Dementia and Depression with Ischemic Heart Disease: A Population-Based Longitudinal Study Comparing Interventional Approaches to Medical Management

BACKGROUND: We compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical). METHODS AND FINDINGS: De-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients. CONCLUSIONS: Patients managed with PCI had the lowest likelihood of dementia-only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation

Logistieke parameters in procesmatig werkende bedrijven

No abstract

Multi-donor trust fund for sustainable logistics (MDTF-SL) : position note on green logistics (supply chains)

Logistics – the services, knowledge, and infrastructure that allow for the free movement of goods and people – is now recognized as a key driver of competitiveness and economic development. Efficient logistics systems are a precondition for regions, countries, cities, and businesses to participate in the global economy, boost growth, and improve livelihoods. Policy making has turned its attention to sustainable growth paths, valuing scarce resources, minimizing environmental impacts, and allowing economies to prosper across generations. In this new integrated vision of development, sustainable logistics is a key nexus. To improve sustainable logistics practices in the developing world, private sector technologies and innovations, as well as governmental policies and academic knowledge, need to be brought together. The government of the Netherlands and the World Bank have taken a first step in this direction and established the first Multi-Donor Trust Fund for Sustainable Logistics (MDTF-SL) in September 2013

Green facility location

Transportation is one of the main contributing factors of global carbon emissions, and thus, when dealing with facility location models in a distribution context, transportation emissions may be substantially higher than the emissions due to production or storage. Because facility location models define the configuration of deliveries, green location models become an important alternative to reduce CO2 emissions in logistics.\u3cbr/\u3eThis chapter presents a variety of green location models that include the estimation of carbon emissions. It also provides basic guidelines in understanding these models in comparison with cost minimization models

Dual sourcing in the age of near-shoring: trading off stochastic capacity limitations and long lead times

\u3cp\u3eWe model a periodic review inventory system with non-stationary stochastic demand, in which a manufacturer is procuring a component from two available supply sources. The faster supply source is modeled as stochastic capacitated with immediate delivery, while the slower supply source is modeled as uncapacitated with a longer fixed lead time. The manufacturer's objective is to choose how the order should be split between the two supply sources in each period, where the slower supply source is used to compensate for the supply capacity unavailability of the faster supply source. This is different from the conventional dual-sourcing problem, and motivated by the new reality of near-shoring options. We derive the optimal dynamic programming formulation that minimizes the total expected inventory holding and backorder costs over a finite planning horizon and show that the optimal policy is relatively complex. We extend our study by developing an extended myopic two-level base-stock policy and we show numerically that it provides a very close estimate of the optimal costs. Numerical results reveal the benefits of dual-sourcing under near-shoring, where we point out that in most cases the manufacturer should develop a hybrid procurement strategy, taking advantage of both supply sources to minimize its expected total cost.\u3c/p\u3

Business Models and Network Design in Hinterland Transport

International Series in Operations Research &amp; Management ScienceInternational container transport is the backbone of global supply chains. Hinterland transport, the transport from the port to the final destination and vice versa, is an important component of international container transport. However, academic attention to hinterland transport has emerged only recently. This chapter discusses business models and network design in hinterland transport. Understanding business models is relevant, as many different types of companies (e.g., shipping lines, terminal operating companies and forwarders) play a role in hinterland transport. Their business models influence how they position themselves in the market, their stance concerning cooperation and coordination in hinterland transport, and their scope in network design. Network design is a core issue in hinterland transport. New services need to be designed&mdash;and in such a way that they are expected to be profitable. Furthermore, current service patterns only change through deliberate redesign. So competition through the (re)design of transport services is a very important&mdash;perhaps the most important&mdash;form of competition in intermodal freight transport. One potentially promising innovation in this respect is the extended gate concept, where an inland hub becomes the &lsquo;virtual gate&rsquo; of the deep sea terminal

Freight distribution in megacities: Perspectives of shippers, logistics service providers and carriers

We analyse the opinions of shippers, logistic service providers (LSPs) and carriers related to regulations and issues faced by these companies regarding freight distribution in megacities, and the logistical performance measures likely affected by those regulations and issues. We present a review of the freight distribution literature focusing on a large number of freight distribution aspects, such as regulatory, collaborative, environmental, logistical and risk. We also investigate some logistical performance indicators adopted by the companies. Subsequently, we conduct a survey with 147 companies working in the São Paulo Metropolitan Region (SPMR). We use multivariate analysis of variance to assess the logistical performance indicators and non-linear canonical correlation analysis to identify the most relevant freight distribution attributes. The results that the majority of carriers are located inside the SPMR and efficiently handle these issues better than others actors. The lack of collaboration, cargo theft, traffic congestion and some regulations affect the LSP’s logistical performance. Moreover, the actors perceive regulatory aspects, mainly traffic congestion, and a lack of security for deliveries in unsafe areas as the significant issues for deliveries in megacities