Logistik: Hur påverkar Just-In-Time på lönsamheten av ett företag?

Ett företag har som grunduppgift att hållas verksamt genom att ekonomiskt prestera bättre för varje år. Logistik är det verksamhetsområde som står för majoriteten av ett företags kostnader. Kostnader i sig är en dålig sak för företag, men det är även en möjlighet för logistiken att sänka dessa kostnader, vilket i sin tur är bra för företagets lön-samhet. Just-In-Time (JIT) är en produktions- och styrfilosofi inom logistiken, där det huvudsakliga målet är att minska lagernivåerna och att eliminera allt onödigt. Syftet med denna studie är att finna ett samband mellan JIT och lönsamhet ur ett logistiskt perspektiv. Vid studien används DuPont-modellen som definition av lönsamhet samt som ett jämförelseverktyg där sex olika finansiella faktorer mäts. Metoden för studien är kvalitativ i form av en litteraturstudie. Materialet som analyseras hämtas endast från Arcadas databaser och analysen av materialet sker i form av innehållsanalys. Resultaten av materialet som analyserades är väldigt blandat. Många studier påpekar att det råder brist på forskning inom detta ämnesområdet, vilket även kan vara orsaken till dessa blandade resultat. Det går dock att urskilja tre finansiella mått från DuPont-modellen som påver-kas positivt av JIT. Dessa är: intäkter, kostnader och lager. Ingen studie visade att JIT skulle ha negativ inverkan på ett företags lönsamhet. Andra intressanta faktorer som JIT hade en positiv inverkan på är operativa prestanda, t.ex. minskade ledtider

Enhance quality care performance: Determination of the variables for establishing a common database in French paediatric critical care units

Abstract Selected variables for the French Paediatric Intensive Care registry. Rationale, aims, and objectives Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA). Such a registry is not yet available in France. The aim of this study was to determine variables that ought to be included in a French paediatric critical care registry. Methods Variables, items, and subitems from 3 foreign registries and 2 French local databases were used. Items described each variable, and subitems described items. The Delphi method was used to evaluate and rate 65 variables, 90 items, and 17 subitems taking into account importance or relevance based on input from 28 French physicians affiliated with the French Paediatric Critical Care Group. Two ratings were used between January and May 2013. Results Fifteen files from 10 paediatric intensive care units were included. Out of 65 potential variables, 48 (74%) were considered to be indispensable, 16 (25%) were considered to be optional, and 1 (2%) was considered to be irrelevant. Out of 90 potential items, 62 (69%) were considered to be relevant, 23 (26%) were considered to be of little relevance, and 5 (6%) were considered to be irrelevant. Out of 17 potential subitems, 9 (53%) were considered to be relevant, 6 (35%) were considered to be of little relevance, and 2 (12%) were considered to be irrelevant. Conclusions The necessary variables that ought to be included in a French paediatric critical care registry were identified. The challenge now is to develop the French registry for paediatric intensive care units

Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

BackgroundDepending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Accurate newborn monitoring during and after surgery is essential to adapt resuscitation protocols. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause.ObjectiveEvaluating changes in cerebral and renal regional oxygen saturation during neonatal digestive surgeries, conducted according to normal practices, with commonly used monitoring parameters. Analyzing retrospectively the inter-relationships between NIRS values and mean arterial pressure (MAP) values as well as pre-ductal SpO2.MethodsProspective, descriptive, monocentric study. All neonates referred for surgery were included. NIRS allows the measurement of cerebral and renal oxygenation fluctuations, as well as calculating difference in intraoperative and postoperative values.ResultsNineteen patients were included. Cerebral regional oxygen saturation (C rSO2) values were stable while renal regional oxygen saturation (R rSO2) values tended to decrease with time during surgery. Indeed, 72% of rSO2 decline episodes occurred after the first 30 min of surgery, without any significant statistical differences for the next 90 min of surgery. After surgery, the lowest average C and R rSO2 values were evidenced during the first 6 h, with 60% of C rSO2 and R rSO2 anomalies occurring in that time frame. There was no significant statistical difference observed in the following 18 h. There was a significant correlation between R rSO2 and SpO2 values (p < 0.01), but not with C rSO2 values. There was no correlation with the MAP either for the C rSO2 values or R rSO2 ones.ConclusionNIRS is a promising non-invasive bedside tool to monitor cerebral and tissue perfusion, analyzing tissue microcirculation. NIRS has its interest to guide neonatal digestive surgeries (bowel manipulation, viscera reduction) and may represent an early warning for identifying patients requiring resuscitation during or after these surgeries

