Exploring the interaction of inventory policies across the supply chain: An agent-based approach

The Bullwhip Effect, which refers to the increasing variability of orders traveling upstream the supply chain, has shown to be a severe problem for many industries. The inventory policy of the various nodes is an important contributory factor to this phenomenon, and hence it significantly impacts on their financial performance. This fact has led to a large amount of research on replenishment and forecasting methods aimed at exploring their suitability depending on a range of environmental factors, e.g. the demand pattern and the lead time. This research work approaches this issue by seeing the whole picture of the supply chain. We study the interaction between four widely used inventory models in five different contexts depending on the customer demand variability and the safety stock. We show that the concurrence of distinct inventory models in the supply chain, which is a common situation in practice, may alleviate the generation of inefficiencies derived from the Bullwhip Effect. In this sense, we demonstrate that the performance of each policy depends not only upon the external environment but also upon the position within the system and upon the decisions of the other nodes. The experiments have been carried out via an agent-based system whose agents simulate the behavior of the different supply chain actors. This technique proves to offer a powerful and risk-free approach for business exploration and transformation

Los Objetivos de Desarrollo Sostenible y las Grandes Empresas Españolas: Un análisis de su Compromiso a partir de su Reporte No Financiero

[EN] This paper aims to analyse the level of commitment with the SDGs of large Spanish companies based on the information published in their Non-Financial Statements and their letters from the chairman. To achieve this objective and identify potential explanatory factors, a balanced sample of 58 Spanish companies, 29 listed and 29 unlisted, in 2019 has been used. The results of this study evidence: i) the greater commitment with the SDGs of companies which are exposed in the stock markets and those which are larger; ii) the relevance of the diversity into the boards of directors, in order to integrate the largest and the widest number of interests as well as those values and principles which are intrinsically associated to women directors; and iii) the greater emphasis on those SDGs related to well-known issues by these organizations, thanks to their greater experience in non-financial reporting, publishing documents such as corporate social responsibility or sustainability reports.[ES] El presente trabajo tiene como principal objetivo evaluar el nivel de compromiso con los Objetivos de Desarrollo Sostenible (ODS) de las grandes empresas españolas a partir de la información contenida en sus Estados de Información No Financiera (EINF) y las cartas de sus presidentes e identificar los posibles factores explicativos asociados a la propia organización. Para ello se ha contado con una muestra equilibrada de 58 compañías españolas, 29 cotizadas y 29 no cotizadas, en el ejercicio 2019. Los resultados obtenidos ponen de relieve: i) la mayor preocupación que despiertan los ODS entre las empresas expuestas en los mercados bursátiles y aquellas que son de mayor tamaño; ii) la importancia de contar con consejos de administración diversos, que integren el mayor número de intereses posibles así como aquellos valores y principios que se atribuyen de forma intrínseca a las mujeres; y iii) el mayor énfasis en aquellos ODS relacionados con aquellas temáticas ya conocidas por este tipo de organizaciones, gracias a su mayor experiencia en el reporting no financiero, publicando documentos como los informes de responsabilidad social corporativa o las memorias de sostenibilidad

Frailty level prediction in older age using hand grip strength functions over time

This version of the article has been accepted for publication, after peer review and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/978-3-030-85099-9_29.Frailty syndrome can be defined as a clinical state in which there is a rise in individual vulnerability, developing an increase in both the dependence of the person and mortality. Frailty is completely related to age. A fundamental factor to apply rehabilitative interventions successfully resides in having a simple and reliable method capable of identifying frailty syndrome. Frailty indexes (FI) have several sources of uncertainty trough the opinion of the patients, white coat effect and external factors. Moreover, in the clinical practice, the experience of the geriatricians led them to determine an approximation of the frailty level only with a simple handshake. Hand grip strength (HGS) has been widely used in tests by investigators and therapists to be able to diagnose sarcopenia and frailty, as it is a reliable indicator of the overall muscle strength, which decreases with age. Most researches focused mainly on peak HGS, which will not give insight on how the patient’s strength was distributed over time. In the present work it is proposed to evaluate HGS behavior over a period of time, and to develop a system based on Machine Learning for the identification of frailty levels using physiological features, FI and the classical signal processing based on statistics of the HGS signals. The starting hypothesis is that it can be identified the “way” of performing HGS correlated with the level of frailty. To achieve this goal a clinical study was designed and carried out with a cohort of 70 elderly persons, in two Hospitals.This work was partially supported by the Spanish Ministry of Ciencia, Innovación y Universidades under project RTI2018-096701-B-C22, and by the Catalonia FEDER program, resolution GAH/815/2018 under the project, PECT Garraf : Envelliment actiu i saludable i dependència.Peer ReviewedPostprint (author's final draft

Sexual Relationships in Hispanic Countries: a Literature Review

This is a pre-print of an article published in Current Sexual Health Reports. The final authenticated version is available online at: https://doi.org/10.1007/s11930-020-00272-6Purpose of Review: Sexuality is a complex dimension for which culture seems to play an important role, particularly in countries that are more traditional. This review summarizes the knowledge about sexual relationships in Hispanic countries, considering sexual debut, attitudes, behaviors, and satisfaction. Recent Findings: In line with the literature reviewed, the sexual double standard seems to be continuing to influence sexual relationships. Some countries show more open expressions of sexuality based on the level of gender inequality or sexualized context, and within countries, variables such as religious commitment, family characteristics, and access to resources may play important roles in sexuality. Summary: Future research, policies, and interventions should consider these specific characteristics, including these forms of expression of sexuality, in the adjustment of cross-cultural and cross-national strategies

Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known. Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson?s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months. The primary outcome is the efficiency of the Parkinson?s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor?patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective. Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Funding This work is supported by AbbVie S.L.U, the Instituto de Salud Carlos III [DTS17/00195] and the European Fund for Regional Development, 'A way to make Europe'

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives