On the design of custom packs: grouping of medical disposable items for surgeries

A custom pack combines medical disposable items into a single sterile package that is used for surgical procedures. Although custom packs are gaining importance in hospitals due to their potential benefits in reducing surgery setup times, little is known on methodologies to configure them, especially if the number of medical items, procedure types and surgeons is large. In this paper, we propose a mathematical programming approach to guide hospitals in developing or reconfiguring their custom packs. In particular, we are interested in minimising points of touch, which we define as a measure for physical contact between staff and medical materials. Starting from an integer non-linear programming model, we develop both an exact linear programming (LP) solution approach and an LP-based heuristic. Next, we also describe a simulated annealing approach to benchmark the mathematical programming methods. A computational experiment, based on real data of a medium-sized Belgian hospital, compares the optimised results with the performance of the hospital’s current configuration settings and indicates how to improve future usage. Next to this base case, we introduce scenarios in which we examine to what extent the results are sensitive for waste, i.e. adding more items to the custom pack than is technically required for some of the custom pack’s procedures, since this can increase its applicability towards other procedures. We point at some interesting insights that can be taken up by the hospital management to guide the configuration and accompanying negotiation processes

MS 671 Anthropology

COURSE DESCRIPTION This course is “An introduction to cultural anthropology, with application to Christian evangelization and mission.” From before the beginning (Genesis 1), our Triune God has been in mission, reaching out in self-giving, other-embracing love (John 1 & I John 1). We now call this the missio Dei, “the mission of God” to remind us that it is not our mission, nor does mission belong to the church. How God does mission is best understood in the sending of Jesus the Christ (Ephesians 2:11-15). As the Father has sent Jesus, so Jesus sends us (John 20:21). It is in the life of Jesus here on earth that we most clearly see our example for mission: Jesus emptied himself, came down to the people, developed relationships and learned the local language and culture for 30 years; and then he began to preach about the Kingdom of God (Matthew 4:17; Luke 4:43) and perform acts of mercy and justice (Luke 4:18-21) that the people saw as signs and wonders of the presence of God among them (Luke 4:22,32,36). The acts of Jesus Christ through the Holy Spirit (the proper title of Acts) continued in the apostles, deacons and those who were called later, like Paul. The apostles began in mission with the Jews (Acts 2-7). The deacons reached out a little further to the half- Jews (Acts 8) and then to the proselytes (Acts 8). Finally, Peter reluctantly reached out to those who were not Jewish, half-Jewish or even wanna-be Jews but were full fledged Gentiles (Acts 10). Still, it was the multi-cultural church at Antioch (not the monocultural church at Jerusalem) that commissioned and sent out the first missionaries: Paul and Barnabas (Acts 13). What they did changed not just the composition of the church but the life of the church. Jesus the Messiah (Christos) became Jesus the Lord (Kyrios) (Acts 28), because that is what the Greeks and Romans were looking for. New understandings of Jesus brought fuller meaning to the cosmic event of the death and resurrection of Jesus. Jesus was interpreted anew as the Logos (John 1), the Pleroma (Colossians 1:19, 2:9-10), the Mystery and Wisdom of God (Ephesians). Every generation deserves a fresh reading of the gospel. Who will speak now to the migrant generation of this globalized world? A critical view of anthropology as it relates to theology will lead us to our main concern, and that is missiology. There will be a conscious effort in our course to maintain a trialogue between anthropology, theology and missiology. Our goal is to gain insights about missiological issues and concerns.https://place.asburyseminary.edu/syllabi/3533/thumbnail.jp

First molecular evidence of an invasive agricultural pest, Drosophila suzukii, in the diet of a common bat, Pipistrellus pipistrellus, in Belgian orchards

Bats are major consumers of arthropods, including many agricultural pest species, and can thus reduce and prevent crop damage. However, few, if any, data is available on the potential role of bats in pest control in central Europe. Evidence that bats prey upon locally important pest species would be an important first step to demonstrate their value to local farmers and facilitate conservation measures. In this pilot study, we used a DNA metabarcoding approach to investigate the diet composition of common pipistrelles and brown long-eared bats captured in orchards in Belgium. We show that the spotted wing drosophila (Drosophila suzukii), one of the most harmful pest species in this region, was part of the diet of common pipistrelles. This pest species was recorded in one of the five samples from common pipistrelles. Our results indicate that bats can be valuable assets for biological pest suppression in West-European orchards, thus setting a path for future studies

1/f noise in patterned GMR spin valves

abstract onl

"You have to get wet to learn how to swim" applied to bridging the gap between research into personnel scheduling and its implementation in practice

Personnel scheduling problems have attracted research interests for several decades. They have been considerably changed over time, accommodating a variety of constraints related to legal and organisation requirements, part-time staff, flexible hours of staff, staff preferences, etc. This led to a myriad of approaches developed for solving personnel scheduling problems including optimisation, meta-heuristics, artificial intelligence, decision-support, and also hybrids of these approaches. However, this still does not imply that this research has a large impact on practice and that state-of-the art models and algorithms are widely in use in organisations. One can find a reasonably large number of software packages that aim to assist in personnel scheduling. A classification of this software based on its purpose will be proposed, accompanied with a discussion about the level of support that this software offers to schedulers. A general conclusion is that the available software, with some exceptions, does not benefit from the wealth of developed models and methods. The remaining of the paper will provide insights into some characteristics of real-world scheduling problems that, in the author’s opinion, have not been given a due attention in the personnel scheduling research community yet and which could contribute to the enhancement of the implementation of research results in practice. Concluding remarks are that in order to bridge the gap that still exists between research into personnel scheduling and practice, we need to engage more with schedulers in practice and also with software developers; one may say we need to get wet if we want to learn how to swim

Characteristics of Interstitial Fibrosis and Inflammatory Cell Infiltration in Right Ventricles of Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

Objective. Systemic sclerosis-associated pulmonary arterial hypertension (SScPAH) has a disturbed function of the right ventricle (RV) when compared to idiopathic PAH (IPAH). Systemic sclerosis may also affect the heart. We hypothesize that RV differences may occur at the level of interstitial inflammation and—fibrosis and compared inflammatory cell infiltrate and fibrosis between the RV of SScPAH, IPAH, and healthy controls. Methods. Paraffin-embedded tissue samples of RV and left ventricle (LV) from SScPAH (n = 5) and IPAH (n = 9) patients and controls (n = 4) were picrosirius red stained for detection of interstitial fibrosis, which was quantified semiautomatically. Neutrophilic granulocytes (MPO), macrophages (CD68), and lymphocytes (CD45) were immunohistochemically stained and only interstitial leukocytes were counted. Presence of epi- or endocardial inflammation, and of perivascular or intimal fibrosis of coronary arteries was assessed semiquantitatively (0–3: absent to extensive). Results. RV's of SScPAH showed significantly more inflammatory cells than of IPAH (cells/mm2, mean ± sd MPO 11 ± 3 versus 6 ± 1; CD68 11 ± 3 versus 6 ± 1; CD45 11 ± 1 versus 5 ± 1 , P < .05) and than of controls. RV interstitial fibrosis was similar in SScPAH and IPAH (4 ± 1 versus 5 ± 1%, P = .9), and did not differ from controls (5 ± 1%, P = .8). In 4 SScPAH and 5 IPAH RV's foci of replacement fibrosis were found. No differences were found on epi- or endocardial inflammation or on perivascular or intimal fibrosis of coronary arteries. Conclusion. SScPAH RVs display denser inflammatory infiltrates than IPAH, while they do not differ with respect to interstitial fibrosis. Whether increased inflammatory status is a contributor to altered RV function in SScPAH warrants further research

Prognostic value of microvessel density in stage II and III colon cancer patients:a retrospective cohort study

Background Microvessel density (MVD), as a derived marker for angiogenesis, has been associated with poor outcome in several types of cancer. This study aimed to evaluate the prognostic value of MVD in stage II and III colon cancer and its relation to tumour-stroma-percentage (TSP) and expression of HIF1A and VEGFA. Methods Formalin-fixed paraffin-embedded (FFPE) colon cancer tissues were collected from 53 stage II and 54 (5-fluorouracil-treated) stage III patients. MVD was scored by digital morphometric analysis of CD31-stained whole tumour sections. TSP was scored using haematoxylin-eosin stained slides. Protein expression of HIF1A and VEGFA was determined by immunohistochemical evaluation of tissue microarrays. Results Median MVD was higher in stage III compared to stage II colon cancers (11.1% versus 5.6% CD31-positive tissue area, p <0.001). High MVD in stage II patients tended to be associated with poor disease free survival (DFS) in univariate analysis (p = 0.056). In contrast, high MVD in 5FU-treated stage III patients was associated with better DFS (p = 0.006). Prognostic value for MVD was observed in multivariate analyses for both cancer stages. Conclusions MVD is an independent prognostic factor associated with poor DFS in stage II colon cancer patients, and with better DFS in stage III colon cancer patients treated with adjuvant chemotherapy

Suitability and managerial implications of a Master Surgical Scheduling approach

Abstract: Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes impose specific implementation issues that affect the success of planning approaches. Current tactical OR planning approaches often fail to account for these issues.Master surgical scheduling (MSS) is a promising approach for hospitals to optimize resource utilization and patient flows. We discuss the pros and cons of MSS and compare MSS with centralized and decentralized planning approaches. Finally, we address various implementation issues of MSS and discuss its suitability for hospitals with different organizational foci and culture

Gross genomic damage measured by DNA image cytometry independently predicts gastric cancer patient survival

BACKGROUND: DNA aneuploidy reflects gross genomic changes. It can be measured by flow cytometry (FCM-DNA) or image cytometry (ICM-DNA). In gastric cancer, the prevalence of DNA aneuploidy has been reported to range from 27 to 100%, with conflicting associations with clinicopathological variables. The aim of our study was to compare the DNA ploidy status measured using FCM-DNA and ICM-DNA in gastric cancer and to evaluate its association with clinicopathological variables. METHODS: Cell nuclei were isolated from 221 formalin-fixed, paraffin-embedded gastric cancer samples. DNA ploidy was assessed using FCM-DNA and ICM-DNA. RESULTS: A total of 178 (80.5%) gastric cancer samples were classified as DNA aneuploid using FCM-DNA, compared with 172 (77.8%) gastric cancer samples when using ICM-DNA. Results obtained from both methods were concordant in 183 (82.8%) cases (kappa = 0.48). Patients with ICM-DNA diploid gastric cancer survived significantly longer than those with ICM-DNA aneuploid gastric cancer (log rank 10.1, P = 0.001). For FCM-DNA data, this difference did not reach statistical significance. The multivariate Cox model showed that ICM-DNA ploidy status predicted patient survival independently of tumour-node-metastasis status. CONCLUSION: ICM-DNA ploidy status is an independent predictor of survival in gastric cancer patients and may therefore be a more clinically relevant read out of gross genomic damage than FCM-DNA. British Journal of Cancer (2009) 101, 1011-1018. doi:10.1038/sj.bjc.6605266 www.bjcancer.com (C) 2009 Cancer Research U