Cooperation in an HMMS-type supply chain: A management application of cooperative game theory = Kooperáció egy HMMS-típusú ellátási láncban: A kooperatív játékelmélet egy menedzsment alkalmazása

We apply cooperative game theory concepts to analyze a Holt-Modigliani-Muth-Simon (HMMS) supply chain. The bullwhip effect in a two-stage supply chain (supplier-manufacturer) in the framework of the HMMS-model with quadratic cost functions is considered. It is assumed that both firms minimize their relevant costs, and two cases are examined: the supplier and the manufacturer minimize their relevant costs in a decentralized and in a centralized (cooperative) way. The question of how to share the savings of the decreased bullwhip effect in the centralized (cooperative) model is answered by the weighted Shapley value, by a transferable utility cooperative game theory tool, where the weights are for the exogenously given “bargaining powers” of the participants of the supply chain. = A cikkben a kooperatív játékelmélet fogalmait alkalmazzuk egy Holt-Mogigliani-Muth-Simon-típusú ellátási lánc esetében. Az ostorcsapás-hatás elemeit egy beszállító-termelő ellátási láncban ragadjuk meg egy kvadratikus készletezési és termelési költség mellett. Feltételezzük, hogy mindkét vállalat minimalizálja a releváns költségeit. Két működési rendszert hasonlítunk össze: egy hierarchikus döntéshozatali rendszert, amikor először a termelő, majd a beszállító optimalizálja helyzetét, majd egy centralizált (kooperatív) modellt, amikor a vállalatok az együttes költségüket minimalizálják. A kérdés úgy merül fel, hogy a csökkentett ostorcsapás-hatás esetén hogyan osszák meg a részvevők ebben a transzferálható hasznosságú kooperatív játékban a költség megtakarítást, exogén módon adott tárgyalási pozíció mellett.

Pre-Disaster Risk Management in Post-Earthquake (1999) Turkey

This paper assesses the status of pre-disaster risk management in the case of Turkey. By focusing on the period following the catastrophic August 17, 1999 earthquake, the study benefits from USAID’s Disaster Risk Management Benchmarking Tool (DRMBT). In line with the benchmarking tool, the paper covers key developments in the four components of pre-disaster risk management, namely: risk identification, risk mitigation, risk transfer and disaster preparedness. In the end, it will present three major conclusions: (i) Although post-1999 Turkey has made some important progress in the pre-disaster phase of DRM, particularly with the enactment of obligatory earthquake insurance and tightened standards for building construction, the country is far away from substantial levels of success in DRM. (ii) In recent years, local governments have had been given more authority in the realm of DRM, however, Turkey’s approach to DRM is still predominantly centralized at the expense of successful DRM practices at the local level. (iii) While the devastating 1999 earthquake has resulted in advances in the pre-disaster components of DRM; progress has been mostly in the realm of earthquakes. Turkey’s other major disasters (landslides, floods, wild fires i.e.) also require similar attention by local and central authorities.

Iowa DOT Project Management Peer Exchange, 2016

This project supported the planning and conduct of a two-day Iowa Department of Transportation–hosted peer exchange for state agencies that have implemented some or all of the suggested strategies outlined in the Second Strategic Highway Research Program–sponsored project R10, Project Management Strategies for Complex Projects. Presentations were made by participating states, and several opportunities were provided for directed discussion. General themes emerging from the presentations and discussions were identified as follows: To implement improvements in project management processes, agency leadership needs to decide that a new approach to project management is worth pursuing and then dedicate resources to developing a project management plan. The change to formalized project management and five-dimensional project management (5DPM) requires a culture shift in agencies from segmented “silo” processes to collaborative, cooperative processes that make communication and collaboration high priorities. Agencies need trained project managers who are empowered to execute the project management plan, as well as properly trained functional staff. Project management can be centralized or decentralized with equal effect. After an agency’s project management plan and structure are developed, software tools and other resources should be implemented to support the plan and structure. All projects will benefit from enhanced project management, but the project management plan should specify appropriate approaches for several project levels as defined by factors in addition to dollar value. Project management should be included in an agency’s project development manual.

