Logistiikkavaraston henkilöstökustannusten optimointi

Tämän diplomityön tavoitteena on case-esimerkin kautta tutkia, kuinka hyvin vähittäiskaupan logistiikkavarastossa pystytään sovittamaan yhteen työn kysyntä ja tarjonta ja mikä on vuokratyövoiman rooli tässä yhtälössä. Diplomityössä käsitellään logistiikkavaraston työmäärän ennustettavuutta, työvoiman joustavuutta, lasketaan vertailukelpoiset kustannukset eri henkilöstöryhmille sekä esitetään ehdotuksia kokonaiskustannusten optimoimiseksi. Diplomityössä käy ilmi, että tutkittavassa yrityksessä henkilöstöresurssien käyttö ei ole aivan optimaalinen, vaan että tehdyistä työtunneista jopa 21% on ylimääräisiä, mikä aiheuttaa vuosittain 1,0 miljoonan euron kustannushukan. Tämä johtuu sekä työmäärän epätasaisesta jakautumisesta kuukausien kesken, että työvoimatarpeen heikosta suunnittelusta. Työmäärän vaikeasta ennustettavuudesta johtuen turhia työtunteja ei ole mahdollista kokonaan poistaa, mutta hyvällä etukäteissuunnittelulla henkilöstökustannuksia pystytään laskemaan noin 13%. Henkilöstöryhmistä tehtyjen vertailulaskelmien perusteella ylitöiden teettäminen vakituisella henkilökunnalla osoittautuu kannattamattomaksi. Määräaikaisen henkilöstön käyttäminen on kustannuksiltaan edullista, mutta mahdollista vain, jos työvoiman tarve on tilapäinen ja tiedossa hyvissä ajoin etukäteen. Vuokratyövoima on tuntikustannukseltaan kalliimpaa, mutta sen nopea saatavuus mahdollistaa työvoiman entistä paremman sopeuttamisen työn kysynnän mukaan. Kun vuokratyövoimaa on saatavilla, ei varastolla tarvitse pitää ylimääräistä työvoimaa nopeiden työmäärän muutosten varalta.

Fluid flow processes at basin scale

S u b s u r face fluid flow plays a significant role in many geologic processes and is increasingly being studied in the scale of sedimentary basins and geologic time perspective. Many economic resources such as petroleum and mineral deposits are products of basin scale fluid flow operating over large periods of time. Such ancient flow systems can be studied through analysis of diagenetic alterations and fluid inclusions to constrain physical and chemical conditions of fluids and rocks during their paleohy d r og e o l ogic evolution. Basin simulation models are useful to complement the paleohy d r og e o l ogic record preserved in the rocks and to derive conceptual models on hydraulic basin evolution and generation of economic resources. Different types of fluid flow regimes may evo l ve during basin evolution. The most important with respect to flow rates and capacity for transport of solutes and thermal energy is gr avitational fluid flow driven by the topographic configuration of a basin. Such flow systems require the basin to be elevated above sea level. Consolidational fluid flow is the principal fluid migration process in basins below sea level, caused by loading of compressible rocks. Flow rates of such systems are several orders of magnitude below topogr a p hy driven flow. Howeve r, consolidation may create significant fluid ove rpressure. Episodic dewatering of ove rpressured compart m e n t s m ay cause sudden fluid release with elevated flow velocities and may cause a transient local thermal and chemical disequilibrium betwe e n fluid and rock. This paper gives an ove rv i ew on subsurface fluid flow processes at basin scale and presents examples related to the Pe n e d è s basin in the central Catalan continental margin including the offshore Barcelona half-graben and the compressive South-Pyrenean basin.

Hankintariskienhallinta Suomen IVD-teollisuudessa

Kansainvälinen ja kiristyvä kilpailu on muuttanut yritysten liiketoimintaympäristöä yhä monimutkaisemmaksi ja riskialttiimmaksi. Yritysten keskittyessä yhä syvemmin omaan ydinosaamiseensa on ulkoisten resurssien hallinnan merkitys korostunut. Työnjakoa syventämällä tavoitellaan parempaa joustavuutta, ajanhallintaa sekä kustannustehokkuutta. Myös hankintatoimen tehtävät ja vastuualueet muuttuvat ennakoivampaan ja riskialttiimpaan suuntaan. Modernin hankintatoimen on kyettävä tunnistamaan, analysoimaan ja hallitsemaan riskejä yhä pirstaloituneemmista lähteistä ja muodoista. Proaktiivinen hankintatoimi osallistuu yrityksen strategiseen suunnitteluun ja riskienhallintaan. Hankintariskit voidaan luokitella seuraaviin kymmeneen riskiluokkaan: keskeytymisriskit, saatavuusriskit, hintariskit, varasto- ja aikatauluriskit, teknologiariskit, luottamuksellisen tiedon vuotoriskit, laaturiskit, konfiguraatioriskit, opportunismiriskit sekä riippuvuusriskit. Tässä tutkimuksessa hankintariskienhallintaa tarkastellaan hankintastrategian valinnan näkökulmasta. Hankintastrategian yksi elementti on toimittajasuhteen ja toimittajien lukumäärän valinta. Tilanteesta riippuen yhteistyöstrategialla tai perinteisellä kilpailuttamisella voidaan tavoitella parempaa riskienhallintaa. Yhteistyöstrategioita ovat eri tasoiset kumppanuussuhteet ja liittoutumat, jolloin suhde toimittajaan on syvä ja luottamuksellinen hyödyttäen aidosti molempia osapuolia. Riskienhallinnan näkökulmasta yhteistyöstrategia soveltuu parhaiten tilanteissa, joissa toimittajista on pitkä kokemus sekä hankintanimikkeen tuottama arvo on merkittävä. Kilpailuttamisstrategia eli hankintojen toteuttaminen usealta toimittajalta vaatii ostavalta organisaatiolta tehokkaasti hyödynnettynä suurempia resursseja kuin yhteistyöstrategian käyttö. Kilpailuttaminen soveltuu usein parhaiten silloin, kun hankintanimikkeet ovat tavanomaisia ja vaihtoehtoisia hankintalähteitä on runsaasti. Lisäksi usean toimittajan käyttö suojaa materiaalivirran katkoksilta sekä lisää hankintamarkkinoiden tuntemusta. Empiirisessä tutkimusosassa tutkitaan, miten soveltuviksi riskienhallintamenetelmiksi erilaiset hankintastrategiat koetaan Suomen IVD-teollisuudessa. Lisäksi tunnistetaan Suomen IVD-teollisuudessa merkittävimmiksi koetut hankintariskiluokat sekä selvitetään millä organisaation tasolla hankintariskienhallinta pääasiassa suoritetaan. Lisäksi selvitetään, millä menetelmin hankintariskejä pääasiassa analysoidaan.

Embolic Strokes of Undetermined Source in the Athens Stroke Registry: an Outcome Analysis.

BACKGROUND AND PURPOSE: Information about outcomes in Embolic Stroke of Undetermined Source (ESUS) patients is unavailable. This study provides a detailed analysis of outcomes of a large ESUS population. METHODS: Data set was derived from the Athens Stroke Registry. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group criteria. End points were mortality, stroke recurrence, functional outcome, and a composite cardiovascular end point comprising recurrent stroke, myocardial infarction, aortic aneurysm rupture, systemic embolism, or sudden cardiac death. We performed Kaplan-Meier analyses to estimate cumulative probabilities of outcomes by stroke type and Cox-regression to investigate whether stroke type was outcome predictor. RESULTS: 2731 patients were followed-up for a mean of 30.5±24.1months. There were 73 (26.5%) deaths, 60 (21.8%) recurrences, and 78 (28.4%) composite cardiovascular end points in the 275 ESUS patients. The cumulative probability of survival in ESUS was 65.6% (95% confidence intervals [CI], 58.9%-72.2%), significantly higher compared with cardioembolic stroke (38.8%, 95% CI, 34.9%-42.7%). The cumulative probability of stroke recurrence in ESUS was 29.0% (95% CI, 22.3%-35.7%), similar to cardioembolic strokes (26.8%, 95% CI, 22.1%-31.5%), but significantly higher compared with all types of noncardioembolic stroke. One hundred seventy-two (62.5%) ESUS patients had favorable functional outcome compared with 280 (32.2%) in cardioembolic and 303 (60.9%) in large-artery atherosclerotic. ESUS patients had similar risk of composite cardiovascular end point as all other stroke types, with the exception of lacunar strokes, which had significantly lower risk (adjusted hazard ratio, 0.70 [95% CI, 0.52-0.94]). CONCLUSIONS: Long-term mortality risk in ESUS is lower compared with cardioembolic strokes, despite similar rates of recurrence and composite cardiovascular end point. Recurrent stroke risk is higher in ESUS than in noncardioembolic strokes.

Prévention des troubles du rythme cardiaque en hémodialyse: quels sont les facteurs modulables [Prevention of cardiac arrhythmias in hemodialysis: what are the modulating factors?].

La mort subite est la première cause de mortalité chez les patients souffrant d'une insuffisance rénale terminale traités par dialyse chronique. La technique de dialyse utilisée et la composition chimique du dialysat influencent l'incidence des arythmies. Des études pilotes démontrent que l'utilisation d'un dialysat sans acétate avec perfusion de bicarbonate de sodium en aval du filtre de dialyse, couplée à une modulation du profil de potassium pendant la séance de dialyse, ou acetate free biofiltration with potassium profiled dialysate, permet de réduire l'incidence des arythmies, l'intervalle QT et sa dispersion. La limitation du volume de soustraction liquidienne pendant la dialyse et l'augmentation de la concentration de calcium dans le dialysat constituent d'autres stratégies anti-arythmogènes possibles Sudden death is the first cause of mortality in patients with end stage renal disease undergoing chronic dialysis treatment. The technique of dialysis as well as the chemical composition of the dialysate can impact on the incidence of cardiac arrhythmias. Pilot studies reveal that the use of an acetate-free dialysate with a downstream filter infusion of sodium bicarbonate, coupled with a modulated potassium-profiled dialysate during hemodialysis, or acetate free biofiltration with potassium profiled dialysate, reduces the incidence of arrhythmias, the QT interval and QT dispersion. The limitation of the ultrafiltration volume during the dialysis session, and the increase in calcium concentration in the dialysate are other possible strategies to reduce cardiac arrhythmias.

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application.

Status epilepticus (SE) is a life-threatening neurological emergency often refractory to available treatment options. It is a very heterogeneous condition in terms of clinical presentation and causes, which besides genetic, vascular and other structural causes also include CNS or severe systemic infections, sudden withdrawal from benzodiazepines or anticonvulsants and rare autoimmune etiologies. Treatment of SE is essentially based on expert opinions and antiepileptic drug treatment per se seems to have no major impact on prognosis. There is, therefore, urgent need of novel therapies that rely upon a better understanding of the basic mechanisms underlying this clinical condition. Accumulating evidence in animal models highlights that inflammation ensuing in the brain during SE may play a determinant role in ongoing seizures and their long-term detrimental consequences, independent of an infection or auto-immune cause; this evidence encourages reconsideration of the treatment flow in SE patients.

Acute Lyme Neuroborreliosis With Transient Hemiparesis and Aphasia.

Nervous system involvement in Lyme disease often mimics other conditions and thus represents a diagnostic challenge, especially in an emergency department setting. We report a case of a female teenager presenting with sudden-onset aphasia and transient right-sided faciobrachial hemiplegia, along with headache and agitation. Ischemia, vasculitis, or another structural lesion was excluded by brain imaging. Toxicologic evaluation results were negative. Cerebral perfusion computed tomography and electroencephalography showed left parietotemporal brain dysfunction. Lumbar puncture result, although atypical, suggested bacterial infection and intravenous ceftriaxone was initiated. Finally, microbiological cerebrospinal fluid analysis revealed Lyme neuroborreliosis, showing specific intrathecal antibody production and high level of C-X-C motif chemokine 13. The patient rapidly recovered. To our knowledge, this report for the first time illustrates that acute-onset language and motor symptoms may be directly related to Lyme neuroborreliosis. Neuroborreliosis may mimic other acute neurologic events such as stroke and should be taken into diagnostic consideration even in the absence of classic symptoms and evolution.

Reflexiones sobre la escritura y la alfabetización de los niños sordos

Importancia de la lengua escrita en nuestra cultura para apropiarnos del conocimiento social. Las personas sordas precisan de una lengua visual, la Lengua se Signos, para alcanzar un nivel competente de lectura y escritura, y por tanto es necesario que desde los inicios los niños sordos aprendan esta lengua junto con la lengua oral, propia de su comunidad. Se reconoce el bilingüismo como la opción más adecuada para esta población.

Representación fonológica, aprendizaje de la escritura y alumnos sordos

Destaca la importancia del conocimiento fonológico para el aprendizaje de la lectura y la escritura en los alumnos sordos. Estos alumnos precisan de esta representación por canales no auditivos.

Cardiac Toxicity in Selective Serotonin Reuptake Inhibitor Users.

