A new management scheme to support reverse logistics processes in the agrifood distribution sector

During the last decades, reverse logistics and reuse of products have received growing attention as profitable and sustainable business strategies. Looking at the agrifood distribution sector, every day thousands of agrifood stores throw away large quantities of food product no longer suitable for sale. This "waste product", in the majority of cases, could still find new uses as animal feed or fertilizer. The return flow of food product is a typical problem of reverse logistics. This study proposes a new bi-modular scheme for managing the process of collection of "food waste" resulting from the agribusiness distribution sector and its subsequent distribution to livestock farms and collection centers located in the area of interest. The proposed management scheme consists of two modules: - module 1: to cluster the observed area into convenient collection sectors by means of clustering algorithms; - module 2: to identify optimal retrieval routes within each cluster by using Vehicle Routing models. The province of Cagliari in Sardinia (Italy) has been identified as test area. An extensive data collection process has been performed in order to collect the information necessary to portray the existing scenario. The following businesses have been recorded: grocery stores and supermarkets with at least 400 sqm of retail area, livestock farms with at least 200 heads of cattle, feed mills. A number of variables concerning location, type, size and demand data have been collected for each recorded unit.The management scheme has been implemented in a software platform and successfully applied in the test area. The outcome provides useful insights to stakeholders and suggests avenues for further research in the area in order to develop a more general and intuitive tool for managing reverse logistics processes in agrifood chains

Squamous Cell Carcinoma and Ledderhose Disease: A Case Report

Ledderhose disease is disorder of the plantar aponeurosis. This disease is not so common and can be tackled with a surgical or conservative approach. A case of a 73-year-old man came to our attention who had a 26-year history of painless bilateral plantar nodules coalescing into an indurated mass. An ulcerative nodule had been noted in the last 16 months on the right foot, in the absence of trauma, not responsive to conservative treatment, so we decided to perform a biopsy. The histopatologic examination showed squamous cell carcinoma, with warty, well-differentiated, low-grade malignancy. Surgical treatment was suggested, so, in pneumoischemia, we made a surgical incision including the skin lesion. Then we proceeded to sculpture the anterolateral thigh fasciacutaneous flap to obtain adequate soft tissue coverage. The tumor was completely removed. Current reconstructive possibilities comprise a good anatomofunctional recovery even in the case of large demolition requests for the therapy of advanced cases of the disease described in this article. Correlation between Ledderhose disease and the formation of malignant tumors has not been made as yet, but perhaps an element that could unite these pathologies can be researched in the lively cell proliferation that characterizes both. It would be interesting to analyze the biological substrate, as well as the systemic and local levels, in patients where both diseases are manifested

Rapid Identification of Human Adenoviruses and Cytokine Estimation among Patients with Epidemic Keratoconjunctivitis in Babylon Governorate, Iraq

One hundred seventy five conjunctival swabs were collected from patients with keratoconjunctivitis. All swabs were cultured on Blood agar and MacConkey agar , 82 positive bacterial culture isolates were excluded and 93 negative bacterial culture isolates were taken as a study samples. All 93 swabs were subjected to rapid immunochromatography test (IC) test. The results of rapid identification revealed that 79 specimens (84.9%) were found positive for human adenoviruses , whereas 14 specimens (15.1%) were found negative for human adenoviruses. In addition , the results indicated that the positive rate of the IC test for specimens obtained within 1–5 days after of the onset of illness 59 (74.7%) were significantly higher than that for specimens obtained within 6–10 days after of the onset of illness 20 (25.3%) at P-value < 0.05.Tear samples were also collected from both (30) patients and (25) controls to estimate the tear levels of some immune parameters Interleukine-6  (IL-6), Interlukine-8 (IL-8), and tumor necrosis factor alpha (TNF-α) by ELISA (Enzyme linked Immunosorbent Assay) method .The cytokine profile showed that there is a significant increase (P<0.05) in the mean tear concentration of each (IL-6, IL-8 and TNF-α) between EKC patients and control groups , and the result showed that IL-8 was the predominant cytokine released and followed by IL-6 and TNF-α . Keywords: Adenovirus, Keratoconjunctivitis, Immunochromatography test, Cytokin

Midwifery capacity building in Papua New Guinea: Key achievements and ways forward

© 2015 Australian College of Midwives. Background: Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. Aim: This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. Method: A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. Findings: Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. Conclusion: The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates

Nyquist method for Wigner-Poisson quantum plasmas

By means of the Nyquist method, we investigate the linear stability of electrostatic waves in homogeneous equilibria of quantum plasmas described by the Wigner-Poisson system. We show that, unlike the classical Vlasov-Poisson system, the Wigner-Poisson case does not necessarily possess a Penrose functional determining its linear stability properties. The Nyquist method is then applied to a two-stream distribution, for which we obtain an exact, necessary and sufficient condition for linear stability, as well as to a bump-in-tail equilibrium.Comment: 6 figure

Dimension reduction in heterogeneous parametric spaces with application to naval engineering shape design problems

