Base and surge strategies for controlling environmental and economic costs in logistics triads

The aim of this paper is to determine the extent to which it is possible to establish a ‘base’ and ‘surge’ strategy for logistics provision with a particular emphasis on minimising environmental and economic costs. Our method is the combination of empirical research outputs on the impact of uncertainty on economic and environmental costs, and a synthesis of the literature on resilience and the role of flexibility therein. We find that logistics planners either build contingents into their schedules (a priori) or that they respond with contingencies (a posteriori). The former is associated with a ‘base‘ approach; an example of which may be the incorporation of ‘slack time‘ into a schedule to accommodate expected delays due to road congestion. The latter is equivalent to a ‘surge‘ approach where as an example the logistics provider may have capacity flexibility, in the form of spare vehicles, to accommodate post-plan changes in shipper volume requirements. This paper explicitly rationalises the links between uncertainty, ‘base’ and ‘surge’ supply chain strategies, and the strategic use of logistics flexibility, in minimising environmental and economic costs in a logistics triad. The output is in the form of a conceptual managerial feedback control system

Effects of a nursing care program on functional outcomes in older acute medical in-patients: protocol for a randomized controlled trial

Background: Hospitalization often leads to long periods of bed rest and inactivity which is associated with an increase in length of hospital stay, loss of capacity for basic self-care and discharge into a nursing home. Objective: This trial aims to verify if a nursing care program centered on basic self-care and predefined physical activity, improves functional outcomes in older hospitalized patients. Methods: This is a 2-group randomized controlled trial with repeated measures: 182 older acute medical patients will be blindly randomly allocated to the control group (n = 91) or intervention group (n = 91). The intervention will consist of nursing care intervention centered on basic self-care that includes a twice daily walking training, plus privileging pre-established trips to the toilet by walking and all daytime meals seated, off the bed. The main outcome was changes in the number of independent activities of daily living from 2 weeks before admission (baseline) to discharge. Trial registration: ClinicalTrials.gov (Identifier NCT03106064). Results: This intervention has the potential to change the outcomes of the older patient in the acute setting. Conclusion: The loss of independence in self-care is determinant in future health care needs. If our hypothesis is correct and demonstrate that this nursing care program centered on basic self-care for older acute medical patients improves functional outcomes, a change in the paradigmatic organization of hospital care may be justifiable

Functional trajectories of older acute medical inpatients: increased vulnerability with age

info:eu-repo/semantics/publishedVersio

Dental Care for Children with Leukemia: Major Updates

Leukemia is a haematological neoplasm that among 300 children and adolescents in Brazil. Its standard treatment consists of the use of antineoplastic based on chemotherapy or radiotherapy, these recommended therapies can provoke several side effects among them buccal alterations mainly due to the immunosupression picture. In view of the exposed this study has the objective to describe the main updates of the dental care to the child carrier of leukemia by reviewing the literature. Immunosuppression and the very fragility and stage of development of children with leukemia lead to greater vulnerability to all types of opportunistic infections and pathologies resulting from antineoplastic therapy. Currently, modern oncology requires the presence of the dentist in all phases of treatment and even before diagnosis in a sine qua non condition for management, maintenance of oral health and quality of life of the leukemic patient. The dentist besides being part of the cancer team is required both in the in-hospital environment and in daily clinical practice. Currently there is a wide range of resources and medicines to promote a satisfactory handling and quality of life for these patients

Semi-parametric seasonal unit root tests

We extend the M class of unit root tests introduced by Stock (1999, Cointegration, Causality and Forecasting. A Festschrift in Honour of Clive W.J. Granger. Oxford University Press), Perron and Ng (1996, Review of Economic Studies 63, 435–463) and Ng and Perron (2001, Econometrica 69, 1519–1554) to the seasonal case, thereby developing semi-parametric alternatives to the regression-based augmented seasonal unit root tests of Hylleberg, Engle, Granger, and Yoo (1990, Journal of Econometrics 44, 215–238). The success of this class of unit root tests to deliver good finite sample size control even in the most problematic (near-cancellation) case where the shocks contain a strong negative moving average component is shown to carry over to the seasonal case as is the superior size/power trade-off offered by these tests relative to other available tests

