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PurposeThe purpose of our study is to investigate how a manufacturing plant’s internal operations along with its network of connections (upstream and downstream) can have an impact on its recovery time from a disruption. The authors also examine the inverse-U impact of complexity. Finally, the authors test the moderating role that business continuity management plans (BCP) at the plant level have on recovery time.Design/methodology/approachTo test our hypotheses, the authors partnered with Resilinc Corporation, a Silicon Valley-based provider of supply chain risk management solutions to identify focal firms’ suppliers, customers and plant-level data including information on parts, manufacturing activities, bill of materials, alternate sites and formal business continuity plans. The authors employed censored data regression technique (Tobit).FindingsSeveral important findings reveal that the plant’s internal operations and network connections impact recovery time. Specifically, the number of parts manufactured at the plant as well as the number of internal plant processes significantly increase disruption recovery time. In addition, the number of supply chains (upstream and downstream) involving the plant as well as the echelon distance of the plant from its original equipment manufacturer significantly increase recovery time. The authors also find that there exists an inverted-U relationship between complexity and recovery time. Finally, the authors find partial support that BCP will have a negative moderating effect between complexity and recovery time.Originality/valueThis research highlights gaps in the literature related to supply chain disruption and recovery. There is a need for more accurate methods to measure recovery time, more research on recovery at the supply chain site level and further analysis of the impact of supply chain complexity on recovery time.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

Accurate studies on the dynamics of Pfizer-Biontech BNT162b2-induced antibodies are crucial to better tailor booster dose administration depending on age, comorbidities, and previous natural infection with SARS-CoV-2. To date, little is known about the durability and kinetics of antibody titers months after receiving a booster dose. In this work, we studied the dynamic of anti-Trimeric Spike (anti-TrimericS) IgG titer in the healthcare worker population of a large academic hospital in Northern Italy, in those who had received two vaccine doses plus a booster dose. Blood samples were collected on the day of dose 1, dose 2, then 1 month, 3 months, and 6 months after dose 2, the day of the administration of the booster dose, then 1 month and 3 months after the booster dose. The vaccination immunogenicity was evaluated by dosing anti-TrimericS IgG titer, which was further studied in relation to SARS-CoV-2 infection status, age, and sex. Our results suggest that after the booster dose, the anti-TrimericS IgG production was higher in the subjects that were infected only after the completion of the vaccination cycle, compared to those that were infected both before and after the vaccination campaign. Moreover, the booster dose administration exerts a leveling effect, mitigating the differences in the immunogenicity dependent on sex and age.

Background: Chronic kidney disease (CKD) is characterized by an overproduction and accumulation of advanced glycation end products (AGEs). Because AGEs may play a role in the development of malnutrition and sarcopenia, two essential components of frailty, we evaluated whether they may also contribute to the onset of frailty in CKD patients. Methods: We performed a cross-sectional analysis of 117 patients. AGEs were quantified using a fluorescence spectrophotometer and soluble receptor for AGE (sRAGE) isoforms by ELISA. We defined frailty according to the frailty phenotype (FP) proposed by Fried. Results: The average age of patients was 80 ± 11 years, 70% were male, and the mean eGFR was 25 + 11 mL/min/1.73m2. Frailty was diagnosed in 51 patients, and 40 patients were classified as pre-frail. AGEs and RAGE isoforms seem not to correlate with overall frailty. Instead, AGEs were associated with specific frailty domains, inversely associated with BMI (R = −0.22, p = 0.016) and directly associated with gait test time (R = 0.17, p = 0.049). AGEs were also associated with involuntary weight loss (OR 1.84 p = 0.027), independent of age and sex. Conclusions: AGEs are associated with some pivotal components of the frailty phenotype, although they are not associated with frailty overall.

