A grey approach to predicting healthcare performance

© 2018 Elsevier Ltd The success of an organization or a particular activity is evaluated through the measurement of key performance indicators (KPIs). The aim of this paper is to analyze and predict the indicators of healthcare performance using grey systems theory. Recent advancements in science and technology have made the healthcare industry extremely efficient at collecting data using electronic claims systems such as electronic health records. Therefore, collecting field level primary data becomes easier and accumulate them to generate secondary data for research purpose and to get an insight of the organization performance is absolutely necessary. Our research analyzes the KPIs of a hospital based on a secondary data source. Since, secondary data contains uncertainty and sometimes poor information, grey prediction model suits best to make a prediction model in this regard. Conventional grey model has considerable drawbacks while making a rigorous prediction model. For this, we apply an improved grey prediction model to predict the KPIs of the healthcare performance indicators. Several error measures in our model give a best fit of the data and allow prediction of the KPIs. The prediction model gives good estimates of the quantitative indicators and produced error rate within an acceptable range. We observe that the KPIs of bed turnover rate (BTR) and bed occupancy rate (BOR) have an increasing trend, whereas the KPIs of average length of stay (ALOS), hospital death rate (HDR) and hospital infection rate (HIR) show a decreasing trend over time. The main contribution of this research is a grey-based prediction model that can provide managers with the information they need to evaluate and predict the performance of a hospital. The research indicates that managers should give greater priority to the indicators which will result in better patients’ satisfaction and improved profit margin. Healthcare managers striving towards better performance will now have an empirical basis upon which to formulate and adjust their strategies, after analyzing the predicted value

Drivers to sustainable manufacturing practices and circular economy: A perspective of leather industries in Bangladesh

© 2017 Elsevier Ltd Sustainable manufacturing practices and the circular economy have recently received significant attention in academia and within industries to improve supply chain practices. Manufacturing industries have started adopting sustainable manufacturing practices and a circular economy in their supply chain to mitigate environmental concerns, as sustainable manufacturing practices and a circular economy result in the reduction of waste generation and energy and material usage. The leather industry, in spite of it contributing remarkably to a country's economic growth and stability, does not bear a good image because of its role in polluting the environment. Therefore, the leather industries of Bangladesh are trying to implement sustainable manufacturing practices as a part of undertaking green supply chain initiatives to remedy their image with the buyer and to comply with government rules and regulations. The main contribution of this study is to assess, prioritize and rank the drivers of sustainable manufacturing practices in the leather industries of Bangladesh. We have used graph theory and a matrix approach to examine the drivers. The results show that knowledge of the circular economy is paramount to implementing sustainable manufacturing practices in the leather industry of Bangladesh. This study will assist managers of leather companies to formulate strategies for the optimum utilization of available resources, as well as for the reduction of waste in the context of the circular economy

Examining price and service competition among retailers in a supply chain under potential demand disruption

© 2017 Elsevier Ltd Supply chain disruptions management has attracted significant attention among researchers and practitioners. The paper aims to examine the effect of potential market demand disruptions on price and service level for competing retailers. To investigate the effect of potential demand disruptions, we consider both a centralized and a decentralized supply chain structure. To analyze the decentralized supply chain, the Manufacturing Stackelberg (MS) game theoretical approach was undertaken. The analytical results were tested using several numerical analyses. It was shown that price and service level investment decisions are significantly influenced by demand disruptions to retail markets. For example, decentralized decision makers tend to lower wholesale and retail prices under potential demand disruptions, whereas a proactive retailer needs to increase service level with an increased level of possible disruptions. This research may aid managers to analyze disruptions prone market and to make appropriate decision for price and service level. The manufacturer or the retailers will also be able to better determine when to close a market based on the proposed analysis by considering anticipated disruptions. The benefits and usefulness of the proposed approach are explained through a real-life case adopted from a toy supply chain in Bangladesh

Barriers to green supply chain management: An emerging economy context

© 2019 Elsevier Ltd Green supply chain management is attracting increasing attention as a way to decrease the adverse environmental effects of industries worldwide. However, considering the context of an emerging economy like Bangladesh, green supply chain management is still in its inception and has not been widely embraced in the textile industry, and therefore barriers hindering its adoption in emerging economy context demand a comprehensive investigation. This research reviews the viewpoints and hurdles in adopting green supply chain management practices in the context of the Bangladeshi textile industry. A questionnaire survey of Bangladeshi textile practitioners of operations and supply chain management division, having a sample size of thirty, was undertaken to identify the barriers, and a hierarchical cluster analysis technique was used in the detailed analysis of this data. Opinions were sought from experts on the significance of the resulting clusters, considering the relative importance of the barriers. Fifteen barriers to the adoption of green supply chain management were identified in the review of the literature, with these barriers then analyzed by using the data collected from Bangladeshi textile industry practitioners. The research indicates that the most important barrier is that there is low demand from customers and financial constraint resulting from short term little financial benefit to businesses, with lack of government regulations also a commonly faced barrier in adopting green supply chain initiatives. This study will provide valuables insights to practitioners and relevant policy makers about the barriers prevailing in the emerging economies towards the adoption of green supply chain management practices, which, in turn, can guide to undertake appropriate steps for alleviating those barriers

The Micro-Shear Bond Strength of Various Resinous Restorative Materials to Aged Biodentine

Introduction: The type of materials and application time of veneering restorations on calcium silicate cements are important factors which influence the interfacial properties. The aim of this study was to measure the micro-shear bond strength of a resin composite (RC) using several adhesive systems and a resin-modified glass ionomer cement (RM-GIC) to different aged Biodentine specimens. Methods and Materials: A total of 15 Biodentine blocks were prepared and assigned to three aging periods: 12 min, one week and one month. Then they were subdivided into five sub-groups to receive cylinders of resinous materials. RC was applied using different adhesive systems: A) no adhesive B) etch and rinse C) two-step self-etch and D) universal adhesive in self-etch mode and E) RM-GIC applied directly over Biodentine. Micro-shear bond strength was measured and the data were analyzed using one-way and two-way ANOVA. The level of significance was set at 0.05. Result: There was significant interaction between Biodentine aging periods and resinous materials (P<0.05). The highest value was obtained in group D bonded to the recently set Biodentine. Increasing the aging period to one week resulted in increased micro-shear bond strength in all groups expect for group D. One-month incubation time led to reduced shear bond strength in group A, C and D. Micro-shear bond strength values of group E increased to the longer aged Biodentine. Conclusion: Group D showed the highest bond strength to freshly mixed Biodentine.Keywords: Bond Strength; Composite Resin; Dental Adhesive; Glass Ionomer Cement; Tricalcium Silicat

Validation of the self-management ability scale (SMAS) and development and validation of a shorter scale (SMAS-S) among older patients shortly after hospitalisation

Background: The 30-item Self-Management Ability Scale (SMAS) measures self-management abilities (SMA). Objectives of this study were to (1) validate the SMAS among older people shortly after hospitalisation and (2) shorten the SMAS while maintaining adequate validity and reliability. Methods: Our study was conducted among older individuals (>= 65) who had recently been discharged from a hospital. Three months after hospital admission, 296/456 patients (65% response) were interviewed in their homes. We tested the instrument by means of structural equation modelling, and examined its validity and reliability. In addition, we tested internal consistency of the SMAS and SMAS-S among a study sample of patients at risk for cardiovascular diseases. Results: After eliminating 12 items, the confirmatory factor analyses revealed good indices of fit with the resulting 18-item SMAS (SMAS-S). To estimate construct validity of the instrument, we looked at correlations between SMAS subscale scores and overall well-being scores as measured by Social Product Function (SPF-IL) and Cantril's ladder. All SMAS subscales of the original and short version significantly correlated with SPF-IL scores (all at p <= 0.001) and Cantril's ladder (for the cognitive well-being subscale p <= 0.01; all other subscales at p <= 0.001). The findings indicated validity. Analyses of the SMAS and SMAS-S in the sample of patients at risk for cardiovascular diseases showed that both instruments are reliable. Conclusions: The psychometric properties of both the SMAS and SMAS-S are good. The SMAS-S is a promising alternate instrument to evaluate self-management abilities

IL-4Rα Blockade by Dupilumab Decreases Staphylococcus aureus Colonization and Increases Microbial Diversity in Atopic Dermatitis.

Dupilumab is a fully human antibody to interleukin-4 receptor α that improves the signs and symptoms of moderate to severe atopic dermatitis (AD). To determine the effects of dupilumab on Staphylococcus aureus colonization and microbial diversity on the skin, bacterial DNA was analyzed from swabs collected from lesional and nonlesional skin in a double-blind, placebo-controlled study of 54 patients with moderate to severe AD randomized (1:1) and treated with either dupilumab (200 mg weekly) or placebo for 16 weeks. Microbial diversity and relative abundance of Staphylococcus were assessed by DNA sequencing of 16S ribosomal RNA, and absolute S.&nbsp;aureus abundance was measured by quantitative PCR. Before treatment, lesional skin had lower microbial diversity and higher overall abundance of S.&nbsp;aureus than nonlesional skin. During dupilumab treatment, microbial diversity increased and the abundance of S.&nbsp;aureus decreased. Pronounced changes were seen in nonlesional and lesional skin. Decreased S.&nbsp;aureus abundance during dupilumab treatment correlated with clinical improvement of AD and biomarkers of type 2 immunity. We conclude that clinical improvement of AD that is mediated by interleukin-4 receptor α inhibition and the subsequent suppression of type 2 inflammation is correlated with increased microbial diversity and reduced abundance of S.&nbsp;aureus

Urinary biomarker concentrations of captan, chlormequat, chlorpyrifos and cypermethrin in UK adults and children living near agricultural land

There is limited information on the exposure to pesticides experienced by UK residents living near agricultural land. This study aimed to investigate their pesticide exposure in relation to spray events. Farmers treating crops with captan, chlormequat, chlorpyrifos or cypermethrin provided spray event information. Adults and children residing ≤100 m from sprayed fields provided first-morning void urine samples during and outwith the spray season. Selected samples (1–2 days after a spray event and at other times (background samples)) were analysed and creatinine adjusted. Generalised Linear Mixed Models were used to investigate if urinary biomarkers of these pesticides were elevated after spray events. The final data set for statistical analysis contained 1518 urine samples from 140 participants, consisting of 523 spray event and 995 background samples which were analysed for pesticide urinary biomarkers. For captan and cypermethrin, the proportion of values below the limit of detection was greater than 80%, with no difference between spray event and background samples. For chlormequat and chlorpyrifos, the geometric mean urinary biomarker concentrations following spray events were 15.4 μg/g creatinine and 2.5 μg/g creatinine, respectively, compared with 16.5 μg/g creatinine and 3.0 μg/g creatinine for background samples within the spraying season. Outwith the spraying season, concentrations for chlorpyrifos were the same as those within spraying season backgrounds, but for chlormequat, lower concentrations were observed outwith the spraying season (12.3 μg/g creatinine). Overall, we observed no evidence indicative of additional urinary pesticide biomarker excretion as a result of spray events, suggesting that sources other than local spraying are responsible for the relatively low urinary pesticide biomarkers detected in the study population

A Systematic Review of Online Sex Addiction and Clinical Treatments Using CONSORT Evaluation

Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction