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With growing concerns related to the environment, sustainable transportation has gained importance. For geographies with an ample coastline, coastal shipping offers a sustainable transportation option to move massive freight quantities. This paper presents a case that allows students to appreciate the role of coastal shipping in multimodal logistics planning. Furthermore, it gives students an opportunity to mathematically model transportation planning at a strategic and tactical level for automotive distribution. The students learn how to assess the financial viability of a mode shift from roadways to coastal shipping. The instructors can use this case for theoretical discussion on multimodal logistics and the application of mixed-integer linear programming (MILP) and heuristics as solution methods. Furthermore, the case presents an opportunity to demonstrate the improvement in solution quality with an MILP solver compared with heuristics.

This paper analyses the modal shift from a primary road-based to coastal shipping-based freight distribution. A mathematical model is developed to optimize the coastal shipping route planni...

Objectives:. Implement a connected network between two Tele-ICU programs to support staffing and rounding during the first wave of the coronavirus disease 2019 pandemic in the United States. Design:. Proof of Concept model. Setting:. Northwell Health; a 23 Hospital, 40 ICU (500 ICU beds) healthcare organization serving the downstate NY area. During the initial coronavirus disease 2019 pandemic, Northwell Health rapidly expanded to greater than 1,000 ICU beds. The surge in patients required redeployment of noncritical care providers to the ICU bedside. The Tele-ICU program expanded from covering 176 beds pre pandemic to assisting with care for patients in approximately 450 beds via deployment of Wi-Fi-enabled mobile telehealth carts to the newly formed ICUs. Patients:. Critically ill coronavirus disease 2019 patients hospitalized at Northwell Health, NY, at any point from March 2020 to June 2020. Interventions:. To offset the shortage of critical care physicians, Northwell Health established a collaboration with the Tele-ICU program of Providence, St. Joseph Health in the state of Washington, which enabled the critical care physicians of Providence, St. Joseph Health to participate in virtual rounding on critically ill coronavirus disease 2019 patients at Northwell Health. Main Results:. We developed an innovative hybrid model that allowed for virtual rounding on an additional 40–60 patients per day by a remote critical care physician at Providence, St. Joseph Health. This was accomplished in approximately 3 weeks and provided remote care to complex patients. Conclusions:. Our findings demonstrate the proof of concept of establishing a network of connected Tele-ICU programs as a rapidly scalable and sustainable paradigm for the provision of support from critical care physicians for noncritical care teams at the bedside.

The connection between inventory leanness and various dimensions of financial return has been explored in many previous research studies. However, there is still a void in the literature regarding the mechanism that is responsible for the consequences of inventory leanness on the firm’s financial outcome. Thus, the purpose of this work is to study how inventory leanness influences financial outcome, with the focus on the mediation effect of production efficiency. The empirical analysis is performed using a fixed-effect model on firm-level data of various US manufacturing industries from 2000-2018. The result on overall data indicates that the association between inventory leanness (IL) and financial outcome(FO) is partially mediated through enhancement in production efficiency. Further, empirical analysis on each industry-specific subsample reveals that the mediation effect of production efficiency varies across industries. Thus, this article contributes to the theory of inventory control in operations management literature by empirically verifying the mediation effect of production efficiency.

ObjectiveDescribe the changes in patient population, bed occupancy, severity of illness and ventilator requirements across a large health system in the greater New York City area during the pandemic response in comparison with the 2019 baseline.DesignObservational, descriptive study of ICUs monitored by a tele-ICU system across Northwell Health. Inclusion criteria: All patients admitted to Northwell Health tele-ICUs during 2019 and between March 23, 2020 and April 6, 2020.ExposureA data extract was developed to collect data every hour for each ICU bed in the Northwell tele-critical care program as a quality reporting initiative to understand ICU capacity and resource utilization. A similar extract was developed for each hour of 2019.Main Outcomes and MeasuresAverage of any given hour during the pre-COVID-19 and pandemic periods for the following metrics: proportion of beds occupied, proportion of ventilated patients, severity of illness (measured by the ICU Discharge Readiness Score (DRS)), and length of stay (LOS).ResultsHourly analysis of data from 186 ICU beds from 14 ICUs and 9 hospitals were included, representing 10,714 patients in 2019 and 465 patients between March 23 and April 6, 2020. Average hourly occupancy increased from 64% to 78%, while the proportion of patients invasively ventilated increased from 33.9% to 84.2%. Median DRS (severity of illness score) increased from 1.08 (IQR: 0.24-6.98) to 39.38 (IQR: 12.00-71.28). Proportion of patients with Hispanic ethnicity doubled (7.8% to 16.6%; pConclusions and RelevanceIn addition to the expected increase in ICU occupancy and ventilator requirements, this large group of ICUs in midst of the COVID-19 epidemic are faced with managing a cohort of ICU patients with a dramatically higher severity of illness than their typical census.