Enabling planetary science across light-years. Ariel Definition Study Report

Ariel, the Atmospheric Remote-sensing Infrared Exoplanet Large-survey, was adopted as the fourth medium-class mission in ESA's Cosmic Vision programme to be launched in 2029. During its 4-year mission, Ariel will study what exoplanets are made of, how they formed and how they evolve, by surveying a diverse sample of about 1000 extrasolar planets, simultaneously in visible and infrared wavelengths. It is the first mission dedicated to measuring the chemical composition and thermal structures of hundreds of transiting exoplanets, enabling planetary science far beyond the boundaries of the Solar System. The payload consists of an off-axis Cassegrain telescope (primary mirror 1100 mm x 730 mm ellipse) and two separate instruments (FGS and AIRS) covering simultaneously 0.5-7.8 micron spectral range. The satellite is best placed into an L2 orbit to maximise the thermal stability and the field of regard. The payload module is passively cooled via a series of V-Groove radiators; the detectors for the AIRS are the only items that require active cooling via an active Ne JT cooler. The Ariel payload is developed by a consortium of more than 50 institutes from 16 ESA countries, which include the UK, France, Italy, Belgium, Poland, Spain, Austria, Denmark, Ireland, Portugal, Czech Republic, Hungary, the Netherlands, Sweden, Norway, Estonia, and a NASA contribution

La surveillance sentinelle pour les maladies vectorielles : une étude de cas de la maladie de Lyme au Canada Sentinel surveillance for vector-borne disease : a case study of Lyme disease in Canada

