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

The FRIED grid of mass-loss rates for externally irradiated protoplanetary discs

We present an open access grid of 3930 calculations of externally evaporating protoplanetary discs. This spans a range of disc sizes (1-400AU), disc masses, UV field strengths (10-10$^4$G$_0$) and stellar masses (0.05-1.9M$_\odot$). The grid is publicly available for download, and offers a means of cheaply including external photoevaporation in disc evolutionary calculations. It can also be queried using an online tool for quick estimates of instantaneous mass loss rates (e.g for convenient evaluation of real observed systems). The `FRIED' grid itself illustrates that for discs around stars $\leq0.3$M$_\odot$ external photoevaporation is effective down to small radii ($<50$AU) down to UV fields at least as weak as 10G$_0$. At the other end of the scale, in a $10^4$G$_0$ environment photoevaporation is effective down to 1AU even for stellar masses at least as high as 1.9M$_\odot$. We also illustrate in which regimes CO survives in the photoevaporative outflow for significant mass loss rates; marking a system a good candidate to detect external photoevaporation in weak-intermediate UV environments through sub-Keplerian rotation. Finally we make illustrative mass loss rate estimates for discs in Taurus based on the Guilloteau et al. (2011) star-disc parameters, finding that around half are expected to have both significant mass loss and retain CO in the photoevaporative outflow.Comment: 16 pages, 9 figures. Accepted for publication in MNRA

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

Genomic Analysis of Response to Neoadjuvant Chemotherapy in Esophageal Adenocarcinoma

Neoadjuvant therapy followed by surgery is the standard of care for locally advanced esophageal adenocarcinoma (EAC). Unfortunately, response to neoadjuvant chemotherapy (NAC) is poor (20-37%), as is the overall survival benefit at five years (9%). The EAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns may result in chemotherapy sensitivity or resistance. To identify associations between genomic events and response to NAC in EAC, a comparative genomic analysis was performed in 65 patients with extensive clinical and pathological annotation using whole-genome sequencing (WGS). We defined response using Mandard Tumor Regression Grade (TRG), with responders classified as TRG1-2 (n = 27) and non-responders classified as TRG4-5 (n =38). We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs. 1.70/Mb, p = 0.036) and elevated copy number variation in non-responders (282 vs. 136/patient, p < 0.001). We identified copy number variants unique to each group in our cohort, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of note, NAV3 mutations were exclusively present in the non-responder group with a frequency of 22%. Thus, lower mutation burden, higher chromosomal instability and specific copy number alterations are associated with resistance to NAC

Correlative tomography of an exceptionally preserved Jurassic ammonite implies hyponome-propelled swimming

The extreme rarity of soft-tissue preservation in ammonoids has meant there are open questions regarding fundamental aspects of their biology. We report an exceptionally preserved Middle Jurassic ammonite with unrivaled information on soft-body organization interpreted through correlative neutron and X-ray tomography. Three-dimensional imaging of muscles and organs of the body mass for the first time in this iconic fossil group provides key insights into functional morphology. We show that paired dorsal muscles withdrew the body into the shell, rather than acting with the funnel controlling propulsion as in Nautilus. This suggests a mobile, retractable body as a defense strategy and necessitates a distinct swimming mechanism of hyponome propulsion, a trait that we infer evolved early in the ammonoid-coleoid lineage.Copyright © 2021, The Authors. This document is the author’s final accepted version of the journal article. You are advised to consult the published version if you wish to cite from it

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria

<p>Abstract</p> <p>Background</p> <p>To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.</p> <p>Methods</p> <p>Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.</p> <p>Results</p> <p>There were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (<it>Vernonia amygdalina</it>) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m²; P = 0.05).</p> <p>Conclusion</p> <p>A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.</p

Modern Slavery, Environmental Degradation and Climate Change: Fisheries, Field, Forests and Factories

In this commentary paper, the current state of research on the tightly connected and bi-directional relationships among modern slavery, environmental degradation and climate change is critically assessed and reviewed. An emerging branch of research has begun to conceptualize linkages between slavery and environmental change. Responding to a gap in the extant literature, this paper synthesizes and makes sense of this emerging research base and proposes a future research agenda for exploring the slavery–environment nexus. Through an exploration of 19 key texts which explicitly examine the relationship between slavery and environmental change, spanning across diverse disciplines and spatial scales, we draw out two key arguments that can be adopted in proposing a future research agenda. Firstly, we identify the sectoral emergence of the nexus, forming primarily around four key sectors: (i) Fisheries, (ii) Fields, (iii) Forests and (iv) Factories. The review suggests that a sufficient exploration of slavery–environment linkages needs to transverse these sectoral boundaries. Secondly, the paper highlights the bi-directional interactions among modern slavery, climate change and environmental degradation. Accordingly, we argue for a holistic lens which explores how slavery practices and environmental change are continually shaping one another. Existing research has provided initial understandings of the relationship among modern slavery, environmental destruction and climate change. However, there remains considerable scope for the connections between the three to be further interrogated and unpacked. Based on the review, the paper sets out three key research agendas, highlighting the need to move beyond a spatially and sectorally confined exploration of slavery–environment interactions towards an integrated and sophisticated interrogation of the nexus. Additionally, we propose the future examination of the deep underlying drivers of slavery–environment interactions and to situate these within contemporary capitalist social and economic relations