Several classes of recreational and prescription drugs have been associated with an increased risk of cardiovascular disease and the occurrence of arrhythmias, which may be involved in sudden deaths in chronic users even at therapeutic doses. The study presented herein focuses on pathological changes involving the heart, which may be caused by selective serotonin reuptake inhibitor use and their possible role in the occurrence of sudden cardiac death. A total of 40 cases were included in the study and were divided evenly into 2 groups: 20 cases of patients treated with selective serotonin reuptake inhibitors and 20 cases of sudden deaths involving patients void of any drug treatment. The first group included 16 patients treated with citalopram and 4 with sertraline. Autopsies, histology, biochemistry, and toxicology were performed in all cases. Pathological changes in selective serotonin reuptake inhibitor users consisted of various degrees of interstitial and perivascular fibrosis as well as a small degree of perineural fibrosis within the myocardium of the left ventricle. Within the limits of the small number of investigated cases, the results of this study seem to confirm former observations on this topic, suggesting that selective serotonin reuptake inhibitors may play a potential, causative role in the pathogenesis of sudden deaths in chronic users even at therapeutic concentrations.

Prospects for Paleoseismology in Spain

Paleoseismology is the study of prehistoric earthquakes, especially their location, timing and size. Paleoseismology and Neotectonics should not be confused. Whereas Neotectonics deals with general crustal deformation in recent times (late Cenozoic), Paleoseismology is concerned with sudden deformation of landforms and sediments during earthquakes. Paleoseismologists are only able to study earthquakes that produce recognizable surface deformation, i.e. earthquakes of M>6...

(210)Po poisoning as possible cause of death: forensic investigations and toxicological analysis of the remains of Yasser Arafat.

The late president of the Palestinian Authority, Yasser Arafat, died in November 2004 in Percy Hospital, one month after having experienced a sudden onset of symptoms that included severe nausea, vomiting, diarrhoea and abdominal pain and which were followed by multiple organ failure. In spite of numerous investigations performed in France, the pathophysiological mechanisms at the origin of the symptoms could not be identified. In 2011, we found abnormal levels of polonium-210 ((210)Po) in some of Arafat's belongings that were worn during his final hospital stay and which were stained with biological fluids. This finding led to the exhumation of Arafat's remains in 2012. Significantly higher (up to 20 times) activities of (210)Po and lead-210 ((210)Pb) were found in the ribs, iliac crest and sternum specimens compared to reference samples from the literature (p-value <1%). In all specimens from the tomb, (210)Po activity was supported by a similar activity of (210)Pb. Biokinetic calculations demonstrated that a (210)Pb impurity, as identified in a commercial source of 3MBq of (210)Po, may be responsible for the activities measured in Arafat's belongings and remains 8 years after his death. The absence of myelosuppression and hair loss in Mr Arafat's case compared to Mr Litvinenko's, the only known case of malicious poisoning with (210)Po, could be explained by differences in the time delivery-scheme of intake. In conclusion, statistical Bayesian analysis combining all the evidence gathered in our forensic expert report moderately supports the proposition that Mr Arafat was poisoned by (210)Po.

Study of tergal glands morphogenesis through an integrative analysis of genomic data

About 50% of living species are holometabolan insects. Therefore, unraveling the ori- gin of insect metamorphosis from the hemimetabolan (gradual metamorphosis) to the holometabolan (sudden metamorphosis at the end of the life cycle) mode is equivalent to explaining how all this biodiversity originated. One of the problems with studying the evolution from hemimetaboly to holometaboly is that most information is available only in holometabolan species. Within the hemimetabolan group, our model, the cock- roach Blattella germanica, is the most studied species. However, given that the study of adult morphogenesis at organismic level is still complex, we focused on the study of the tergal gland (TG) as a minimal model of metamorphosis. The TG is formed in tergites 7 and 8 (T7-8) in the last days of the last nymphal instar (nymph 6). The comparative study of four T7-T8 transcriptomes provided us with crucial keys of TG formation, but also essential information about the mechanisms and circuitry that allows the shift from nymphal to adult morphogenesis.

Therapeutic and recreational methadone cardiotoxicity.

Several classes of drugs have been associated with an increased risk of cardiovascular disease and occurrence of arrhythmias potentially involved in sudden deaths in chronic users even at therapeutic doses. The study presented herein focuses on pathological changes involving the heart possibly due to methadone use. 60 cases were included in the study in total and were divided into three groups (therapeutic methadone users: 20 cases, recreational methadone users: 20 cases, and sudden death group in subjects who had never taken methadone: 20 cases). Autopsies, histology, biochemistry and toxicology were performed in all cases. Macroscopic and microscopic investigation results in therapeutic methadone users were similar to those observed in sudden, unexpected deaths in non-methadone users. In recreational methadone consumers, macroscopic and microscopic examination of the heart failed to provide results consistent with acute or chronic myocardial or coronary damage, thereby corroborating the hypothesis of death most likely following respiratory depression.

Coronary anomalies: what the radiologist should know

AbstractCoronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies.