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The primary activities of any organization rely on the procurement of the required goods and services at the shortest time and highest quality possible. On this basis, the problem of supplier evaluation, ranking, and selection is considered critically important. Data envelopment analysis is a well-known and successful approach in this field. In this study, we propose a robust-stochastic data envelopment analysis model to measure the efficiency of decision-making units under uncertainty. We measure efficiency through a standard and an inverted model in terms of resilience and agility. In order to demonstrate the practical potential of the proposed model, we apply the model to a case study of the Iranian telecom industry with 90 decision-making units. Numerical results reveal that human resources and cash assets are the most important input criteria. Also, the output indicators, including adaptability, reliability, visibility, and coordination, have high importance in measuring the efficiency of decision-making units. It should be noted that employing the robust-stochastic optimization approach leads to controlling the fluctuations of uncertain parameters and maintaining a desirable optimal level of efficiency for decision-making units under different scenarios. The results suggest that the model is sufficiently valid and reliable for evaluating the performance of suppliers in the telecom industry, may be employed under uncertain conditions, and can incorporate decision-makers’ varying preferences. The managerial insights derived from this research indicate that, in the short term, uncertainty throughout the evaluation process of suppliers often leads to reduced efficiency among the decision-making units. However, operating under uncertainty is associated with several advantages in the long term, such as increased decision-making consistency and improved vital ability to cope with uncertainty.

Probiotics are beneficial live microorganisms that can modify the gut microbiota. It is assumed that they help improve enteral feeding intolerance (EFI) and nosocomial infections in critically ill patients. The present clinical trial aimed to investigate the efficacy of synbiotics in improving EFI and oropharyngeal aspiration in patients admitted to the intensive care unit (ICU).This randomized clinical trial was conducted on 105 critically ill patients admitted to the ICU of a tertiary referral hospital affiliated with a medical university. The patients were randomly assigned to either a synbiotic or control group and underwent 7 days of investigation. The primary end point was reduced gastric residual volume, which is suggestive of an improvement in EFI. The secondary end point included requirement for prokinetics, frequency of aspiration, duration of mechanical ventilation, length of ICU stay, and level of consciousness.The present clinical trial showed that synbiotic intervention has resulted in a significantly diminished requirement for prokinetics (P = 0.019), fewer oropharyngeal aspirations (P = 0.01), improved volume of bolus administration, and decreased gastric residual volume during the 7-day follow-up period. The patients who received synbiotic had an improved level of consciousness (P = 0.01).This clinical trial showed that the prescription of synbiotic from the initial days of enteral feeding has resulted in a significantly diminished requirement for prokinetics, less oropharyngeal aspiration, decreased gastric residual volume, improved volume of bolus administration, and hence, better tolerance of enteral feeding.

Human-made, natural, and unexpected disasters always cause human and financial losses to communities. Disaster management is a framework with proven performance to reduce the damage caused by disaster and supply chain disruptions. Transferring the injured people from affected areas to hospitals at the minimum possible time is a crucial goal in times of disaster. This paper develops a two-stage stochastic programming model to transport the injured people from affected areas to hospitals in the incidence of multiple disruptions at transportation links and facilities under uncertainties. Herein, economic, social, and environmental aspects of sustainability are considered, while simultaneous disruptions are managed to minimize the adverse impacts of the disasters. We aim to determine optimal locations to establish transfer points and flows between the relief network nodes with sustainability considerations. Ultimately, a case study in District 12 of Tehran, Iran is conducted to ensure the proposed model’s validity and performance. Various sensitivity analyses are also implemented to ensure the model’s effectiveness. The results indicate that disruptions in facilities and transportation links lead to increased relief time, hence has the most significant negative impact on relief operations.