In maritime transportation of automobiles, roll-on/roll-off (ro–ro) shipping companies operate liner shipping services across major trade routes. Large ro–ro shipping companies are well placed to offer end-to-end integrated logistics services to auto manufacturers engaged in international trade of vehicles. Therefore, we present a new mixed integer programming model for fleet deployment including inventory management at the ports along each trade route. Due to the complexity of the problem, a rolling horizon heuristic (RHH) is proposed. The RHH solves the problem by iteratively solving sub-problems with shorter planning horizon. Computational results based on real instances are presented.

Outbound logistics management practices, specific to India have drawn limited attention in the past. Recently though, this sector has garnered renewed attention of researchers and practitioners. Through an exploratory study, we attempt to understand and illustrate the outbound logistics management practices of automotive industry in India. Outbound logistics is divided into a set of interlinked functions based on a logistics framework and described accordingly. Based on findings from the exploratory study and extant literature in this field, a framework for the development of integrated logistics management practices in the aut omotive industry in India is derived and several research directions are proposed.

Multi-modal transportation takes advantage of multiple transport modes and can be an effective way to ease the negative environmental effects of freight transportation. This paper addresses a multi-modal distribution network design problem with the aim of balancing the trade-off between economic and environmental benefits. The distribution network that we consider includes both transportation with trucks and ships. We propose a new mixed integer programming (MIP) model which decides the optimal design of the system, i.e. how many ships of each type to use, their corresponding routes and sailing speeds. It also suggests an optimal cargo flow through the maritime and road-based network. We show how the MIP model can be used to provide decision support through a case study from the distribution of automobiles in India, which has a vast coastline that can be used for maritime transportation. Environmental emissions from automobile transportation in India have been rapidly increasing in recent years with the fast economic development, and it has become a major contributor to regional air pollution and road congestion. One possible way to ease these negative environmental consequences is to consider a modal shift where some of the automobile transportation from the production facilities located close to the coastline is replaced by roll-on roll-off (RoRo) ships. Our study shows that multi-modal distribution is both environmentally friendly and economically beneficial, especially if more industrial players can collaborate to create economies of scale.

Bluetooth is a short distance unlicensed wireless communication technology operating at 2.4 GHz band and primarily used for data transfer between portable devices. In this paper, small size microstrip patch antennas, loaded by symmetric and asymmetric T-shaped slots are designed and a comparative study of their performance at Bluetooth frequency band is presented. High frequency structure simulator (HFSS) software is used for antenna simulation. Improved bandwidth, uniform radiation pattern and good gain of the antenna are achieved using asymmetric T-slot microstrip antenna compared to symmetric T-slot microstrip antenna. The dimension of asymmetric T-slot microstrip antenna is 75% less than the symmetric T-slot microstrip antenna. Performance of the antennas, through parametric studies, related to the dimensions of the symmetric and asymmetric T-slots, is also presented. Â

Most of the devices are small in size and require small-size antennas. In this paper, we have investigated a unique design of microstrip antenna with three PLUS-slot of equal area. The geometry is such that three PLUS symbol at an angle of 0°, 45° and 90°. Simulation has been made using HFSS software. Results of proposed antenna proves it to be a good candidate for Bluetooth and WiMAX applications. Good bandwidth, uniform radiation pattern, VSWR value nearly equal to 1 gives excellent impedance matching and better gain of the antenna are achieved.

