Capacity flexibility allocation in an outsourced supply chain with reservation

We consider a contract manufacturer that serves a limited number of outsourcers (customers) on a single capacitated production line. The outsourcers have different levels of demand uncertainty and the contract manufacturer faces the question how to allocate the contractual capacity flexibility in an optimal way. The contractual capacity flexibility is a contract parameter that sets the amount of demand the contract manufacturer is obliged to accept from the outsourcers. We develop a hierarchical model that consists of two decision levels. At the tactical level, the contract manufacturer allocates the capacity flexibility to the different outsourcers by maximizing the expected profit. Offering more flexibility to the more uncertain outsourcer generates higher expected revenue, but also increases the expected penalty costs. The allocated capacity flexibilities (determined at the tactical level) are input parameters to the lower decision level, where the operational planning decisions are made and actual demands are observed. We perform a numerical study by solving the two-level hierarchical planning problem iteratively. We first solve the higher level problem, which has been formulated as an integer program, and then perform a simulation study, where we solve a mathematical programming model in a rolling horizon setting to measure the operational performance of the system. The simulation results reveal that when the acceptance decision is made (given the allocated capacity flexibility decision), priority is given to the less uncertain outsourcer, whereas when the orders are placed, priority is given to the most uncertain outsourcer. Our insights are helpful for contract manufacturers when having contract negotiations with the outsourcers. Moreover, we show that hierarchical integration and anticipation are required, especially for cases with high penalty cost and tight capacities

Differential contractile response of critically ill patients to neuromuscular electrical stimulation

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been investigated as a preventative measure for intensive care unit-acquired weakness. Trial results remain contradictory and therefore inconclusive. As it has been shown that NMES does not necessarily lead to a contractile response, our aim was to characterise the response of critically ill patients to NMES and investigate potential outcome benefits of an adequate contractile response. METHODS: This is a sub-analysis of a randomised controlled trial investigating early muscle activating measures together with protocol-based physiotherapy in patients with a SOFA score ≥ 9 within the first 72 h after admission. Included patients received protocol-based physiotherapy twice daily for 20 min and NMES once daily for 20 min, bilaterally on eight muscle groups. Electrical current was increased up to 70 mA or until a contraction was detected visually or on palpation. Muscle strength was measured by a blinded assessor at the first adequate awakening and ICU discharge. RESULTS: One thousand eight hundred twenty-four neuromuscular electrical stimulations in 21 patients starting on day 3.0 (2.0/6.0) after ICU admission were included in this sub-analysis. Contractile response decreased from 64.4% on day 1 to 25.0% on day 7 with a significantly lower response rate in the lower extremities and proximal muscle groups. The electrical current required to elicit a contraction did not change over time (day 1, 50.2 [31.3/58.8] mA; day 7, 45.3 [38.0/57.5] mA). The electrical current necessary for a contractile response was higher in the lower extremities. At the first awakening, patients presented with significant weakness (3.2 [2.5/3.8] MRC score). When dividing the cohort into responders and non-responders (> 50% vs. ≤ 50% contractile response), we observed a significantly higher SOFA score in non-responders. The electrical current necessary for a muscle contraction in responders was significantly lower (38.0 [32.8/42.9] vs. 54.7 [51.3/56.0] mA, p < 0.001). Muscle strength showed higher values in the upper extremities of responders at ICU discharge (4.4 [4.1/4.6] vs. 3.3 [2.8/3.8] MRC score, p = 0.036). CONCLUSION: Patients show a differential contractile response to NMES, which appears to be dependent on the severity of illness and also relevant for potential outcome benefits. TRIAL REGISTRATION: ISRCTN ISRCTN19392591 , registered 17 February 201

Mesozoic evolution of West Antarctica and the Weddell Sea Basin: new paleomagnetic constraints

Paleomagnetic data from the Antarctic Peninsula and our recent results from the Ellsworth-Whitmore Mountains block suggest that since the Middle Jurassic these two West Antarctic blocks have undergone little relative movement and together have rotated relative to the East Antarctic craton. New data from Lower Cretaceous rocks from the Thurston Island region of West Antarctica suggest that on the basis of paleomagnetic constraints, the Antarctic Peninsula, Ellsworth-Whitmore Mountains and Thurston Island blocks define a single entity which we call Weddellia; some motion between these blocks is possible within the limits of the paleomagnetic data. Between the Middle Jurassic and Early Cretaceous, Weddellia remained attached to West Gondwanaland while East Antarctica moved southward (dextrally) relative to Weddellia. From the Early Cretaceous to mid-Cretaceous, Weddellia rotated clockwise 30° and moved sinistrally approximately 2500 km relative to East Antarctica, to its present-day position. We suggest the Early to mid-Cretaceous to be the time of the main if not initial opening of the Weddell Sea