Les maladies vectorielles sont en processus d’émergence à travers le monde. Au Canada, la maladie de Lyme (ML) a été identifiée comme une maladie infectieuse émergente prioritaire. La surveillance, si elle est efficace, peut suivre le portrait d’une maladie en évolution afin d'informer les autorités de santé publique; toutefois, en raison de ressources limitées, elle doit être optimisée. La surveillance sentinelle permet de réduire les coûts, car un nombre limité d'unités statistiques sont mesurées de manière répétée dans le temps. Néanmoins, ces unités sentinelles doivent être représentatives du portrait épidémiologique de la maladie pour assurer l'efficacité du système de surveillance. Le premier objectif de cette thèse était d'évaluer la représentativité de la surveillance sentinelle pour décrire le risque de ML au Québec, Canada. Deux types de systèmes de surveillance active acarologique sont déjà en place au Québec : 1) un système sentinelle, où les sites de terrain sentinelles sont maintenus constants et visités à chaque saison de terrain, et 2) un système de surveillance basé sur le risque où les sites accessoires sont priorisés en fonction de leur profil de risque. Des mesures de danger acarologique, en termes d'estimations de la densité de nymphes, ont été dérivées des sites sentinelles entre 2015 et 2019 et comparées à celles obtenues dans les sites accessoires. Les mesures de danger acarologique dérivées des sites sentinelles ont également été corrélées avec le nombre de cas humains rapportés à l'échelle municipale pour déterminer si elles étaient représentatives du risque de ML pour la population humaine. Il a été démontré que le système de surveillance sentinelle était capable de suivre les tendances spatio-temporelles d’incidence de ML dans les populations humaines de la zone d'étude et fournissait un meilleur indicateur de l’incidence de ML par rapport au système de surveillance basé sur le risque. Cependant, bien que les modèles aient pu prédire le risque de maladie de Lyme, les sites sentinelles n'ayant pas été choisis selon une approche validée, on peut émettre l’hypothèse que l’utilisation d'une approche holistique standardisée pour la sélection de sites sentinelles pourrait optimiser le design spatial du système de surveillance. Le deuxième objectif de cette thèse était de développer une telle approche et de l'appliquer à une étude de cas : la surveillance acarologique sentinelle pour le risque de ML à travers le Canada. Une revue de la portée a été utilisée pour inventorier les initiatives précédentes de surveillance sentinelle pour les maladies vectorielles, et pour cataloguer les critères qui ont été utilisés pour sélectionner les emplacements des unités sentinelles dans la zone d'étude. Les articles pertinents ont ensuite été analysés à l'aide d'une revue du type réaliste afin de créer un outil décisionnel permettant de sélectionner des critères pertinents pour la planification du design spatial d'un système de surveillance sentinelle pour les maladies vectorielles. Enfin, l'outil a été utilisé lors de la création d'un nouveau réseau de surveillance sentinelle pour le risque de ML au Canada; les critères retenus ont été incorporés dans une analyse multi-critères spatiale afin de sélectionner les régions sentinelles pour le réseau de surveillance acarologique active. Dans l'ensemble, cette thèse a exploré la surveillance sentinelle pour les maladies vectorielles, et a développé et testé une approche pour optimiser et standardiser la planification du design spatial des systèmes de surveillance sentinelle pour les maladies vectorielles. Dans de futurs travaux, cette approche devrait être mise en œuvre, évaluée et validée pour d’autres maladies et contextes épidémiologiques.Vector-borne diseases are emerging all over the globe. In Canada, Lyme disease (LD) has been identified as a priority emerging infectious disease. Public health surveillance, if effective, can track disease risk to inform public health authorities; however, due to finite resources, it must be optimized. Sentinel surveillance can cut costs, since a limited number of statistical units are measured repeatedly through time. Nonetheless, these sentinel units must be representative of the risk landscape to ensure an effective surveillance system. The first objective of this thesis was to evaluate the representativeness of sentinel tick surveillance for the risk of LD in Québec, Canada. Two types of tick-based active surveillance systems are already in place in Québec: 1) a sentinel system, where sentinel field sites are kept constant and visited every field season, and 2) a risk-based surveillance system where accessory sites are prioritized according to their risk profile. Acarological hazard measures, in the form of nymph density estimates, were derived from sentinel sites between 2015 and 2019 and compared with those obtained from accessory sites. Hazard measures derived from sentinel sites were also correlated with LD incidence at the municipal scale to see if they were representative of LD risk to human populations. It was shown that the sentinel tick-based surveillance system was able to follow spatiotemporal LD incidence trends in human populations across the study zone and provided a better indicator of LD incidence in comparison with the risk-based surveillance system. However, as sentinel sites were not chosen using a validated approach, it can be hypothesized that the spatial design for the system could be optimized through the development of a standardized, holistic approach for sentinel site selection. The second objective of this thesis was therefore to develop such an approach and apply it to a case example: sentinel surveillance of LD across Canada. A scoping review was used to inventory previous sentinel surveillance initiatives for vector-borne diseases, and catalogue criteria which had been used to select sentinel unit locations across the study zone. Relevant papers were subsequently analyzed using a realist-type review to create a decision tool to select relevant criteria for planning the spatial design of a sentinel surveillance system for vector-borne diseases. Finally, the tool was applied to guide the creation of a new sentinel tick-based surveillance network for LD risk in Canada; the retained criteria were incorporated into a spatial multi-criteria decision analysis to select sentinel regions for the active surveillance network. Overall, this thesis has explored sentinel surveillance for vector-borne disease and has developed and applied an approach to optimize and standardize spatial design planning for vector-borne sentinel surveillance systems. In future work, this approach should be implemented, evaluated, and validated for other types of diseases and epidemiological contexts