Early mobilization and rehabilitation of patients in intensive care units (ICUs) may improve physical function, and reduce the duration of delirium, mechanical ventilation, and ICU length of stay. However, safety concerns are an important barrier to widespread implementation.To synthesize safety data regarding patient mobilization and rehabilitation in the ICU, including falls, removal of endotracheal tubes, removal or dysfunction of intravascular catheters, removal of other catheters/tubes, cardiac arrest, hemodynamic changes, and desaturation.Systematic literature review, including searches of five databases. Eligible studies evaluated patients who received mobilization-related interventions in the ICU. Exclusion criteria included: (1) case series with fewer than 10 patients; (2) majority of patients under 18 years of age; and (3) data not reported to permit calculation of incidence of safety events.Number of patients, mobilization/rehabilitation sessions, potential safety events, and events with negative consequences (e.g., requiring intervention or additional therapy).Heterogeneity was assessed by IPatient mobilization and physical rehabilitation in the ICU appears safe, with a low incidence of potential safety events, and only rare events having any consequences for patient management. Heterogeneity in the definition of safety events across studies emphasizes the importance of implementing existing consensus-based definitions.

PurposeThe ocean transportation of automobiles is carried out by specialized Roll‐on/Roll‐off ships, which are designed to carry a large number of automobiles at a time. Many of these shipping companies have vertically integrated or collaborated with other logistics services providers to offer integrated maritime logistics solution to car manufacturers. The purpose of this study is to develop an optimization model to address the tactical level maritime logistics planning for such a company.Design/methodology/approachThe problem is formulated as a mixed integer linear program and we propose an iterative combined Ant colony and linear programming‐based solution technique for the same.FindingsThis paper can integrate the maritime transportation planning of internally managed cargoes with the inventory management at the loading and discharging ports to minimize supply‐chain cost and also maximize additional revenue through optional cargoes using same fleet of ships.Research limitations/implicationsThe mathematical model does not consider the variability in production and consumption of products across various locations, travel times between different nodes, etc.Practical implicationsThe suggested mathematical model to the supply‐chain planning problem and solution technique can be considered in the development of decision support system for operations planning.Originality/valueThis paper extends the maritime inventory routing model by considering simultaneous planning of optional cargoes with internally managed cargoes.

In this paper a design of two-stage CMOS operational amplifier for sigma-delta ADC is presented, which operates at ±1.8 V power supply using 180 nm technology. This two-stage CMOS OP-AMP has been designed to indicate a unity gain frequency of 18.2MHz and indicates a gain of 71.27 dB. The design and simulation part has been done on Cadence Custom IC CAD. The simulated results are encouraging and has better performance.

Acute injuries of the kidney or lung each represent serious, complex clinical problems, and their combination drastically decreases patient survival. However, detailed understanding of interactions between these two organs is scarce. To evaluate this further, we used the folic acid (FA) and myohemoglobinuria models of acute kidney injury (AKI) together with Pseudomonas aeruginosa inhalation to study kidney–lung cross-talk in mice during acute kidney and lung injury. Subgroups of mice received antineutrophil antibody or platelet-depleting serum to assess the role of neutrophil and platelets, respectively. AKI by itself did not cause clinically relevant acute lung injury. Pneumonia was neutrophil dependent, whereas pneumonia-induced AKI was platelet dependent. AKI attenuated pulmonary neutrophil recruitment and worsened pneumonia. Mice with AKI had lower oxygen saturations and greater bacterial load than mice without. Neutrophils isolated from mice with FA-induced AKI also had impaired transmigration and F-actin polymerization in vitro. Thus, during acute kidney and pneumonia-induced lung injury, clinically relevant kidney–lung interactions are both neutrophil and platelet dependent.

Leachates derived from dry wastes of the metal, tannery, and dye industries of the state of Uttar Pradesh (India) were analyzed for their mutagenic potential using reverse mutation assay. Both the spot and plate incorporation assays were conducted with four tester strains of Salmonella typhimurium (TA97a, TA98, TA100, and TA102). The metal concentrations in the samples were also determined. The result suggests that leachates derived from metal and tannery wastes possess mutagenic properties. The findings are indicative of the type of environmental and health risks posed by improper waste disposal.

The research on advancement of container security standards has gained considerable importance in recent years. Worldwide container transportation is large in scale and involves multiple stakeholders at multiple touch-points. This makes it particularly vulnerable for use by terrorists as a medium to smuggle weapons of mass destruction into different countries for carrying out attacks, which may lead to loss of human lives and have adverse impact on economic stability and growth. A survey of research publications in this area suggests a lack of a unified frame of reference. We present a detailed classification of literature on operations management aspects of container security and discuss the various advancements in research and practice. Future research directions are outlined.