Back-to-back coral bleaching events on isolated atolls in the Coral Sea

Severe bleaching events caused by marine heatwaves over the past four decades have now affected almost every coral reef ecosystem in the world. These recurring events have led to major losses of coral cover, with adverse consequences for tropical reef ecosystems and the people who depend on them. Here, we document two consecutive and widespread coral bleaching events on remote atolls in the Coral Sea in 2016 and 2017. In each year, the proportion of colonies that bleached was strongly related to heat exposure (measured as Degree Heating Weeks, DHW, °C-weeks), depth and coral assemblage structure. Bleaching was more severe at higher DHW exposure, and at sites with a higher proportion of susceptible taxa. Bleaching was also lower at 6 m than at 2 m depth. Despite the severe bleaching in 2016 on reefs in the central section of the Coral Sea Marine Park, total coral cover was not significantly reduced by 2017, suggesting that most bleached corals survived. Moreover, bleaching was less severe in 2017 despite a higher exposure to heat stress. These results indicate that while the isolation of these oceanic reefs provides no refuge from bleaching, low nutrient levels, high wave energy and proximity to cooler deeper waters may make coral on these reefs more resistant to bleaching induced mortality

A SIMULATION BASED SCHEDULING MODEL FOR CALL CENTERS WITH UNCERTAIN ARRIVAL RATES

In this paper we develop a two stage algorithm for scheduling call centers with strict SLAs and arrival rate uncertainty. The first cut schedule can be developed in less than a minute using a constructive heuristic. The schedule is then refined via a simulation based optimization approach. We find that when allowed to run for five minutes or less this two stage process can create a schedule with a total expected cost within a few percentage points of schedules generated using much more computationally intensive methods. This rapid scheduling process is designed to support front line managers who wish to evaluate multiple scheduling options in a what if analysis mode

Estimation in supply chain inventory management

Differences in estimation or forecasting procedures could produce dramatically different parameter estimates in supply chain inventory management. We show, for example, that determining when to introduce estimates of lead times in the calculation of the variance of demand during lead time can yield dramatically different safety stocks and order-up-to levels. Also, calculations of supply chain variance amplification using a firewalled, sequential chain execution differ markedly from an analysis that considers a k-echelon analysis as a whole, k  > 2. There is also the issue of forecasting lumpy demand when negative orders are not allowed. Our research compares the results in the recent literature and shows how apparently equivalent estimation procedures concerning demand during lead time (for example, using separate historical lead time and demand rate data versus directly using historical data of demand during lead time) are not equivalent; also, that the conventional exponential smoothing forecasting may not be appropriate at the higher echelons of supply chains where lumpy demand frequently occurs

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

<p>Abstract</p> <p>Background</p> <p>Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.</p> <p>Methods</p> <p>We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.</p> <p>Results</p> <p>One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).</p> <p>Conclusions</p> <p>One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.</p

Dynamic analysis and design of a semiconductor supply chain: a control engineering approach

The combined make-to-stock and make-to-order (MTS-MTO) supply chain is well-recognised in the semiconductor industry in order to find a competitive balance between agility, including customer responsiveness and minimum reasonable inventory, to achieve cost efficiency while maintaining customer service levels. Such a hybrid MTS-MTO supply chain may suffer from the bullwhip effect, but few researchers have attempted to understand the dynamic properties of such a hybrid system. We utilise a model of the Intel supply chain to analytically explore the underlying mechanisms of bullwhip generation and compare its dynamic performance to the well-known Inventory and Order-Based Production Control System (IOBPCS) archetype. Adopting a control engineering approach, we find that the feedforward forecasting compensation in the MTO element plays a major role in the degree of bullwhip and the Customer Order Decoupling Point (CODP) profoundly impacts both the bullwhip effect and the inventory variance in the MTS part. Thus, managers should carefully tune the CODP inventory correction and balance the benefit between CODP inventory and bullwhip costs in hybrid MTS-MTO supply chains

An alternative to the hand searching gold standard: validating methodological search filters using relative recall

BACKGROUND: Search filters or hedges play an important role in evidence-based medicine but their development depends on the availability of a "gold standard" – a reference standard against which to establish the performance of the filter. We demonstrate the feasibility of using relative recall of included studies from multiple systematic reviews to validate methodological search filters as an alternative to validation against a gold standard formed through hand searching. METHODS: We identified 105 Cochrane reviews that used the Highly Sensitive Search Strategy (HSSS), included randomized or quasi-randomized controlled trials, and reported their included studies. We measured the ability of two published and one novel variant of the HSSS to retrieve the MEDLINE-index studies included in these reviews. RESULTS: The systematic reviews were comprehensive in their searches. 72% of included primary studies were indexed in MEDLINE. Relative recall of the three strategies ranged from .98 to .91 across all reviews and more comprehensive strategies showed higher recall. CONCLUSION: An approach using relative recall instead of a hand searching gold standard proved feasible and produced recall figures that were congruent with previously published figures for the HSSS. This technique would permit validation of a methodological filter using a collection of approximately 100 studies of the chosen design drawn from the included studies of multiple systematic reviews that used comprehensive search strategies

Opposing effects of dietary n-3 and n-6 fatty acids on mammary carcinogenesis: The Singapore Chinese Health Study

10.1038/sj.bjc.6601340British Journal of Cancer8991686-1692BJCA

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Low Utilization of Circulating Glucose after Food Withdrawal in Snell Dwarf Mice

Glucose metabolism is altered in long-lived people and mice. Although it is clear that there is an association between altered glucose metabolism and longevity, it is not known whether this link is causal or not. Our current hypothesis is that decreased fasting glucose utilization may increase longevity by reducing oxygen radical production, a potential cause of aging. We observed that whole body fasting glucose utilization was lower in the Snell dwarf, a long-lived mutant mouse. Whole body fasting glucose utilization may be reduced by a decrease in the production of circulating glucose. Our isotope labeling analysis indicated both gluconeogenesis and glycogenolysis were suppressed in Snell dwarfs. Elevated circulating adiponectin may contribute to the reduction of glucose production in Snell dwarfs. Adiponectin lowered the appearance of glucose in the media over hepatoma cells by suppressing gluconeogenesis and glycogenolysis. The suppression of glucose production by adiponectin in vitro depended on AMP-activated protein kinase, a cell mediator of fatty acid oxidation. Elevated fatty acid oxidation was indicated in Snell dwarfs by increased utilization of circulating oleic acid, reduced intracellular triglyceride content, and increased phosphorylation of acetyl-CoA carboxylase. Finally, protein carbonyl content, a marker of oxygen radical damage, was decreased in Snell dwarfs. The correlation between high glucose utilization and elevated oxygen radical production was also observed in vitro by altering the concentrations of glucose and fatty acids in the media or pharmacologic inhibition of glucose and fatty acid oxidation with 4-hydroxycyanocinnamic acid and etomoxir, respectively