Serving the World - Sustainability?

Item does not contain fulltextEurOMA/JOMSA/POMS 2012 P&OM World Conference Proceeding

Outsourcing Strategies of Emerging Country Firms : Are they Different from Developed Country Multinationals?

The purpose of the paper is to analyze differences in the sourcing strategies of manufacturing firms from emerging and from developed markets. More specifically, we test whether manufacturers from emerging markets have other objectives when sourcing from within their countries or from international sources, as compared to firms in developed markets. Contingency effects of the business strategy followed are taken into account. The key findings are that companies that source globally try to achieve cost benefits; companies that source nationally try to achieve capacity flexibility. However, firms do not differ dependent on whether they are located in emerging or in developed markets. Within the group of firms from emerging markets, there is a substantial difference depending on whether firms originate from an emerging market and subsidiaries of companies from developed markets. The discussion is based on a statistical analysis of data from 569 firms collected in the fourth round of the International Manufacturing Strategy Survey (IMSS

Factors associated with hyperglycemia and low insulin levels in children undergoing cardiac surgery with cardiopulmonary bypass who received a single high dose of methylprednisolone

OBJECTIVES: Administering steroids before cardiopulmonary bypass in pediatric heart surgery modulates systemic inflammatory response syndrome and improves postoperative recovery. However, the use of steroids aggravates hyperglycemia, which is associated with a poor prognosis. Adult patients with systemic inflammatory response syndrome usually evolve with hyperglycemia and high insulin levels, whereas >90% of pediatric patients exhibit hyperglycemia and low insulin levels. This study aims to determine: A) the metabolic and inflammatory factors that are associated with hyperglycemia and low insulin levels in children who underwent cardiac surgery with cardiopulmonary bypass and who received a single high dose of methylprednisolone and B) the best predictors of insulin variation using a mathematical model. METHODS: This preliminary study recruited 20 children who underwent heart surgery with cardiopulmonary bypass and received methylprednisolone (30 mg/kg) immediately after anesthesia. Among the 20 patients initially recruited, one was excluded because of the absence of hyperglycemia and lower insulin levels after surgery. However, these abnormalities were confirmed in the remaining 19 children. The C-peptide, CRP, IL-6, and adrenomedullin levels were measured before surgery, immediately after cardiopulmonary bypass, and on the first, second, and third days after cardiac surgery. RESULTS: IL-6, CRP, and adrenomedullin increments were observed, whereas the C-peptide levels remained within reference intervals. CONCLUSION: The multiple regression model demonstrated that in addition to age and glycemia (two well-known factors that are directly involved in glucose metabolism), adrenomedullin and IL-6 levels were independent factors associated with lower insulin concentrations. These four parameters were responsible for 64.7% of the observed insulin variances. In addition, the fact that C-peptide levels did not fall together with insulin could have grounded the medical decision not to administer insulin to patients