New Paleomagnetic Data From Thurston Island: Implications for the Tectonics of West Antarctica and Weddell Sea Opening

Paleomagnetic data from three West Antarctic crustal blocks (Antarctic Peninsula (AP), Thurston Island-Eights Coast (TI), and the Ellsworth-Whitmore Mountains (EWM) indicate that there has been motion between the individual blocks and motion relative to East Antarctica during the Mesozoic. A Triassic paleomagnetic pole from the TI block (116°E, 61°S, A_95 = 19.4°, N = 3 VGPs) appears to indicate that the block has rotated ~90° relative to East Antarctica between 230 Ma and 110 Ma. Our previously reported Middle Jurassic paleomagnetic pole from the EWM block indicates that a 90° rotation relative to East Antarctica occurred sometime between the Cambrian and 175 Ma. We believe that the 90° counterclockwise EWM rotation occurred between ~220 Ma and 175 Ma related to the development of post-Gondwanide Orogeny shear zones. The motion of the AP, TI, and EWM blocks appears to be linked during the mid- to late Mesozoic to three major events in the evolution of the southern ocean basins. Opening in the Mozambique-Somali-Weddell Sea basins may have produced major counterclockwise rotation of the TI block with respect to East Antarctica between the Jurassic and Early Cretaceous based on new Late Jurassic (145°E, 64.5°S, A_95 = 7°,N = 5 VGPs) poles. We believe that the TI rotation, as well as deformation in the southern AP block, was caused by collision and shearing of the EWM block against the other two as the EWM block moved southward with East Antarctica. An Early Cretaceous paleomagnetic pole (232°E, 49°S, A_95 = 7.9°, N = 5 VGPs) from the TI block requires that between the Early and mid- Cretaceous there was clockwise rotation, with respect to East Antarctica, of the AP-TI-EWM blocks (an entity we call Weddellia). A change in the opening history of the Weddell Sea basin caused by initiation of spreading in the South Atlantic ocean basin at ~130 Ma probably started Weddellia's clockwise rotation. Two new ~110 and ~90 Ma poles from the TI block (210°E, 73°S, A_95 = 7.6°,N = 7 VGPs and 161°E, 81°S, A_95= 3.9°,N = 18 VGPs, respectively) are similar to equivalent age poles from the AP block and East Antarctica and indicate that Weddellia was at or near its present-day position with respect to East Antarctica by ~110 Ma. This corresponds to a time of major plate reorganization in the South Atlantic and southeast Indian Oceans. Based on both the new TI paleomagnetic data and previously reported data from Marie Byrd Land (MBL), dextral shearing would be expected to have occurred between MBL and Weddellia since the mid-Cretaceous. Pine Island Bay, the area between the TI and MBL blocks, marks a fundamental and complex tectonic boundary in West Antarctica that we propose has largely been a zone of transcurrent shearing

Observation of mesospheric air inside the arctic stratospheric polar vortex in early 2003

During several balloon flights inside the Arctic polar vortex in early 2003, unusual trace gas distributions were observed, which indicate a strong influence of mesospheric air in the stratosphere. The tuneable diode laser (TDL) instrument SPIRALE (Spectroscopie InFrarouge par Absorption de Lasers Embarqués) measured unusually high CO values (up to 600 ppb) on 27 January at about 30 km altitude. The cryosampler BONBON sampled air masses with very high molecular Hydrogen, extremely low SF6 and enhanced CO values on 6 March at about 25 km altitude. Finally, the MIPAS (Michelson Interferometer for Passive Atmospheric Sounding) Fourier Transform Infra-Red (FTIR) spectrometer showed NOy values which are significantly higher than NOy* (the NOy derived from a correlation between N2O and NOy under undisturbed conditions), on 21 and 22 March in a layer centred at 22 km altitude. Thus, the mesospheric air seems to have been present in a layer descending from about 30 km in late January to 25 km altitude in early March and about 22 km altitude on 20 March. We present corroborating evidence from a model study using the KASIMA (KArlsruhe Simulation model of the Middle Atmosphere) model that also shows a layer of mesospheric air, which descended into the stratosphere in November and early December 2002, before the minor warming which occurred in late December 2002 lead to a descent of upper stratospheric air, cutting of a layer in which mesospheric air is present. This layer then descended inside the vortex over the course of the winter. The same feature is found in trajectory calculations, based on a large number of trajectories started in the vicinity of the observations on 6 March. Based on the difference between the mean age derived from SF6 (which has an irreversible mesospheric loss) and from CO2 (whose mesospheric loss is much smaller and reversible) we estimate that the fraction of mesospheric air in the layer observed on 6 March, must have been somewhere between 35% and 100%