We present the results of the first application in the naval architecture field of a methodology based on active subspaces properties for parameter space reduction. The physical problem considered is the one of the simulation of the hydrodynamic flow past the hull of a ship advancing in calm water. Such problem is extremely relevant at the preliminary stages of the ship design, when several flow simulations are typically carried out by the engineers to assess the dependence of the hull total resistance on the geometrical parameters of the hull, and others related with flows and hull properties. Given the high number of geometric and physical parameters which might affect the total ship drag, the main idea of this work is to employ the active subspaces properties to identify possible lower dimensional structures in the parameter space. Thus, a fully automated procedure has been implemented to produce several small shape perturbations of an original hull CAD geometry, in order to exploit the resulting shapes and to run high fidelity flow simulations with different structural and physical parameters as well, and then collect data for the active subspaces analysis. The free form deformation procedure used to morph the hull shapes, the high fidelity solver based on potential flow theory with fully nonlinear free surface treatment, and the active subspaces analysis tool employed in this work have all been developed and integrated within SISSA mathLab as open source tools. The contribution will also discuss several details of the implementation of such tools, as well as the results of their application to the selected target engineering problem

Detailed single crystal EPR lineshape measurements for the single molecule magnets Fe8Br and Mn12-ac

It is shown that our multi-high-frequency (40-200 GHz) resonant cavity technique yields distortion-free high field EPR spectra for single crystal samples of the uniaxial and biaxial spin S = 10 single molecule magnets (SMMs) [Mn12O12(CH3COO)16(H2O)4].2CH3COOH.4H2O and [Fe8O2(OH)12(tacn)6]Br8.9H2O. The observed lineshapes exhibit a pronounced dependence on temperature, magnetic field, and the spin quantum numbers (Ms values) associated with the levels involved in the transitions. Measurements at many frequencies allow us to separate various contributions to the EPR linewidths, including significant D-strain, g-strain and broadening due to the random dipolar fields of neighboring molecules. We also identify asymmetry in some of the EPR lineshapes for Fe8, and a previously unobserved fine structure to some of the EPR lines for both the Fe8 and Mn12 systems. These findings prove relevant to the mechanism of quantum tunneling of magnetization in these SMMs.Comment: Phys. Rev. B, accepted with minor revision

Symphysiotomy in Zimbabwe; Postoperative Outcome, Width of the Symphysis Joint, and Knowledge, Attitudes and Practice among Doctors and Midwives

BACKGROUND: Obstructed labour remains one of the leading causes of maternal and foetal death and morbidity in poorly resourced areas of the world, where the 24 hours availability of a caesarean section (CS) cannot be guaranteed, and the CS related mortality rate is still high. In these settings, reinstatement of symphysiotomy has been advocated. The objectives were, in1994; to study perioperative and long-term complications of symphysiotomy and compare them to those related to CS for similar indications, in 1996; to measure the symphyseal width after symphysiotomy and compare it to that after normal vaginal delivery, and, in 1998; to assess knowledge, attitudes and practice related to symphysiotomy among doctors and midwives in Zimbabwe. METHODS AND FINDINGS: Thirty-four women who had undergone symphysiotomy and 29 women who had undergone a CS for obstructed labour were interviewed. The symphyseal widths of 19 women with a previous symphysiotomy were compared to that of 92 women with previous normal vaginal deliveries, using ultrasound technique. Forty-one doctors and 39 midwives, in three central hospitals and seven district hospitals in Zimbabwe, were interviewed about symphysiotomy. None of the 34 women reported serious soft tissue injuries or infections post symphysiotomy. Long-term complications after symphysiotomy do not differ notably from those after CS for similar indications. The intra-articular width of the symphysis pubis is increased after a symphysiotomy. Seventy-nine of the 80 interviewed health care workers knew about symphysiotomy. One obstetrician had performed symphysiotomies. Two-thirds of the participants considered symphysiotomy an obsolete and second-class operation, but lifesaving and appropriate in remote areas of Zimbabwe. Ten of 13 midwives in remote areas wanted to carry out symphysiotomies themselves. CONCLUSIONS: No severe complications due to symphysiotomy were revealed in this study. The results suggest that a modest permanent enlargement of the pelvis post symphysiotomy (together with the absence of a scarred uterus) may facilitate subsequent vaginal delivery. Doctors and midwives working in district hospitals have a more positive attitude to symphysiotomies than the colleagues in central hospitals. Obstetricians (who would have to do the teaching), working in the large urban hospitals almost exclude symphysiotomy as an alternative management in Zimbabwe

Pain in patients with pancreatic cancer: prevalence, mechanisms, management and future developments

Pain affects approximately 80% of patients with pancreatic cancer, with half requiring strong opioid analgesia, namely: morphine-based drugs on step three of the WHO analgesic ladder (as opposed to the weak opioids: codeine and tramadol). The presence of pain is associated with reduced survival. This article reviews the literature regarding pain: prevalence, mechanisms, pharmacological, and endoscopic treatments and identifies areas for research to develop individualized patient pain management pathways. The online literature review was conducted through: PubMed, Clinical Key, Uptodate, and NICE Evidence. There are two principal mechanisms for pain: pancreatic duct obstruction and pancreatic neuropathy which, respectively, activate mechanical and chemical nociceptors. In pancreatic neuropathy, several histological, molecular, and immunological changes occur which correlate with pain including: transient receptor potential cation channel activation and mast cell infiltration. Current pain management is empirical rather etiology-based and is informed by the WHO analgesic ladder for first-line therapies, and then endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with resistant pain. For EUS-CPN, there is only one clinical trial reporting a benefit, which has limited generalizability. Case series report pancreatic duct stenting gives effective analgesia, but there are no clinical trials. Progress in understanding the mechanisms for pain and when this occurs in the natural history, together with assessing new therapies both pharmacological and endoscopic, will enable individualized care and may improve patients’ quality of life and survival