriately at work. Questionnaires measuring clinical practice nurses' digital competence lack content validity because attitude is not included as a measure of digital competence. The aim of the current study was to identify items for an item pool of a questionnaire to measure clinical practice nurses' digital competence and to evaluate the content validity. A normative Delphi study was conducted, and the content validity index on item and scale levels was calculated. In each round, 21 to 24 panelists (medical informatics specialists, nurse informatics specialists, digital managers, and researchers) were asked to rate the items on a 4-point Likert scale ranging from “not relevant” to “very relevant.” Within three rounds, the panelists reached high consensus and rated 26 items of the initial 37 items as relevant. The average content validity index of 0.95 (SD, 0.07) demonstrates that the item pool showed high content validity. The final item pool included items to measure knowledge, skills, and attitude. The items included represent the international recommendations of core competences for clinical nursing. Future research should conduct psychometric testing for construct validity and internal consistency of the generated item pool

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

The attitude of nursing staff towards restraint use can be decisive for whether restraints are used. So far, nursing staff’s attitudes have been studied primarily in long-term and mental health care settings, while findings from somatic acute care hospital settings are largely lacking. Therefore, we aimed to investigate (a) the attitudes of hospital nursing staff towards restraint use, and (b) the construct validity and reliability of a measurement instrument for use in hospital settings that was developed and validated in long-term care settings (Maastricht Attitude Questionnaire (MAQ)). Using a cross-sectional design, the attitudes of 180 nursing staff towards restraint use were assessed. The data were analysed descriptively and by means of regression analysis and factor analysis. We found that nursing staff in hospitals have a neutral attitude towards restraint use and that the MAQ, with minor adaptations, can be used in hospital settings, although further testing is recommended. Neutral attitudes of nursing staff have also been observed in long-term and mental health care settings, where changing attitudes were found to be challenging. Interventions at the national level (e.g., legal regulations) and management level (e.g., providing alternatives and changing institutional culture) are suggested

Prospecting in the marshland: the Sumerian city Fara-Šuruppak (Iraq)

Fara-Šuruppak was a major Sumerian city of the third millennium B.C. By magnetometer prospecting we discovered and traced a casemate city wall that enclosed the city. On the west bank of the Euphrates river we identified a large harbour complex of Fara-Šuruppak. The magnetogram revealed the existence of channels, a bridge, hydraulic constructions and agricultural fields

Advanced Practice Nurses and Their Roles in Swiss Cancer Care: A Cross-Sectional Study.

OBJECTIVES To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system. METHODS A cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses. RESULTS The participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching). CONCLUSIONS This study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified. IMPLICATIONS FOR NURSING PRACTICE More systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care

Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria

Background: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). Methods: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. Results: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. Conclusions: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible. Keywords: Hospitals, Multilevel analysis, Organisational culture, Quality of health care, Restrain