Ellsworth-Whitmore Mountains Crustal Block, Western Antarctica: New paleomagnetic results and their tectonic significance

Preliminary paleomagnetic study of granitic and sedimentary rocks from the Ellsworth-Whitmore Mountains crustal block (EVH), Vest Antarctica, leads to the following conclusions: (1) The EVH has a paleogole for the Middle Jurassic located at 235°E, 41°S, (α₉₅ = 5.3, N = 8 sites) assuming that no widespread regional tilting has occurred since the magnetization measured was acquired. A Middle Jurassic paleolatitude of 47°S is indicated for the sites and precludes an original location for the EVH block south of the Antarctic Peninsula crustal block (AP). (2) This pole is not significantly different from the previously published Middle Jurassic paleopole obtained from rocks of the northern Antarctic Peninsula. The combined AP-EVH paleopole, compared to the Middle Jurassic mean paleopole obtained from igneous rocks of the Ferrar Supergroup in East Antarctica, suggests about 15° tectonic clockwise rotation of the AP and EVH. Since the AP and EVH poles coincide, these two crustal blocks may have moved as one unit since the Middle Jurassic. ( 3) The new data are compatible with two different Gondwanaland reconstructions. The first considers the AP and EVH as separate entities. The second is based on the movement of the AP and EVH as one block. For the Middle Jurassic, both reconstructions would locate the EVH west of Coats Land and south of the Falkland Plateau, with the adjacent AP located south of southernmost South America. (4) Enigmas concerning the structural trend and isolation of the thick Ellsworth Mountains Paleozoic succession persist

Impact of protocol‐based physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients

Background: The impact of physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients is not well understood. Methods: This pooled analysis investigates the impact of different physiotherapeutic strategies on insulin sensitivity in critically ill patients. We pooled data from two previous trials in adult patients with sequential organ failure assessment score (SOFA)>= 9 within 72 h of intensive care unit (ICU) admission, who received hyperinsulinaemic euglycaemic (HE) clamps. Patients were divided into three groups: standard physiotherapy (sPT, n = 22), protocol-based physiotherapy (pPT, n = 8), and pPT with added muscle activating measures (pPT+, n = 20). Insulin sensitivity index (ISI) was determined by HE clamp. Muscle metabolites lactate, pyruvate, and glycerol were measured in the M. vastus lateralis via microdialysis during the HE clamp. Histochemical visualization of glucose transporter-4 (GLUT4) translocation was performed in surgically extracted muscle biopsies. All data are reported as median (25th/75th percentile) (trial registry: ISRCTN77569430 and ISRCTN19392591/ethics approval: Charite-EA2/061/06 and Charite-EA2/041/10). Results Fifty critically ill patients (admission SOFA 13) showed markedly decreased ISIs on Day 17 (interquartile range) 0.029 (0.022/0.048) (mg/min/kg)/(mU/L) compared with healthy controls 0.103 (0.087/0.111), P < 0.001. ISI correlated with muscle strength measured by medical research council (MRC) score at first awakening (r = 0.383, P = 0.026) and at ICU discharge (r = 0.503, P = 0.002). Different physiotherapeutic strategies showed no effect on the ISI [sPT 0.029 (0.019/0.053) (mg/min/kg)/(mU/L) vs. pPT 0.026 (0.023/0.041) (mg/min/kg)/(mU/L) vs. pPT+ 0.029 (0.023/0.042) (mg/min/kg)/(mU/L); P = 0.919]. Regardless of the physiotherapeutic strategy metabolic flexibility was reduced. Relative change of lactate/pyruvate ratio during HE clamp is as follows: sPT 0.09 (-0.13/0.27) vs. pPT 0.07 (-0.16/0.31) vs. pPT+ -0.06 (-0.19/0.16), P = 0.729, and relative change of glycerol concentration: sPT -0.39 (-0.8/-0.12) vs. pPT -0.21 (-0.33/0.07) vs. pPT+ -0.21 (-0.44/-0.03), P = 0.257. The majority of ICU patients showed abnormal localization of GLUT4 with membranous GLUT4 distribution in 37.5% (3 of 8) of ICU patients receiving sPT, in 42.9% (3 of 7) of ICU patients receiving pPT, and in 53.8% (7 of 13) of ICU patients receiving pPT+ (no statistical testing possible). Conclusions: Our data suggest that a higher duration of muscle activating measures had no impact on insulin sensitivity or metabolic flexibility in critically ill patients with sepsis-related multiple organ failure