The evaluation of an information booklet in the use of effective patient communication in the setting of thoracic anesthesia

Effective communication is crucial in assuring a good patient experience during an in-hospital stay. In some settings, such as thoracic anaesthesia, patients are given a heavy load of new complex information, in a very limited space of time. Written information, such as patient information booklets, could help as an aid memoir and improve patient’s subjective understanding and preparedness for procedures. This study aims to produce a booklet, specifically targeted at thoracic anaesthesia, and to evaluate it using a linguistics framework in relation to the patient experience and clinical communication. For the study, a booklet was produced in the context of thoracic anaesthesia – a setting where the doctor-patient interaction is limited by time factors. The booklet was produced with reference to the BALD criteria. A questionnaire was given to patients with the booklet, focussing on patient’s subjective reflections on the effects of the booklet. The patient questionnaires showed that readability and comprehensibility of the booklet were high (96% and 93%, respectively). After having read the booklet, there was a statistically significant increase in patients feeling well informed, knowing about side-effects, what would happen in the anaesthetic room, and who to contact regarding any questions, compared to before. According to patients, giving information booklets at the time of admission could benefit patients. They are seen as an effective way of enhancing doctor-patient communication, in a setting where time could limit this interaction. They can be used effectively as a means of increasing patient’s perceived knowledge and thus improving the patient experience

the evolutionary dynamics of plastic foraging and its ecological consequences: a resource-consumer model

Phenotypic plasticity has important ecological and evolutionary consequences. In particular, behavioural phenotypic plasticity such as adaptive foraging (AF) by consumers, may enhance community stability. Yet little is known about the ecological conditions that favor the evolution of AF, and how the evolutionary dynamics of AF may modulate its effects on community stability. In order to address these questions, we constructed an eco-evolutionary model in which resource and consumer niche traits underwent evolutionary diversification. Consumers could either forage randomly, only as a function of resources abundance, or adaptatively, as a function of resource abundance, suitability and consumption by competitors. AF evolved when the niche breadth of consumers with respect to resource use was large enough and when the ecological conditions allowed substantial functional diversification. In turn, AF promoted further diversification of the niche traits in both guilds. This suggests that phenotypic plasticity can influence the evolutionary dynamics at the community-level. Faced with a sudden environmental change, AF promoted community stability directly and also indirectly through its effects on functional diversity. However, other disturbances such as persistent environmental change and increases in mortality, caused the evolutionary regression of the AF behaviour, due to its costs. The causal relationships between AF, community stability and diversity are therefore intricate, and their outcome depends on the nature of the environmental disturbance, in contrast to simpler models claiming a direct positive relationship between AF and stability

the evolutionary dynamics of plastic foraging and its ecological consequences: a resource-consumer model

Phenotypic plasticity has important ecological and evolutionary consequences. In particular, behavioural phenotypic plasticity such as adaptive foraging (AF) by consumers, may enhance community stability. Yet little is known about the ecological conditions that favor the evolution of AF, and how the evolutionary dynamics of AF may modulate its effects on community stability. In order to address these questions, we constructed an eco-evolutionary model in which resource and consumer niche traits underwent evolutionary diversification. Consumers could either forage randomly, only as a function of resources abundance, or adaptatively, as a function of resource abundance, suitability and consumption by competitors. AF evolved when the niche breadth of consumers with respect to resource use was large enough and when the ecological conditions allowed substantial functional diversification. In turn, AF promoted further diversification of the niche traits in both guilds. This suggests that phenotypic plasticity can influence the evolutionary dynamics at the community-level. Faced with a sudden environmental change, AF promoted community stability directly and also indirectly through its effects on functional diversity. However, other disturbances such as persistent environmental change and increases in mortality, caused the evolutionary regression of the AF behaviour, due to its costs. The causal relationships between AF, community stability and diversity are therefore intricate, and their outcome depends on the nature of the environmental disturbance, in contrast to simpler models claiming a direct positive relationship between AF and stability