Identifying Dominant Stakeholder Perspectives on Sustainability Issues in Reefer Transportation

Driven by global climate concerns, seaports have formulated sustainability goals, which also require sustainability gains in the fast growing temperature-controlled logistics market—increasing energy e ciency, reducing waste, and streamlining logistics processes. This, however, requires cooperation and buy-in from a wide range of stakeholders. To explore the barriers and facilitators of such a transition, we map the interests and attitudes of cold chain actors in the Port of Rotterdam regarding sustainability issues in reefer transportation and cold chains. We identify a limited number of broadly shared perspectives using Q-methodology—a survey-based method to study subjective viewpoints (originating from psychology) that has been used only rarely in the freight transport field. The analysis yields four ‘dominant’ perspectives that together account for 46% of the variation among stakeholder viewpoints. We label these perspectives “sustainability as part of strategy”, “short term constraints”, “optimistic about technology, limited role for policy”, and “long run willingness under risk avoidance.” These perspectives are characterized by multiple factors, including the evaluation of organizational capabilities, expectations from policymakers and technology, and the time horizon stakeholder organizations consider regarding sustainability concerns. From the findings, we derive recommendations for managers and policy makers to facilitate stakeholder dialogue and possibly convergence and coalition building

Richtlijn schizofrenie 2012: basiszorg op het gebied van psychosociale interventies en verpleegkundige zorg.

Background An updated version of the Dutch multidisdplinaiy guideline on schizophrenia was published in 2012. aim We aim to provide an overview of the psychosocial interventions and nursing care which, according to the guideline, should be included in basic care programmes for patients with schizophrenia. We consider which interventions are effective and which are optional. In addition, we argue for continuous updating of the guideline so that it rejlects current developments. method We conducted a systematic review on the basis of specific predefined search terms. We included articles published up to February 2010. We used the methodfor evidence-based guideline development in order to formulate treatment recommendations. conclusion Cognitive behavioural therapy and Jamily interventions are scientifically proven interventions that should be included in the care programmes. Although there is no clear evidence that psycho-education is effective, it is nevertheless recommended. Optional interventions are peer support groups and, in the case of negative symptoms, psychomotor therapy. Although scientific evidence concerning nursing care is limited, we do make some recommendations. We are strongly in/avour of a 'living guideline' that is constantly developed and updated

Risk factors and oral health-related quality of life: A case–control comparison between patients after a first-episode psychosis and people from general population

INTRODUCTION: No research is available about the oral health risk factors and oral health-related quality of life (OHRQoL) in patients diagnosed with a psychotic disorder. AIM: To compare oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder (first-episode) to people with no history of psychotic disorder. METHOD: A case-control comparison (1:2) multivariable linear regression analysis and an estimation of prevalence of impact on OHRQoL. RESULTS: Patients diagnosed with a psychotic disorder (first-episode) have lower OHRQoL with more associated risk factors. Of the patients diagnosed with a psychotic disorder (first-episode), 14.8% reported a negative impact on OHRQoL, higher than the prevalence of 1.8% found in people from the general population. DISCUSSION: The high prevalence rate of a negative impact on OHRQoL in patients diagnosed with a psychotic disorder (first-episode) shows the importance of acting at an early stage to prevent a worse outcome. IMPLICATIONS FOR PRACTICE: The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening) in order to improve the OHRQoL

Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial

BACKGROUND: For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation. QUESTIONS/PURPOSES: Does minimally invasive hip arthroplasty result in superior clinical outcomes? PATIENTS AND METHODS: In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year. RESULTS: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group. CONCLUSIONS: The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidenc

The reefer container market and academic research: A review study

The refrigerated (or ‘reefer’) container market grows rapidly. Researchers and sector stakeholders increasingly realize that this container market segment has its distinct dynamics and demands. This article provides a comprehensive overview of the reefer container sector, its most important characteristics and trends, and a systematic review of the academic literature on reefer containers and logistics. First the authors outline the characteristics, composition, and development of the reefer container market, showing its growth through modal shift (from conventional reefer ships and airfreight) and differentiation into new cargo markets and niche services. Secondly the authors outline reefer chains in terms of their relevant stages, stakeholders, and processes. Data on insurance claims shows that cold chain failure and cargo loss not only occur due to technical failures, but just as often due to organizational errors – especially due to hold-up risk at container transfer points. Thirdly the authors map the present knowledge on reefer containers and reefer transportation through a systematic literature review. The current body of research on reefer containers consists mostly of highly specialized, technical studies on product characteristics and quality preservation, monitoring and control, refrigeration technology, and temperature management. While technological advances in these fields have largely enabled the containerization of cold logistics chains, the first sections of this paper also highlight that many current pressing issues in reefer transportation are logistical and organizational in nature. Therefore, the authors propose a research agenda addressing these overlooked aspects, including supply chain coordination issues and implications of reefer market developments for port policy

MRI Abdominal Organ Tissue Identification using Statistical Distance in Color Space

Abstract Magnetic resonance imaging (MRI) is a powerful medical imaging technique to provide detailed images of soft abdomen organ tissues. An automatic organ tissue identification algorithm is useful for physicians to perform initial reading and interpret MRI images. The algorithm presented in the paper uses the distance in color space between centers of organ tissues to identify abdominal organs in MRI images. Experimental results show the algorithm is effective in the RGB, LAB and AB color spaces

Deep learning-enabled MRI-only photon and proton therapy treatment planning for paediatric abdominal tumours

Purpose: To assess the feasibility of magnetic resonance imaging (MRI)-only treatment planning for photon and proton radiotherapy in children with abdominal tumours. Materials and methods: The study was conducted on 66 paediatric patients with Wilms' tumour or neuroblastoma (age 4 +/- 2 years) who underwent MR and computed tomography (CT) acquisition on the same day as part of the clinical protocol. MRI intensities were converted to CT Hounsfield units (HU) by means of a UNet-like neural network trained to generate synthetic CT (sCT) from T1- and T2-weighted MR images. The CT-to-sCT image similarity was evaluated by computing the mean error (ME), mean absolute error (MAE), peak signal-to-noise ratio (PSNR) and Dice similarity coefficient (DSC). Synthetic CT dosimetric accuracy was verified against CT-based dose distributions for volumetric-modulated arc therapy (VMAT) and intensity-modulated pencil-beam scanning (PBS). Relative dose differences (D-diff) in the internal target volume and organs-at-risk were computed and a three-dimensional gamma analysis (2 mm, 2%) was performed. Results: The average +/- standard deviation ME was -5 +/- 12 HU, MAE was 57 +/- 12 HU, PSNR was 30.3 +/- 1. 6 dB and DSC was 76 +/- 8% for bones and 92 +/- 9% for lungs. Average D-diff were 99% (range [85; 100]%) for VMAT and >96% (range [87; 100]%) for PBS. Conclusion: The deep learning-based model generated accurate sCT from planning T1w- and T2w-MR images. Most dosimetric differences were within clinically acceptable criteria for photon and proton radiotherapy, demonstrating the feasibility of an MRI-only workflow for paediatric patients with abdominal tumours. (C) 2020 The Authors. Published by Elsevier B.V