Fused Deposition Modeling (FDM), is one of the most popular and widely used Additive Manufacturing filament based technology employing materials such as Acrylonitrile Butadiene Styrene (ABS), Polycarbonate (PC), Thermoplastic Polyurethane (TPU) and Polylactic Acid (PLA). In this technique, the part is built up layer-by-layer, affecting, both the resolution along the z-axis, and the mechanical properties dependent on the mesostructure, controlled by a large amount of production parameters such as layer thickness, raster orientation, number of contour and air gap. When dealing with functional and structural printed parts, a deep understanding of these tunable building parameters and their influence on the mechanical properties is of the utmost importance and over the years many experimental studies have been carried to investigate this need. This study is intended to explore specimens realized through FDM technique with different combinations of printing parameters to analyse their effect on the mechanical properties of ABS Plus p430. To this aim, tensile and compression specimens, had been designed and tested. Sixteen different types of tensile specimen had been realized by varying four different parameters, namely, layer thickness, part interior style, infill orientation and number of contours. Whereas, the number of compression specimens had been limited to four considering the variation of two parameters: layer thickness and part interior style. Three samples for each specimen had been produced in ABS Plus p430 using a Stratasys Fortus 250mc FDM printer and tested with a universal testing machine through tension and compression tests to analyse the correlation between printing parameters and material properties. Test results had led to important conclusions on the consistency and homogeneity of the mechanical properties and on the variation of the material’s performances in accordance with the different combinations of production parameters.

Background: in patients with chronic kidney disease (CKD), the inflammatory and pro-oxidant milieu may contribute to malnutrition development. In this study, we investigated the relationship between inflammation, advanced glycation end-products (AGEs), and their receptors (RAGEs) with malnutrition in CKD patients. Methods: we evaluated 117 patients. AGEs were quantified by fluorescence intensity using a fluorescence spectrophotometer, soluble RAGEs isoforms, and inflammatory interleukins by ELISA. Malnutrition was assessed by a malnutrition inflammation score. Results: mean age was 80 ± +11 years, eGFR was 25 ± +11 mL/min/1.73 m2 and BMI was 28 ± 5 Kg/m2. Malnourished individuals were older, had lower estimated protein intake (nPCR 0.65 ± 0.2 vs. 0.8 ± 0.2 vs. 0.8 ± 0.3, p = 0.01), higher C reactive protein (CRP 0.6 ± 1 vs. 0.6 ± 0.7 vs. 0.17 ± 0.13, p = 0.02) and tumor necrosis factor α (TNF α 14.7 ± 8.7 vs. 15.6 ± 8 vs. 11.8 ± 5.8, p = 0.029). Malnourished patients had higher sRAGE (2813 ± 1477 vs. 2158 ± 1236 vs. 2314 ± 1115, p = 0.035) and esRAGE (648 [408–1049] vs. 476 [355–680] vs. 545 [380–730] p = 0.033). In the multivariate analysis, only sRAGE maintained its association with malnutrition (p = 0.02) independently of aging and inflammation. Conclusions: in CKD patients, RAGEs isoforms, but not AGEs, are associated with malnutrition, irrespective of systemic inflammation, aging, and renal function.

Funding Acknowledgements Type of funding sources: None. Introduction There is still controversy regarding the exercise characteristics that are more effective for improving peak oxygen uptake (VO2 peak), cardiac and metabolic function. High- intensity interval exercise training (HIIT) has been shown to elicit comparable and/or superior performance on endurance capacity (EC), ventricular function (VF) and quality of life. By other side, there is robust evidence that combined endurance and strength training is significantly more effective than endurance training only for improving EC, muscle mass and muscle strength. There is no enough information if the combination of HIIT with high strength training (HST) could enhance the physical conditions of these patients. Purpose The purpose of our study was to analyze the combination of HIIT + HST and its effect on physical performance compared to different types of combined training: HIIT and MCT with low load resistance training (RT) and HIIT or MCT only. Methods We evaluated 140 male patients (p) with CAD documented by angiographic studies, clinically stables with medical treatment and sinus rhythm. All of them performed a stress testing in treadmill without handrail support using a ramp protocol until maximal effort. VO2 peak (ml/kg/min) was measured indirectly through ACSM formula. We used YMCA´s method of estimating body fat with measurement of skinfolds in four sites (BF %), 30-second chair stand test (CST), 8-foot up and go test (FUGT), six-minute walk test (T6min) and one maximum repetition for quadriceps extension (1RMq) .Training intervention: p were randomly allocated to HIIT + RT (n=30), MCT + RT (n=30), HIIT (n=30), MCT (n=30) and HIIT + HST (n=20) during 3 month period of training. HIIT: 4 x 4 (85-95% peak heart rate) and 60-70% during active breaks. (36 min) MCT: 70-75% peak heart rate.(36 min) RT: 40-50% 1RM for lower body with 12-15 repetitions in 2 sets HST: ≥ 70% 1RM for lower body with low number of repetitions. Statistical analysis: all data were analyzed using IBM SPSS V.24. Comparisons were performed by following one-way ANOVA(parametric distribution) with post-hoc Tuckey or Kruskal-Wallis(non parametric distribution). The level of statistical significance was P< 0.05. Results Analyzing values pretraining (PRE) vs. postraining (POST), VO2 peak increased significantly by 27,52% for HIIT + HST P< 0,03 vs. HIIT + RT- MCT + RT and MCT. A positive effect in HIIT + HST with FUGT P< 0,001 and CST P< 0,005 between group changes and favourable observations in relation to 1RMq (PRE 60,00 ± 9,07 vs. POST 73,00 ± 9,86) and %BF(PRE 26,60 ± 3,21 vs. POST 24,80 ± 3,72) compared to MCT and HIIT P < 0,05. We didn´t find statistical significant differences with both modalities of combined training (low workloads) and HIIT for T6min. Conclusions High intensity combined training (HIIT + HST) had an additional effect related to others aerobic and resistance exercises attributed to neuromuscular adaptations, increased power and muscle strength.

To investigate the presence of genetic material of viral agents and the serum level of inflammatory cytokines in patients submitted to carotid endarterectomy having vulnerable versus stable atherosclerotic plaques.Data of patients consecutively submitted to carotid endarterectomy for a significant stenosis from July 2019 to December 2019 were prospectively collected. The genetic material of Epstein-Barr (EBV), CitoMegalo (CMV), Herpes Simplex (HSV), Varicella-Zoster (VZV) and Influenza (IV) Viruses was searched in the patient's plaques, both in the "mid" of the plaque and in an adjacent lateral portion of no-plaque area. The serum levels of TNF-α, IL-1β, IL-6, IL10 and CCL5 were determined. The obtained results were then correlated to the histologic vulnerability of the removed carotid plaque. P values0.05 were considered statistically significant.Data of 50 patients were analyzed. A vulnerable plaque was found in 31 patients (62%). The genome of CMV, HSV, VZV and IV was not found in any of the vascular samples, while the EBV genome was found in the "mid" of 2 vulnerable plaques, but not in their respective control area. Eighty-two percent of patients who did not receive anti-IV vaccination (23/28) had vulnerable carotid plaque, compared with 36% of vaccinated patients (8/22, P = 0.001). Serum levels of TNF-α and IL-6 were higher in patients with a vulnerable plaque compared to patients with a stable plaque (73.6 ± 238.2 vs. 3.9 ± 13.1 pg/ml, P= 0.01, and 45.9 ± 103.6 vs. 10.1 ± 25.3 pg/ml, P= 0.01, respectively), independent of comorbidities, viral exposure or flu vaccination.The EBV genome was found in the "core" of 2 vulnerable carotid plaques, but not in their respective adjacent control. Influenza vaccination was associated with a lower incidence of carotid plaque vulnerability. Serum levels of TNF-α and IL-6 were higher in patients with a vulnerable plaque compared to patients with a stable plaque.

Negative stiffness structures (NSS), as a branch of multi-stable mechanical metamaterials, exhibit multiple stable configurations. Their characteristics, such as bistability, snap-through and negative stiffness, make them particularly suitable for shock absorber applications. The majority of NSS is designed in a cuboidal shape and only recently few studies focused on cylindrical NSS. Lately, Fraunhofer for Additive Manufacturing Technologies IAPT, has started some studies to optimize these structures and to profit by their features in different applications, such as InspectionCopter project. During this study, three types of special-shaped NSS were designed, produced and tested. To determine the influence of dimensional parameters and materials on the functionality of these flexible structures, for each one of three concepts, five different versions in two different materials and techniques were realized. The specimens were fabricated in PEBA (PolyEther Block Amide) and TPU (Thermoplastic PolyUrethane) using, respectively, Selective Laser Sintering (SLS) and MultiJet Printing (MJP) technologies; the design freedom of Additive Manufacturing (AM) allows the production of complex structures and the possibility of functional integration, such as shock absorber functionality. To investigate the mechanical and NS properties of these structures and their deformation mechanisms, quasi-static compression tests were performed according to ASTM D695 − 15 regulation. The results, analyzed through force–displacement curves, highlighted the energy recovery of the specimens during deformation and the influence of dimensional parameters on the response to the applied loads. During the tests, it was also evident how the usage of different dimensions and materials can lead, for the same structure, to a symmetric or asymmetric buckling mode in the collapse of the layers and to prevent the structure from returning to its original shape once the load has been removed.

Digital Supply Chains (DSCs) are highly integrated global internet communities of customers, distributors, producers, and suppliers. DSCs have increasingly incorporated Internet of Things (IoT) innovations such as field sensors and real time condition monitoring; and have served as effective platforms for IoT technology diffusion. However, as IoT has become more pervasive, pushing the edges of networks further out, new cyber threat windows have opened everywhere. More recently, Cyber-Supply Chain Risk Management (C-SCRM) has emerged as a critical discipline combining expertise from cybersecurity, supply chain management and enterprise risk management; and designed to stem the proliferation of digital supply chain attacks seeking illicit access to corporate networks for competitive espionage, financial and intellectual property theft, and disruption of operations. Yet to date, there has been little evidence that C-SCRM practices are actually effective in containing all or even some types of breaches. Our decade-long research provides the first statistical analysis of the effects on an organization’s breach profile based on the extent of its adoption of policies and practices defined within the U.S. National Institute of Standards and Technology (NIST) ‘s Cybersecurity Framework, increasingly the de-facto global C-SCRM standard. Our analysis determined that there were specific Framework activity areas and sets of policies/practices within those activity areas that strongly correlated with more effective control of specific breach types. Our findings lay the foundation for an evidence-based approach to mastering IT network vulnerabilities and defending global digital supply chains.

The purpose of this study is to first determine the current incidence of exit from the United States' motor-carrier industry. Second, we develop and test an econometric model of the determinants of motor-carrier exit. Using recent data derived from the Motor Carrier Management Information System database, we find that motor-carrier exit continues to be quite prevalent. This study also finds that motor-carrier crash rates are positively associated with the likelihood of exit from the industry, while fleet size and number of commodity segments handled by motor carriers are negatively associated with a carrier's likelihood of exit. Study findings also suggest that for-hire carriers are more likely to exit, and carriers handling hazardous materials are less likely to exit from the motor-carrier industry. The article discusses these findings, including managerial and public policy implications.

Since the spreading of Sar-CoV-2 in March 2020, many serologic tests have been developed to identify antibody responses. Indeed, different commercial kits are directed against different antigens and could utilise different methods thereby triggering confusion and criticism. Here, we compared two Food and Drug Administration (FDA)-approved automatized assays that detect IgG responses against spike or nucleocapsid protein of Sars-Cov-2 virus in 127 subjects among healthcare workers of IRCCS Policlinico San Donato (MI), Italy. We observed different kinetics of IgG responses, demonstrating the importance of timing of sampling to correctly interpret the results both for infection diagnosis and for epidemiologic studies. We observed that Anti-N response starts earlier than Anti-S1/S2 response but also decreases earlier, affecting the sensitivity of the tests at different time points. Combining two different assays, designed against different antigens, could reduce false negative results. Finally, we observed a patient who produced anti-nucleocapsid IgG, but not anti-spike IgG. In conclusion, we investigated antibody responses in Covid-19 disease, aiming to direct clinicians and laboratory scientists to correctly interpret serologic results by always paying attention to clinical history correlation, timing of sampling, methods and antigens used, to avoid false negative results and obtain relevant epidemiologic data.

Background: In patients with chronic kidney disease (CKD), there is an overproduction and accumulation of advanced glycation end-products (AGEs). Since AGEs may have detrimental effects on muscular trophism and performance, we evaluated whether they may contribute to the onset of sarcopenia in CKD patients. Methods: We enrolled 117 patients. The AGEs were quantified by fluorescence intensity using a fluorescence spectrophotometer and soluble receptor for AGE (sRAGE) isoforms by ELISA. As for the sarcopenia definition, we used the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Results: The average age was 80 ± 11 years, 70% were males, and the mean eGFR was 25 + 11 mL/min/1.73 m2. Sarcopenia was diagnosed in 26 patients (with a prevalence of 22%). The sarcopenic patients had higher levels of circulating AGEs (3405 ± 951 vs. 2912 ± 722 A.U., p = 0.005). AGEs were higher in subjects with a lower midarm muscle circumference (MAMC) (3322 ± 919 vs. 2883 ± 700 A.U., respectively; p = 0.005) and were directly correlated with the gait test time (r = 0.180, p = 0.049). The total sRAGE and its different isoforms (esRAGE and cRAGE) did not differ in patients with or without sarcopenia. Conclusions: In older CKD patients, AGEs, but not sRAGE, are associated with the presence of sarcopenia. Therefore, AGEs may contribute to the complex pathophysiology leading to the development of sarcopenia in CKD patients.

Biobanks are considered to be important resources of Departments of Pathology and Laboratory Medicine allowing the clarification of relevant disease mechanisms and the improvement of the diagnosis, prognosis, and treatment of both pediatric and adult cardiovascular diseases. To successfully establish a cardiovascular biobank, it is important to consider the public opinion and views on it and the factors involved in the willingness of the public to participate in the donation of genetic material. The literature was systematically reviewed to identify the attitude and willingness of patients affected by congenital and acquired heart disease to participate in biobanking research. Six relevant studies were identified in which it was indicated that psychosocial and demographic characteristics, as well as the patient's medical condition, could influence patient and family members' attitudes and willingness to participate in research. In both congenital and acquired heart diseases, participation in biobank research activities was higher if patients and their families were approached when hospitalized, but not during the acute moment of their illness. Other quantitative and qualitative studies are required to improve patient and family participation in these research initiatives.

In the past decade, firms have become more aware of supply chain disruptions and their impact on the firm. Developing a supply chain resilience organizational culture has been proposed as an effective way to manage supply chain risks. This study intends to explore how the geographical location risks impact the decision to develop a supply chain resilience strategy, in particular, to anticipate the disruption proactively and have a business continuity plan in place. Using a unique database including thousands of manufacturing locations that belong to over 7,000 firms across 102 countries, we test three hypotheses to understand if geographical location risks, frequency of disruptive events, and the region in which a site is located are factors for the likelihood of a firm having a business continuity plan at their locations. The study also seeks to understand if there are regional effects and firm effects affecting the decision to develop resilience. With a particular focus in Latin America and the firms with a manufacturing presence in that region. The main findings of the study are that natural disaster risks do tend to develop a culture of resilience, while macroeconomic risks tend to do the opposite. These results remain stable for firms' effects. The Latin America region shows no observable statistical difference in developing resilience compared to the Asia region. While the Northern America region shows more resilience compared to Asia. We conclude that economic risk is less predictable and harder to develop a plan for than disruptions, such as natural disasters. The findings of this study present an opportunity for governments to develop resilience plans that can make their countries more attractive for investment to multinational firms looking to establish new manufacturing locations around the world.

Giusto, barone von Liebig, (Darmstadt, 1803—Monaco, 1873), chimico tedesco che ha dato un contributo significativo all’analisi dei composti organici e alla didattica della chimica basata sulla sua applicazione alla biologia (biochimica) e all’agricoltura. La sua attivita scientifica ha oscillato tra argomenti molto diversi, ma soprattutto e stata dedicata alla chimica organica. Liebig e stato in grado di stabilire con certezza molte formule empiriche di composti organici finora incerti e ne ha scoperti alcuni nuovi. Ha trattato il concetto di isomeria e la teoria della struttura chimica. Ha preparato e studiato molti composti aromatici, e ha dato un notevole contributo alla teoria radicalica. Inoltre Liebig aveva anche una notevole abilita di ricerca nel campo dell’uso di fertilizzanti chimici.

Due to the importance of the recent Federal Motor Carrier Safety Administration requirement that all motor carriers participate in the New Entrant Safety Assurance Program (NESAP), the purpose of this study is to examine the relationship of the NESAP to motor carrier safety performance. Our study finds that carriers who entered the industry before the NESAP program (e.g., more experienced carriers) have significantly better safety performance in comparison to new entrant carriers. We also demonstrate that new entrants who successfully complete the requirements of the NESAP have significantly better safety performance than new entrants who fail to complete the program successfully. The implications of the study are also discussed.

The purpose of this paper is to examine the relationship between motor-carrier firm size and safety outcomes. Leveraging insights from the resource-based view of the firm, we develop hypotheses regarding this important relationship. To test our hypotheses, we constructed an original commercial motor-carrier safety database, drawing on data from the Motor Carrier Management Information System and the Safety Measurement System. The results demonstrate that there is a significant and positive relationship between firm size and safety performance as measured through a carrier's number of crashes, unsafe driving violations, hours-of-service compliance, and vehicle maintenance violations. The impact of firm size on safety performance varies according to industry segment. This study has important academic and public policy implications.

Many studies, focused on identifying new biomarkers for coronary artery disease (CAD) risk computation and monitoring, suggested a potential diagnostic role for fatty acids (FA). In the present study, we explored the potential diagnostic role of FA by using a data mining approach based on fourth generation artificial neural networks (ANN). Forty-one male subjects were enrolled. According to coronary angiography, 31 displayed CAD and 10 did not (non-CAD, control group). FA analysis was performed on plasma samples using a gas chromatography-mass spectrometry system and analyses were performed by an ANN method. The variables most closely related to CAD were low levels of alpha-linolenic acid, eicosapentaenoic acid, eicosatetraenoic and docosahexaenoic acids. High levels of 1,1-dimethoxyhexadecane, total dimethyl acetals and docosatetraenoic acid were related to non-CAD condition. This subset of variables, which were most closely correlated to the target diagnosis, achieved a consistent predictive rate. The average accuracy obtained was 76.5%, with 93% of sensitivity and 60% of specificity. The area under the ROC curve was equal to 0.79. In conclusion, our study highlighted the association between different plasma FA species, CAD and non-CAD conditions. The specific subset of variables could be of interest as a new diagnostic tool for CAD management.

Congress established the Federal Motor Carrier Safety Administration (FMCSA) as a separate administration within the U.S. Department of Transportation in the Motor Carrier Safety Improvement Act of 1999 (Public Law 106-159) and established its primary mission “to reduce crashes, injuries, and fatalities involving large trucks and buses.” This paper is designed to provide a context for assessing the progress that has been made by the FMCSA in achieving the goal of reducing truck crashes, injuries, and fatalities. The paper concludes that brokers/third party logistics providers and shippers do, indeed, share in the responsibility to select competent and safe motor carriers. Their selection and use decisions are enhanced by the FMCSA safety performance measurement system (SMS). The SMS measures carrier performance in a wide range of categories and disseminates this information on a monthly basis through its publically available website. There have been recent efforts to restrict some of these data from the public website. The paper concludes with the argument that the FMCSA’s SMS data are a vital component of the carrier selection and use process and any efforts to restrict the information from the public websites should be vigorously opposed. The overall effort to reduce truck crash rates is linked to having brokers/third party logistics providers and shippers make informed selection and use decisions by relying on individual carrier safety performance data from the FMCSA.

This study investigates how supply chain sourcing strategies are associated with product quality recalls. In particular, the research examines how make-or-buy decisions (i.e., outsourcing), the use of foreign suppliers (i.e., offshore outsourcing), the relocation of production to offshore markets (i.e., offshoring), and decisions to consolidate supply bases (i.e., the use of few vs. myriad suppliers) are related to product recalls. Product recalls are serious quality failures in supply chains with significant, negative impacts on firm performance. Product recalls are frequently connected to the globalization of supply chains. Globalization has, at times, promoted inconsistency in quality control and standards, leading to quality problems and failures. Data across multiple industries, with widely reported recalls, have been collected and analyzed using regression techniques. Our findings indicate that offshore outsourcing has a greater impact on recalls than offshoring without outsourcing; outsourcing domestically has the least influence. Outsourcing to a smaller supplier base may lead to fewer recalls at low levels of outsourcing. However, it may exacerbate the impact of outsourcing on recalls at high levels of outsourcing.