Supply Chain Management and Hypercompetition

Firms nowadays face significant challenges in their operating environments, which have been characterised in two different ways. From a strategic management perspective these environments are in a state of hypercompetition while from a logistics or supply chain perspective these environments require market responsiveness predicated upon agile supply chains. However, firms must also rely on many interorganizational relationships to ensure efficient and effective movements within their supply chains. This paper discusses the relationships among these concepts and proposes a research framework combining aspects of the hypercompetition and responsiveness and agility viewpoints

Resource use data by patient report or hospital records: Do they agree?

Background: Economic evaluations alongside clinical trials are becoming increasingly common. Cost data are often collected through the use of postal questionnaires; however, the accuracy of this method is uncertain. We compared postal questionnaires with hospital records for collecting data on physiotherapy service use. Methods: As part of a randomised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal questionnaires and from hospital records. Results: 315 patients were referred for physiotherapy. Hospital data on attendances was available for 30% (n = 96), compared with 48% (n = 150) of patients completing questionnaire data (95% Cl for difference = 10% to 24%); 19% (n = 59) had data available from both sources. The two methods produced an intraclass correlation coefficient of 0.54 (95% Cl 0.31 to 0.70). However, the two methods produced significantly different estimates of resource use with patient self report recalling a mean of 1.3 extra visits (95% Cl 0.4 to 2.2) compared with hospital records. Conclusions: Using questionnaires in this study produced data on a greater number of patients compared with examination of hospital records. However, the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysi

Investigating the missing data mechanism in quality of life outcomes: a comparison of approaches

Background: Missing data is classified as missing completely at random (MCAR), missing at random (MAR) or missing not at random (MNAR). Knowing the mechanism is useful in identifying the most appropriate analysis. The first aim was to compare different methods for identifying this missing data mechanism to determine if they gave consistent conclusions. Secondly, to investigate whether the reminder-response data can be utilised to help identify the missing data mechanism. Methods: Five clinical trial datasets that employed a reminder system at follow-up were used. Some quality of life questionnaires were initially missing, but later recovered through reminders. Four methods of determining the missing data mechanism were applied. Two response data scenarios were considered. Firstly, immediate data only; secondly, all observed responses (including reminder-response). Results: In three of five trials the hypothesis tests found evidence against the MCAR assumption. Logistic regression suggested MAR, but was able to use the reminder-collected data to highlight potential MNAR data in two trials. Conclusion: The four methods were consistent in determining the missingness mechanism. One hypothesis test was preferred as it is applicable with intermittent missingness. Some inconsistencies between the two data scenarios were found. Ignoring the reminder data could potentially give a distorted view of the missingness mechanism. Utilising reminder data allowed the possibility of MNAR to be considered.The Chief Scientist Office of the Scottish Government Health Directorate. Research Training Fellowship (CZF/1/31

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU

BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia," which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document

Investigating the origin of magnetic perturbations associated with the FIP Effect

Recently, magnetic oscillations were detected in the chromosphere of a large sunspot and found to be linked to the coronal locations where a first ionization potential (FIP) effect was observed. In an attempt to shed light on the possible excitation mechanisms of these localized waves, we further investigate the same data by focusing on the relation between the spatial distribution of the magnetic wave power and the overall field geometry and plasma parameters obtained from multi-height spectropolarimetric non-local thermodynamic equilibrium (NLTE) inversions of IBIS data. We find, in correspondence with the locations where the magnetic wave energy is observed at chromospheric heights, that the magnetic fields have smaller scale heights, meaning faster expansions of the field lines, which ultimately results in stronger vertical density stratification and wave steepening. In addition, the acoustic spectrum of the oscillations at the locations where magnetic perturbations are observed is broader than that observed at other locations, which suggests an additional forcing driver to the p-modes. Analysis of the photospheric oscillations in the sunspot surroundings also reveals a broader spectrum between the two opposite polarities of the active region (the leading spot and the trailing opposite polarity plage), and on the same side where magnetic perturbations are observed in the umbra. We suggest that strong photospheric perturbations between the two polarities are responsible for this broader spectrum of oscillations, with respect to the p-mode spectrum, resulting in locally excited acoustic waves that, after crossing the equipartition layer, located close to the umbra-penumbra boundary at photopheric heights, are converted into magnetic waves and steepen due to the strong density gradient

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.

BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of "optimal analgesia" as set forth in this document

A chromospheric resonance cavity in a sunspot mapped with seismology

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordData availability: The data used in this paper are from the observing campaign entitled ‘The Influence of Magnetism on Solar and Stellar Atmospheric Dynamics’ (NSO-SP proposal T1081; principal investigator: D.B.J.), which employed the ground-based Dunn Solar Telescope, USA, during July 2016. Additional supporting observations were obtained from the publicly available NASA’s Solar Dynamics Observatory (https://sdo.gsfc.nasa.gov) data archive, which can be accessed via http://jsoc.stanford.edu/ajax/lookdata.html. The data that support the plots within this paper and other findings of this study are available from the corresponding author upon reasonable request.Code availability: The numerical code (Lare2D) used in the work can be downloaded from: https://warwick.ac.uk/fac/sci/physics/research/cfsa/people/tda/larexd/Sunspots are intense collections of magnetic fields that pierce through the Sun’s photosphere, with their signatures extending upwards into the outermost extremities of the solar corona1. Cutting-edge observations and simulations are providing insights into the underlying wave generation2, configuration3,4 and damping5 mechanisms found in sunspot atmospheres. However, the in situ amplification of magnetohydrodynamic waves6, rising from a few hundreds of metres per second in the photosphere to several kilometres per second in the chromosphere7, has, until now, proved difficult to explain. Theory predicts that the enhanced umbral wave power found at chromospheric heights may come from the existence of an acoustic resonator8–10, which is created due to the substantial temperature gradients experienced at photospheric and transition region heights11. Here, we provide strong observational evidence of a resonance cavity existing above a highly magnetic sunspot. Through a combination of spectropolarimetric inversions and comparisons with high-resolution numerical simulations, we provide a new seismological approach to mapping the geometry of the inherent temperature stratifications across the diameter of the underlying sunspot, with the upper boundaries of the chromosphere ranging between 1,300 ± 200 km and 2,300 ± 250 km. Our findings will allow the three-dimensional structure of solar active regions to be conclusively determined from relatively commonplace two-dimensional Fourier power spectra. The techniques presented are also readily suitable for investigating temperature-dependent resonance effects in other areas of astrophysics, including the examination of Earth–ionosphere wave cavities12.Science and Technology Facilities Council (STFC)Invest NI and Randox Laboratories LtdSpanish Ministry of Economy and CompetitivenessEuropean Union Horizon 2020Research Council of NorwayINAF Istituto Nazionale di AstrofisicaCalifornia State University Northridg

Double-chambered right ventricle in an adult patient diagnosed by transthoracic echocardiography

BACKGROUND: Double-chambered right ventricle is a rare congenital disease frequently misdiagnosed in the adult patient. An anomalous muscle band divides the right ventricle in two cavities causing variable degree of obstruction. Although echocardiography is considered a useful method for the diagnosis of this pathology in children, it has been recognized the transthoracic scanning limitation in adults. CASE PRESENTATION: A 29 year-old patient with double-chambered right ventricle presenting mild exercise intolerance referred for follow up of a known ventricular septal defect in whom a complete diagnosis was obtained based only on transthoracic two dimensional echocardiography without the needing of cardiac catheterization. CONCLUSION: Based on non invasive echocardiographic diagnosis, patient was referred to surgical correction, which was completely successful

Terahertz imaging through emissivity control

This is the final version. Available on open access from Optica Publishing Group via the DOI in this recordData availability: Data underlying the results presented in this paper are not publicly available at this time but may be obtained from the authors upon reasonable request.Electromagnetic radiation in the terahertz (THz) frequency band has unique potential for future communication and imaging applications.However, the adoption of THz technologies is hindered by the lack of cost-effective THz sources. Here we demonstrate a way to generate and control THz radiation, via spatio-temporal emissivity modulation. By patterning the optical photoexcitation of a surface-passivated silicon wafer, we locally control the free-electron density, and thereby pattern the wafer's emissivity in the THz part of the electromagnetic spectrum.We show how this unconventional source of controllable THz radiation enables a form of incoherent computational THz imaging.We use it to image various concealed objects, demonstrating that this scheme has the penetrating capability of other THz imaging approaches, without the requirement of femtosecond pulsed laser sources. Furthermore, the incoherent nature of thermal radiation also ensures the obtained images are free of interference artifacts. Our spatio-temporal emissivity control could enable a family of long-wavelength structured illumination, imaging, and spectroscopy systems.Engineering and Physical Sciences Research Council (EPSRC)European Research Council (ERC)Royal Academy of Engineering (RAE