Due to the high risk in the business environment, supply chains must adopt a tailored mechanism to deal with disruptions. This research proposes a multi-objective formulation to design a robust and resilient forward supply chain under multiple disruptions and uncertainty. The mentioned objective functions include minimizing the total cost, environmental impacts, and the network non-resiliency associated with the supply chain simultaneously countered using an augmented ε-constraint method. A Mulvey robust optimization approach is also utilized to deal with uncertainty. Ultimately, the developed model is validated based on three datasets associated with a case study of the steel industry. The results indicate that preventive and mitigation resilience strategies have significantly promoted the supply chain’s capabilities to deal with disruptions. Controlling network resiliency via non-resiliency measures has also created a risk-aware and robust structure in the incidence of disturbances. Numerical results reveal that multiple sourcing, lateral transshipment, and fortification of facilities will lead to the greatest cost-efficiency in the case study. Observations also indicate that the fortified supply chain will be highly economically viable in the long run due to the reduction of costs resulting from lost sales, unnecessary inventory holding, and the company’s credit risk.

Introduction: This study compared the extubation of patients in prone versus supine positions in patients undergoing lumbar disc surgery. Material and Methods: In this single-blind clinical trial, 60 patients who were candidates for elective lumbar disc surgery were selected and randomly assigned into two groups of 30 patients. All patients primarily underwent surgery in the prone position. After surgery and discontinuation of anesthesia gases (T0), patients were assigned into two groups, prone and supine. From T0 to extubation time, heart rate, systolic and diastolic blood pressure, mean arterial pressure, Spo2, cough severity, and secondary complications after extubation such as laryngospasm and shortness of breath were measured and recorded in both groups. Results: The results showed that in all the variables under study, the supine group had higher values than the prone group. There was a significant difference in oxygen pressure between the two groups, and the prone group had a more suitable status than the supine group (P=0.02). The incidence of cough was higher in the supine group compared to the prone group, and the observed difference was significant (P=0.001). Conclusion: Based on the findings of this study, maintaining the prone position after lumbar disc surgery for extubation causes the patient to be less affected by the change of position and is in a superior status in terms of coughing and oxygen pressure.

Background: Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group.Methods: The study was performed as a multicenter, proof-of-concept, observational study with prospective data collection. Patients were treated with a cementless 1-stage revision according to the CORIHA protocol between 2009 and 2014. Fifty-six patients, McPherson type III-A/B-1/2, were enrolled with a mean follow-up time from the CORIHA procedure of 4 years (minimum of 2 years). The primary outcome was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure.Results: The cumulative incidence of re-revision due to infection was 8.9% (confidence interval [CI] 3.2%-18.1%). The 1-year and 5-year survival incidence was 96% (CI 86%-99%) and 89% (CI 75%-95%). OHS at baseline was 19.9 (CI 17.3-22.6) and at 24-month follow-up 35.1 (CI 31.7-38.5). The mean change in OHS from baseline to 24-month follow-up was 11.8 points (CI 7.3; 16.3). Three patients had aseptic revision performed: two suffered periprosthetic fractures and one had stem subsidence. Failure analysis of the 5 reinfections did not detect a clear pattern as to the cause of failure.Conclusion: We found that cementless 1-stage revision in chronic periprosthetic hip joint infections has low reinfection rates in selected patients and may be applicable as a first-line treatment. (c) 2017 Elsevier Inc. All rights reserved.

Background Limited information is available on health-related quality of life (HRQoL) and patient-reported hip function following treatment for a chronic periprosthetic hip joint infection. The purpose of this study is to evaluate changes in HRQoL and patient-reported hip function 2 years following a cementless 1-stage revision for chronic periprosthetic hip joint infection. Methods Patients (n = 52) enrolled in a previously published clinical study on cementless 1-stage revision in chronic periprosthetic hip joint infection prospectively answered the EuroQol-5D, Short-Form Health Survey 36 (SF-36), and Oxford Hip Score preoperatively and at 3, 6, 12, and 24 months follow-up. Results were compared to age-matched and gender-matched population norm. Results A significant improvement in HRQoL and patient-reported hip function appeared in the first 3 months after surgery and reached a plateau after 6 months. The patients statistically reached age-matched and gender-matched population norm after 3 to 12 months follow-up on most items, except for Physical Functioning and Social Functioning on the SF-36. The largest effect sizes were found for Oxford Hip Score at 1.8 and for Role Limitation, Physical and Bodily Pain on the SF-36 at 1.5 and 1.6, respectively. Conclusion Patients treated with a cementless 1-stage revision for chronic periprosthetic hip joint infection experienced a marked increase in HRQoL and patient-reported hip function, and matched population norms on many parameters.