Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided. Mortality remains at approximately 30%.

Moralising Gold Supply Chains

During the late twentieth century the supply chains for gold were considered by the majority of consumers (when they were considered at all) to be driven by simple commercial imperatives. That notion was shattered during the first decade of the twenty-first century by the appearance of ethical campaigns, led by advocates determined to present major players in the gold industry as morally reprehensible. The ‘No Dirty Gold’ campaign sought to shift the purchasing of gold onto a moral register, in order to challenge the activities of large mining corporations. It was followed by the Fairtrade Foundation’s ‘Fairtrade Gold’ initiative, which had aspirations to support subsistence mining communities at the expense of big business. By directly targeting a luxury material and playing on its inherent social ambiguities, campaigners hoped to thoroughly moralise the purchasing of gold objects. Dr Oakley’s presentation will examine the forces behind this developing social phenomenon, describe the trajectories of a selection of major campaigns, and consider the extent to which these have impacted on public attitudes, gold miners and the actions of consumers, producers and retailers of luxury goods.

The Impacts of Variety on the Costs and Profits of a Hotel Chain’s Properties

In the hotel industry, undistributed operating expenses represent a significant portion of the operating costs for a hotel. Exactly how most of these expenses arise is not well understood. Using data from more than 40 hotels operated by a major chain, the authors examine the links between the variety of a hotel’s products and customers and its undistributed operating expenses and revenues. Their findings show that undistributed operating expenses are related to the extent of the property’s business and product-services mix. The results suggest that although increasing a property's product-service mix results in higher undistributed operating expenses, the incremental costs are compensated for by higher revenues. However, increasing business mix while increasing undistributed operating expenses does not result in higher revenues.

Assessing energy consumption in supply chains

The paper addresses the transport activities and associated energy consumption involved in the production and supply of two products: jeans and yoghurt. In the case of jeans, the analysis is from the locations in which cotton is grown, to retail outlets in the UK; in the case of yoghurt, the analysis is from the supply of milk on farms, to retail outlets in France. The results show that the transport stages from the point of jeans manufacture to UK port are responsible for the greatest proportion of transport energy use per kilogram of jeans in the UK supply chain. In the case of the French yoghurt supply chains, the results indicate that each of the three transport stages from farm to third-party distribution centre consume approximately the same proportion of total freight transport energy. The energy used on the transport stage for yoghurt from third-party distribution centre to retail outlet varies depending on the type of retail outlet served. Far greater quantities of energy are used in transporting jeans than yoghurts from farm/field to retail outlet. This is explained by the distances involved in the respective supply chains. Both case studies demonstrate that the energy used by consumers transporting goods to their homes by car can be as great as total freight transport energy used in the supply chain from farm/field to retail outlet (per kilogram of product transported).

Analysing energy use in supply chains: the case of fruits & vegetables and furniture

An increasing number of producers, retailers and third-party logistics providers are interested in carrying out energy assessments of their product supply chain. This is due to sensitivity about climate change and carbon emissions, but also to high energy prices. This paper presents an analytical approach developed to measure energy use in logistics activities in product supply chains. The approach (based on the Life Cycle Approach) quantifies energy use in transport and logistics activities at all stages of a product supply chain. The work has demonstrated that such an assessment approach based on the supply chain is useful in comparing the energy use implications of different strategies. This supply chain approach can be used to consider options such as sourcing and distribution centre locations, transport modes, road freight vehicle types and weights, vehicle load factors, empty running, transport distance and the balance between consumer shopping trips and delivery to the home.

Energy efficiency and greenhouse gas emissions of different supply chains: a comparison of French, UK and Belgian cases

Freight transportation system is critical to economic activity but it carries significant environmental costs, notably GHG emissions and climate change : energy use and corresponding CO2 emissions is increasing faster in freight transport than in other sectors and this increase is primarily the result of increased trade. This paper compares the transport activities, associated energy consumption and CO2 emissions of different supply chains for a range of products in three countries: Belgium, France and United Kingdom. Among the products considered are furniture and ‘fruits & vegetables’. For each of these products, different supply chains, involving more or less transport activity and associated energy consumption are analysed in each country. The comparison highlights some of the main factors that influence GHG emissions for different supply chains and illustrates how they vary according to product and country of final distribution. In more detail, the paper addresses the main differences between the supply chains of these products namely, the origin of their sourcing, the logistical organisation between production and retail and different types of retail outlet. The origin of the sourcing impact is mainly related to distance. The impact of the logistical organisation between raw material and retail on GHG emissions is linked to the mode and vehicle choice and to the load factor. As for retail, the consumer trip emissions, between his home and the retail outlet, are also an important part of the whole supply chain emissions. It is worthwhile to notice that our goal in this project is to consider the whole supply chain, from production to consumption. Therefore a particular focus is put on the mobility behaviours of consumers purchasing the studied products during their shopping and dropping back home activities related to these products. Especially a web based survey has been conducted and the gathered results offer an opportunity for drawing a more detailed picture of the associated CO2 emissions. This paper uses the results of an ongoing research on supply chain energy efficiency, funded by ADEME (the French Energy Agency) through the French program on transport research (PREDIT). This research is based on a comprehensive review of the various approaches to quantifying the environmental impacts of supply chains together with data collection from a range of organisations including manufacturers, retailers and transport companies. We will first present the developed methodologies, then the results corresponding to each studied product will be described. A discussion of the potential application of the research approach to the wider debate about the environmental impact of freight transport and the scope for GHG emissions reduction targets to be achieved will be included.

Energy efficiency and greenhouse gas emissions of different supply chains: a comparison of French, UK and Belgian cases

Freight transportation system is critical to economic activity but it carries significant environmental costs, notably GHG emissions and climate change : energy use and corresponding CO2 emissions is increasing faster in freight transport than in other sectors and this increase is primarily the result of increased trade. This paper compares the transport activities, associated energy consumption and CO2 emissions of different supply chains for a range of products in three countries: Belgium, France and United Kingdom. Among the products considered are furniture and fruits & vegetables. For each of these products, different supply chains, involving more or less transport activity and associated energy consumption are analysed in each country. The comparison highlights some of the main factors that influence GHG emissions for different supply chains and illustrates how they vary according to product and country of final distribution. In more detail, the paper addresses the main differences between the supply chains of these products namely, the origin of their sourcing, the logistical organisation between production and retail and different types of retail outlet. The origin of the sourcing impact is mainly related to distance. The impact of the logistical organisation between raw material and retail on GHG emissions is linked to the mode and vehicle choice and to the load factor. As for retail, the consumer trip emissions, between his home and the retail outlet, are also an important part of the whole supply chain emissions. It is worthwhile to notice that our goal in this project is to consider the whole supply chain, from production to consumption. Therefore a particular focus is put on the mobility behaviours of consumers purchasing the studied products during their shopping and dropping back home activities related to these products. Especially a web based survey has been conducted and the gathered results offer an opportunity for drawing a more detailed picture of the associated CO2 emissions. This paper uses the results of an ongoing research on supply chain energy efficiency, funded by ADEME (the French Energy Agency) through the French program on transport research (PREDIT). This research is based on a comprehensive review of the various approaches to quantifying the environmental impacts of supply chains together with data collection from a range of organisations including manufacturers, retailers and transport companies. We will first present the developed methodologies, then the results corresponding to each studied product will be described. A discussion of the potential application of the research approach to the wider debate about the environmental impact of freight transport and the scope for GHG emissions reduction targets to be achieved will be included.

A method for analysing operational complexity in supply chains

This paper proposes a method for analysing the operational complexity in supply chains by using an entropic measure based on information theory. The proposed approach estimates the operational complexity at each stage of the supply chain and analyses the changes between stages. In this paper a stage is identified by the exchange of data and/or material. Through analysis the method identifies the stages where the operational complexity is both generated and propagated (exported, imported, generated or absorbed). Central to the method is the identification of a reference point within the supply chain. This is where the operational complexity is at a local minimum along the data transfer stages. Such a point can be thought of as a ‘sink’ for turbulence generated in the supply chain. Where it exists, it has the merit of stabilising the supply chain by attenuating uncertainty. However, the location of the reference point is also a matter of choice. If the preferred location is other than the current one, this is a trigger for management action. The analysis can help decide appropriate remedial action. More generally, the approach can assist logistics management by highlighting problem areas. An industrial application is presented to demonstrate the applicability of the method.

Theorising and analysing digital labour: from global value chains to modes of production

This paper considers the following question—where do computers, laptops and mobile phones come from and who produced them? Specific cases of digital labour are examined—the extraction of minerals in African mines under slave-like conditions; ICT manufacturing and assemblage in China (Foxconn); software engineering in India; call centre service work; software engineering at Google within Silicon Valley; and the digital labour of internet prosumers/users. Empirical data and empirical studies concerning these cases are systematically analysed and theoretically interpreted. The theoretical interpretations are grounded in Marxist political economy. The term ‘global value chain’ is criticised in favour of a complex and multidimensional understanding of Marx’s ‘mode of production’ for the purposes of conceptualizing digital labour. This kind of labour is transnational and involves various modes of production, relations of production and organisational forms (in the context of the productive forces). There is a complex global division of digital labour that connects and articulates various forms of productive forces, exploitation, modes of production, and variations within the dominant capitalist mode of production.

Respiratory and non-respiratory sinus arrhythmia: implications for heart rate variability

The quantity of blood arriving at the left side of the heart oscillates throughout the breathing cycle due to the mechanics of breathing. Neurally regulated fluctuations in the length of the heart period act to dampen oscillations of the left ventricular stroke volume entering the aorta. We have reported that stroke volume oscillations but not spectral frequency variability stroke volume measures can be used to estimate the breathing frequency. This study investigated with the same recordings whether heart period oscillations or spectral heart rate variability measures could function as estimators of breathing frequency. Continuous 270 s cardiovascular recordings were obtained from 22 healthy adult volunteers in the supine and upright postures. Breathing was recorded simultaneously. Breathing frequency and heart period oscillation frequency were calculated manually, while heart rate variability spectral maximums were obtained using heart rate variability software. These estimates were compared to the breathing frequency using the Bland–Altman agreement procedure. Estimates were required to be \±10% (95% levels of agreement). The 95% levels of agreement measures for the heart period oscillation frequency (supine: -27.7 to 52.0%, upright: -37.8 to 45.9%) and the heart rate variability spectral maximum estimates (supine: -48.7 to 26.5% and -56.4 to 62.7%, upright: -37.8 to 39.3%) exceeded 10%. Multiple heart period oscillations were observed to occur during breathing cycles. Both respiratory and non-respiratory sinus arrhythmia was observed amongst healthy adults. This observation at least partly explains why heart period parameters and heart rate variability parameters are not reliable estimators of breathing frequency. In determining the validity of spectral heart rate variability measurements we suggest that it is the position of the spectral peaks and not the breathing

Partner selection in green supply chains using PSO - a practical approach

Partner selection is crucial to green supply chain management as the focal firm is responsible for the environmental performance of the whole supply chain. The construction of appropriate selection criteria is an essential, but often neglected pre-requisite in the partner selection process. This paper proposes a three-stage model that combines Dempster-Shafer belief acceptability theory and particle swarm optimization technique for the first time in this application. This enables optimization of both effectiveness, in its consideration of the inter-dependence of a broad range of quantitative and qualitative selection criteria, and efficiency in its use of scarce resources during the criteria construction process to be achieved simultaneously. This also enables both operational and strategic attributes can be selected at different levels of hierarchy criteria in different decision-making environments. The practical efficacy of the model is demonstrated by an application in Company ABC, a large Chinese electronic equipment and instrument manufacturer.

Occupational exposure to environmental tobacco smoke in hospitality venues: are genetic- or proteomics-based biomarkers predictive of respiratory diseases?

Environmental tobacco smoke (ETS) is recognized as an occupational hazard in the hospitality industry. Although Portuguese legislation banned smoking in most indoor public spaces, it is still allowed in some restaurants/bars, representing a potential risk to the workers’ health, particularly for chronic respiratory diseases. The aims of this work were to characterize biomarkers of early genetic effects and to disclose proteomic signatures associated to occupational exposure to ETS and with potential to predict respiratory diseases development. A detailed lifestyle survey and clinical evaluation (including spirometry) were performed in 81 workers from Lisbon restaurants. ETS exposure was assessed through the level of PM 2.5 in indoor air and the urinary level of cotinine. The plasma samples were immunodepleted and analysed by 2D-SDSPAGE followed by in-gel digestion and LC-MS/MS. DNA lesions and chromosome damage were analysed innlymphocytes and in exfoliated buccal cells from 19 cigarette smokers, 29 involuntary smokers, and 33 non-smokers not exposed to tobacco smoke. Also, the DNA repair capacity was evaluated using an ex vivo challenge comet assay with an alkylating agent (EMS). All workers were considered healthy and recorded normal lung function. Interestingly, following 2D-DIGE-MS (MALDI-TOF/TOF), 61 plasma proteins were found differentially expressed in ETS-exposed subjects, including 38 involved in metabolism, acute-phase respiratory inflammation, and immune or vascular functions. On the other hand, the involuntary smokers showed neither an increased level of DNA/chromosome damage on lymphocytes nor an increased number of micronuclei in buccal cells, when compared to non-exposed non-smokers. Noteworthy, lymphocytes challenge with EMS resulted in a significantly lower level of DNA breaks in ETS-exposed as compared to non-exposed workers (P<0.0001) suggestive of an adaptive response elicited by the previous exposure to low levels of ETS. Overall, changes in proteome may be promising early biomarkers of exposure to ETS. Likewise, alterations of the DNA repair competence observed upon ETS exposure deserves to be further understood. Work supported by Fundação Calouste Gulbenkian, ACSS and FCT/Polyannual Funding Program.

Reliability of nasal auscultation and their relation to middle ear condition – a clinical interest to pediatrics respiratory physiotherapy

Background: Acute respiratory infections are usual in children under three years old occurring in upper respiratory tract, having an impact on child and caregiver’s quality of life predisposing to otitis media or bronchiolitis. There are few valid and reliable measures to determine the child’s respiratory condition and to guide the physiotherapy intervention. Aim: To assess the intra and inter rater reliability of nasal auscultation, to analyze the relation between sounds’ classification and middle ear’s pressure and compliance as well as with the Clinical Severity Score. Methods: A cross-sectional observational study was composed by 125 nursery children aged up to three years old. Tympanometry, pulmonary and nasal auscultation and application of Clinical Severity Score were performed to each child. Nasal auscultation sounds’ were recorded and sent to 3 blinded experts, that classified, as “obstructed” and “unobstructed”, with a 48 hours interval, in order to analyze inter and intra rater reliability. Results: Nasal auscultation revealed a substantial inter and intra rater reliability (=0,749 and evaluator A - K= 0,691; evaluator B - K= 0,605 and evaluator C - K= 0,724, respectively). Both ears’ pressure was significantly lower in children with an "unobstructed" nasal sound when compared with an “obstructed” nasal sound (t=-3,599, p<0,001 in left ear; t=-2,258, p=0,026 in right ear). Compliance in both ears was significantly lower in children with an "obstructed" nasal sound when compared with “unobstructed” nasal sound (t=-2,728, p=0,007 in left ear; t=-3,830, p<0,001 in right ear). There was a statistically significant association between sounds’ classification and tympanograms types in both ear’s (=11,437, p=0,003 in left ear; =13,535, p=0,001 in right ear). There was a trend to children with an "unobstructed" nasal sound that had a lower clinical severity score when compared with “obstructed” children. Conclusion: It was observed a good intra and substantial inter reliability for nasal auscultation. Nasal auscultation sounds’ classification was related to middle ears’ pressure and compliance.