Validation and data characteristics of methane and nitrous oxide profiles observed by MIPAS and processed with Version 4.61 algorithm

The ENVISAT validation programme for the atmospheric instruments MIPAS, SCIAMACHY and GOMOS is based on a number of balloon-borne, aircraft, satellite and ground-based correlative measurements. In particular the activities of validation scientists were coordinated by ESA within the ENVISAT Stratospheric Aircraft and Balloon Campaign or ESABC. As part of a series of similar papers on other species [this issue] and in parallel to the contribution of the individual validation teams, the present paper provides a synthesis of comparisons performed between MIPAS CH4 and N2O profiles produced by the current ESA operational software (Instrument Processing Facility version 4.61 or IPF v4.61, full resolution MIPAS data covering the period 9 July 2002 to 26 March 2004) and correlative measurements obtained from balloon and aircraft experiments as well as from satellite sensors or from ground-based instruments. In the middle stratosphere, no significant bias is observed between MIPAS and correlative measurements, and MIPAS is providing a very consistent and global picture of the distribution of CH4 and N2O in this region. In average, the MIPAS CH4 values show a small positive bias in the lower stratosphere of about 5%. A similar situation is observed for N2O with a positive bias of 4%. In the lower stratosphere/upper troposphere (UT/LS) the individual used MIPAS data version 4.61 still exhibits some unphysical oscillations in individual CH4 and N2O profiles caused by the processing algorithm (with almost no regularization). Taking these problems into account, the MIPAS CH4 and N2O profiles are behaving as expected from the internal error estimation of IPF v4.61 and the estimated errors of the correlative measurements

Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study

Background: Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation. Methods: We conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs. Results: A total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI - 0.09, - 0.05; p 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 mu g/kg/min norepinephrine for out-of-bed (IMS >= 2) and 0.33 mu g/kg/min for in-bed (IMS 0-1) mobilisation. Conclusions: Mobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 mu g/kg/min for out-of-bed (IMS >= 2) and 0.33 mu g/kg/min for in-bed (IMS 0-1) mobilisation

Seismicity and Pn Velocity Structure of Central West Antarctica

We have located 117 previously undetected seismic events mainly occurring between 2015 and 2017 that originated from glacial, tectonic, and volcanic processes in central West Antarctica using data recorded on Polar Earth Observing Network (POLENET/ANET) and UK Antarctic Network (UKANET) seismic stations. The seismic events, with local magnitudes (ML) ranging from 1.1 to 3.5, are predominantly clustered in four geographic regions; the Ellsworth Mountains, Thwaites Glacier, Pine Island Glacier, and Mount Takahe. Eighteen of the events are in the Ellsworth Mountains and can be attributed to a mixture of glacial and tectonic processes. The largest event noted in this study was a mid‐crustal (∼19 km focal depth; ML 3.5) normal mechanism earthquake beneath Thwaites Glacier. We also located 91 glacial events near the grounding zones of Thwaites Glacier and Pine Island Glacier that are predominantly associated with time periods of significant calving activity. Eight events, likely arising from volcano‐tectonic processes, occurred beneath Mount Takahe. Using Pn travel times from the seismic events, we find laterally variable uppermost mantle structure in central West Antarctica. On average, the Ellsworth Mountains are underlain by a faster mantle lid (VPn = ∼8.4 km/s) compared to the Amundsen Sea Embayment region (VPn = ∼8.1 km/s). Within the Amundsen Sea Embayment itself, we find mantle lid velocities ranging from ∼8.05 to 8.18 km/s. Laterally heterogeneous uppermost mantle structure, indicative of variable thermal and rheological structure, likely influences both geothermal heat flux and glacial isostatic adjustment spatial patterns and rates within central West Antarctica