Testing for Episodic Predictability in Stock Returns

Standard tests based on predictive regressions estimated over the full available sample data have tended to find little evidence of predictability in stock returns. Recent approaches based on the analysis of subsamples of the data have been considered, suggesting that predictability where it occurs might exist only within so-called 'pockets of predictability' rather than across the entire sample. However, these methods are prone to the criticism that the sub-sample dates are endogenously determined such that the use of standard critical values appropriate for full sample tests will result in incorrectly sized tests leading to spurious findings of stock returns predictability. To avoid the problem of endogenously-determined sample splits, we propose new tests derived from sequences of predictability statistics systematically calculated over sub-samples of the data. Specifically, we will base tests on the maximum of such statistics from sequences of forward and backward recursive, rolling, and double-recursive predictive sub-sample regressions. We develop our approach using the over-identified instrumental variable-based predictability test statistics of Breitung and Demetrescu (2015). This approach is based on partial-sum asymptotics and so, unlike many other popular approaches including, for example, those based on Bonferroni corrections, can be readily adapted to implementation over sequences of subsamples. We show that the limiting distributions of our proposed tests are robust to both the degree of persistence and endogeneity of the regressors in the predictive regression, but not to any heteroskedasticity present even if the sub-sample statistics are based on heteroskedasticity-robust standard errors. We therefore develop fixed regressor wild bootstrap implementations of the tests which we demonstrate to be first-order asymptotically valid. Finite sample behaviour against a variety of temporarily predictable processes is considered. An empirical application to US stock returns illustrates the usefulness of the new predictability testing methods we propose

Testing for Episodic Predictability in Stock Returns

Standard tests based on predictive regressions estimated over the full available sample data have tended to find little evidence of predictability in stock returns. Recent approaches based on the analysis of subsamples of the data suggest in fact that predictability where it occurs might exist only within so-called \pockets of predictability" rather than across the entire sample. However, these methods are prone to the criticism that the subsample dates are endogenously determined such that the use of standard critical values appropriate for full sample tests will result in incorrectly sized tests leading to spurious findings of stock returns predictability. To avoid the problem of endogenously-determined sample splits, we propose new tests derived from sequences of predictability statistics systematically calculated over subsamples of the data. Specifically, we will base tests on the maximum of such statistics from sequences of forward and backward recursive, rolling, and double-recursive predictive subsample regressions. We develop our approach using the over-identified instrumental variable-based predictability test statistics of Breitung and Demetrescu (2015). This approach is based on partial-sum asymptotics and so, unlike many other popular approaches including, for example, those based on Bonferroni corrections, can be readily adapted to implementation over sequences of subsamples. We show that the limiting null distributions of our proposed test statistics depend in general on whether the putative predictor is strongly or weakly persistent and on any heteroskedasticity present (indeed on any timevariation present in the unconditional variance matrix of the innovations), the latter even if the subsample statistics are based on heteroskedasticity-robust standard errors. As a consequence, we develop fixed regressor wild bootstrap implementations of the tests which we demonstrate to be first-order asymptotically valid. Finite sample behaviour against a variety of temporarily predictable processes is considered. An empirical application to US stock returns illustrates the usefulness of the new predictability testing methods we propose

Surgical Ablation of Atrial Fibrillation and Left Atrial Appendage Occlusion by a Totally Videothoracoscopic Approach - New Paradigm?

Introduction: Atrial fibrillation (AF) contributes to increased morbidity and mortality. Pharmacological and percutaneous catheter therapies are unsatisfactory, with potential serious adverse effects. Cox-Maze III/IV surgery, with higher rates of success, has not been widely adopted because of the associated complexity of the procedure. Methods: We performed a retrospective analysis of the first patients submitted to surgical ablation of AF with occlusion of the left atrial appendage with a totally videothoracoscopic (VATS) approach in our institution. We describe the surgical technique and our results, including duration of surgery, hospital stay, complications and maintenance of sinus rhythm after surgery, at 6, 12 and 18 months of follow-up. Results: We studied 15 patients (ages ranging from 39 to 75 years old; 54,5% female gender). Mean time since the diagnosis of AF was 5,75 years. All had been submitted to prior catheter ablation (mean of 2 attempts). Mean diameter and volume of the left atrium was 42 mm (M-mode) and 70 ml (43 ml/m2), respectively. Mean duration of surgery was 2 hours and 22 minutes. In one patient we had to convert the surgery to median sternotomy. Mean hospital stay was 4,8 days. Mean time of follow-up was 12 months. During follow-up, 91%, 90% and 80% of the patients were in sinus rhythm at 6, 12 and 18 months, respectively. Conclusion: This surgical approach represents a real benefit for those patients with multiple attempts of catheter ablation without success. However, a larger sample of patients with a longer period of follow-up is necessary for further conclusions.info:eu-repo/semantics/publishedVersio

A Novel High Frequency Encoding Algorithm for Image Compression

In this paper a new method for image compression is proposed whose quality is demonstrated through accurate 3D reconstruction from 2D images. The method is based on the Discrete Cosine Transform (DCT) together with a high frequency minimization encoding algorithm at compression stage and a new concurrent binary search algorithm at decompression stage. The proposed compression method consists of five main steps: (1) Divide the image into blocks and apply DCT to each block; (2) Apply a high frequency minimization method to the AC-coefficients reducing each block by 2/3 resulting in a Minimized Array; (3) Build a look up table of probability data to enable the recovery of the original high frequencies at decompression stage; (4) Apply a delta or differential operator to the list of DC-components; and (5) Apply arithmetic encoding to the outputs of steps (2) and (4). At decompression stage, the look up table and the concurrent binary search algorithm are used to reconstruct all high frequency AC-coefficients while the DC-components are decoded by reversing the arithmetic coding. Finally, the inverse DCT recovers the original image. We tested the technique by compressing and decompressing 2D images including images with structured light patterns for 3D reconstruction. The technique is compared with JPEG and JPEG2000 through 2D and 3D RMSE. Results demonstrate that the proposed compression method is perceptually superior to JPEG with equivalent quality to JPEG2000. Concerning 3D surface reconstruction from images, it is demonstrated that the proposed method is superior to both JPEG and JPEG2000

Salud mental en cuidadores informales de ancianos dependientes después de accidente cerebrovascular

Contexto: o acidente vascular cerebral (AVC) constitui um desafio pelo impacto social e pelas repercussões na vida das vítimas e famílias. Torna-se, assim, pertinente estudar a saúde mental do cuidador informal de idosos dependentes pós-AVC. Objetivo: determinar as variáveis preditoras da saúde mental do cuidador informal. Métodos: estudo transversal descritivo realizado numa amostra não-probabilística por conveniência com 636 cuidadores com idades entre os 17 - 85 anos (média=50.19 ± 14.30), residentes na sub-região Dão Lafões integrada, Portugal. A colheita de dados foi suportada em: escala de rastreio em saúde mental, Questionário de Avaliação da Sobrecarga do Cuidador Informal, Inventário de Personalidade, Escala de Vulnerabilidade ao Stress, Índice de Katz. Resultados: constatou-se que a saúde mental é boa em 58% dos inquiridos, razoável em 5,2% e fraca em 36,8%. Apresentou-se vulnerável ao stress 55,0% dos cuidadores e 45,0 % não vulneráveis. Configuraram-se preditoras da saúde mental: a vulnerabilidade ao stress, as implicações na vida pessoal e o neuroticismo. Conclusões: traduzem as evidências que as variáveis psicológicas predizem a saúde mental dos cuidadores informais. Logo, impõe-se considerá-las quando se planeiam boas práticas de enfermagem para o seu atendimento, e se selecionam estratégias atenuantes do impacto do stress e da sobrecarga.Context: Cerebrovascular accident (CVA) is a challenge due to its social impact, and its repercussions on the lives of victims and families. It is, therefore, relevant to study the mental health of informal caregivers of dependent elderly post-CVA patients. Objective: to determine the mental health predictors of informal caregivers. Methods: cross-sectional study conducted with a non-probability convenience sample of 636 informal caregivers aged 17 – 85 years (mean = 50.19 ± 14.30), residing in the dão Lafões, Portugal. Data collection was supported by: the Screening Scale for Mental Health, the Informal Caregiver Overload Assessment Questionnaire, the Personality Inventory, the Vulnerability to Stress scale, and the Katz Index. Results: mental health was found to be good in 58% of respondents, reasonable in 5.2% and poor in 36.8%. We found 55% of the caregivers to be vulnerable to stress and 45% not to be vulnerable. Vulnerability to stress, implications for personal life and neuroticism were found to be predictors of mental health. Conclusions: evidence indicates that psychological variables predict the mental health of informal caregivers. They must be considered when planning best nursing practices for careContexto: el accidente cerebrovascular (avc) es un reto por el impacto social y las repercusiones en las vidas de las víctimas y sus familias, por lo que es relevante para el estudio de la salud mental de los cuidadores informales de personas mayores dependientes pos-avc. Objetivo: determinar los factores predictivos de la salud mental de los cuidadores informales. Métodos: estudio transversal realizado en una muestra no probabilística por conveniencia con 636 cuidadores no profesionales de entre 17- 85 años (media = 50,19 ± 14,30), con domicilio en la sub-región Dão Lafões, Portugal. La recolección de datos fue apoyado por: la Escala de Rastreo de Salud Mental, el Cuestionario de Evaluación de la Sobrecarga del Cuidador Informal, el Inventario de Personalidad, la Escala de Vulnerabilidad al Estrés, el Índice de Katz. Resultados: se encontró que la salud mental es buena por 58% de los encuestados, razonable en el 5,2% y malo en el 36,8%. eran vulnerables al estrés de 55% los cuidadores y 45,0% no vulnerable. Configuranse para ser predictores de la salud mental, la vulnerabilidad al estrés, las implicaciones en la vida personal y el neuroticismo. Conclusiones: traduce la evidencia de que las variables psicológicas predicen la salud mental de los cuidadores informales, lo que exige considerar en la planificación de las mejores prácticas de enfermería y con sus estrategias selecionadas para mitigar el impacto del estrés y la sobrecarga.info:eu-repo/semantics/publishedVersio