Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by the anesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions

A neural blackboard architecture of sentence structure

We present a neural architecture for sentence representation. Sentences are represented in terms of word representations as constituents. A word representation consists of a neural assembly distributed over the brain. Sentence representation does not result from associations between neural word assemblies. Instead, word assemblies are embedded in a neural architecture, in which the structural (thematic) relations between words can be represented. Arbitrary thematic relations between arguments and verbs can be represented. Arguments can consist of nouns and phrases, as in sentences with relative clauses. A number of sentences can be stored simultaneously in this architecture. We simulate how probe questions about thematic relations can be answered. We discuss how differences in sentence complexity, such as the difference between subject-extracted versus object-extracted relative clauses and the difference between right-branching versus center-embedded structures, can be related to the underlying neural dynamics of the model. Finally, we illustrate how memory capacity for sentence representation can be related to the nature of reverberating neural activity, which is used to store information temporarily in this architecture

The value of coordination in a two echelon supply chain: Sharing information, policies and parameters.

We study a coordination scheme in a two echelon supply chain. It involves sharing details of replenishment rules, lead-times, demand patterns and tuning the replenishment rules to exploit the supply chain's cost structure. We examine four different coordination strategies; naïve operation, local optimisation, global optimisation and altruistic behaviour on behalf of the retailer. We assume the retailer and the manufacturer use the Order-Up-To policy to determine replenishment orders and end consumers demand is a stationary i.i.d. random variable. We derive the variance of the retailer's order rate and inventory levels and the variance of the manufacturer's order rate and inventory levels. We initially assume that costs in the supply chain are directly proportional to these variances (and later the standard deviations) and investigate the options available to the supply chain members for minimising costs. Our results show that if the retailer takes responsibility for supply chain cost reduction and acts altruistically by dampening his order variability, then the performance enhancement is robust to both the actual costs in the supply chain and to a naïve or uncooperative manufacturer. Superior performance is achievable if firms coordinate their actions and if they find ways to re-allocate the supply chain gain.Bullwhip; Global optimisation; Inventory variance; Local optimisation; Supply chains; Studies; Coordination; Supply chain; IT; Replenishment rule; Rules; Demand; Patterns; Cost; Structure; Strategy; Retailer; Policy; Order; Variance; Inventory; Costs; Options; Variability; Performance; Performance enhancement; Firms;

Trends in embryo disposition decisions: patients' responses to a 15-year mailing program

BACKGROUND: This study examined the responses of patients of a Belgian fertility center to mailed requests to make or renew an embryo disposition decision (EDD), over a period of 15 years, to investigate trends in the decisions. METHODS: A retrospective analysis was performed on a mailing program from 1992 to 2006, for patients, of the Department of Reproductive Medicine, Ghent University Hospital (Belgium), from whom embryos had been cryopreserved at least 2 years. RESULTS: In 15 years, 3840 EDD forms were prepared for 2334 couples or female patients. The number of forms increased from 21 in 1992 to 558 in 2006. Each year, around a third of the forms were not returned. In general, a quarter of patients who received more than one form never answered. Donation to others for reproduction was overall the least popular option and decreased over the years. The rising trend in decisions to discard reversed into a negative trend from the introduction of donation for science (1997). Since then, donation for science has been the most popular option and its popularity increased with time. In 15 years, 2504 embryos were donated for science. More than a quarter of the patients who chose more than one final EDD in different years did not select the same EDD the second time. CONCLUSIONS: This study showed a positive trend in donation for science and a negative trend in donation to others and discarding. A substantial number of individual patients chose different types of EDDs in consecutive mailings, which shows that advance EDD directives should be used with caution

The role of recurrent networks in neural architectures of grounded cognition: learning of control

Recurrent networks have been used as neural models of language processing, with mixed results. Here, we discuss the role of recurrent networks in a neural architecture of grounded cognition. In particular, we discuss how the control of binding in this architecture can be learned. We trained a simple recurrent network (SRN) and a feedforward network (FFN) for this task. The results show that information from the architecture is needed as input for these networks to learn control of binding. Thus, both control systems are recurrent. We found that the recurrent system consisting of the architecture and an SRN or an FFN as a "core" can learn basic (but recursive) sentence structures. Problems with control of binding arise when the system with the SRN is tested on number of new sentence structures. In contrast, control of binding for these structures succeeds with the FFN. Yet, for some structures with (unlimited) embeddings, difficulties arise due to dynamical binding conflicts in the architecture itself. In closing, we discuss potential future developments of the architecture presented here

Dampening variability by using smoothing replenishment rules.

A major cause of supply chain deficiencies is the bullwhip effect which can be substantial even over a single echelon. This effect refers to the tendency of the variance of the replenishment orders to increase as it moves up a supply chain. Supply chain managers experience this variance amplification in both inventory levels and replenishment orders. As a result, companies face shortages or bloated inventories, run-away transportation and warehousing costs and major production adjustment costs. In this article we analyse a major cause of the bullwhip effect and suggest a remedy. We focus on a smoothing replenishment rule that is able to reduce the bullwhip effect across a single echelon. In general, dampening variability in orders may have a negative impact on customer service due to inventory variance increases. We therefore quantify the variance of the net stock and compute the required safety stock as a function of the smoothing required. Our analysis shows that bullwhip can be satisfactorily managed without unduly increasing stock levels to maintain target fill rates.Bullwhip effect; Companies; Cost; Costs; Impact; Inventory; Managers; Order; Replenishment rule; Rules; Safety stock; Supply chain; Supply chain management; Variability; Variance; Variance reduction;

Smooth is smart: bullwhip, inventory, fill-rates and the golden ratio.

Inventory;