The evolution and performance of river basin management in the Murray-Darling Basin

We explore bioregional management in the Murray-Darling Basin (MDB) in Australia through the institutional design characteristics of the MDB River Basin Organization (RBO), the actors and organizations who supported and resisted the establishment of the RBO, and the effectiveness of the RBO. During the last 25 years, there has been a major structural reform in the MDB RBO, which has changed from an interstate coordinating body to an Australian government agency. Responsibility for basin management has been centralized under the leadership of the Australian government, and a comprehensive integrated Basin plan has been adopted. The driving forces for this centralization include national policy to restore river basins to sustainable levels of extraction, state government difficulties in reversing overallocation of water entitlements, the millennium drought and its effects, political expediency on the part of the Australian government and state governments, and a major injection of Australian government funding. The increasing hierarchy and centralization of the MDB RBO does not follow a general trend toward multilevel participative governance of RBOs, but decentralization should not be overstated because of the special circumstances at the time of the centralization and the continuing existence of some decentralized elements, such as catchment water plans, land use planning, and water quality. Further swings in the centralization–decentralization pendulum could occur. The MDB reform has succeeded in rebalancing Basin water allocations, including an allocation for the environment and reduced diversion limits. There are some longer term risks to the implementation of reform, including lack of cooperation by state governments, vertical coordination difficulties, and perceived reductions in the accountability and legitimacy of reform at the local level. If implementation of the Basin plan is diverted or delayed, a new institution, the Commonwealth Environmental Water Holder, can play a major role in securing and coordinating environmental water supplies.

Solidarity, the network and the history of workers' self-management from the Gdańsk Agreement to shock therapy

This PhD thesis is an empirical research project in the field of modern Polish history. The thesis focuses on Solidarity, the Network and the idea of workers’ self-management. In addition, the thesis is based on an in-depth analysis of Solidarity archival material. The Solidarity trade union was born in August 1980 after talks between the communist government and strike leaders at the Gdansk Lenin Shipyards. In 1981 a group called the Network rose up, due to cooperation between Poland’s great industrial factory plants. The Network grew out of Solidarity; it was made up of Solidarity activists, and the group acted as an economic partner to the union. The Network was the base of a grass-roots, nationwide workers’ self-management movement. Solidarity and the self-management movement were crushed by the imposition of Martial Law in December 1981. Solidarity revived itself immediately, and the union created an underground society. The Network also revived in the underground, and it continued to promote self-management activity where this was possible. When Solidarity regained its legal status in April 1989, workers’ self-management no longer had the same importance in the union. Solidarity’s new politico-economic strategy focused on free markets, foreign investment and privatization. This research project ends in July 1990, when the new Solidarity-backed government enacted a privatization law. The government decided to transform the property ownership structure through a centralized privatization process, which was a blow for supporters of workers’ self-management. This PhD thesis provides new insight into the evolution of the Solidarity union from 1980-1990 by analyzing the fate of workers’ self-management. This project also examines the role of the Network throughout the 1980s. There is analysis of the important link between workers’ self-management and the core ideas of Solidarity. In addition, the link between political and economic reform is an important theme in this research project. The Network was aware that authentic workers’ self-management required reforms to the authoritarian political system. Workers’ self-management competed against other politico-economic ideas during the 1980s in Poland. The outcome of this competition between different reform concepts has shaped modern-day Polish politics, economics and society.

A Decade Of Malaria During Pregnancy In Brazil: What Has Been Done Concerning Prevention And Management.

In Brazil, malaria remains a disease of major epidemiological importance because of the high number of cases in the Amazonian Region. Plasmodium spp infections during pregnancy are a significant public health problem with substantial risks for the pregnant woman, the foetus and the newborn child. In Brazil, the control of malaria during pregnancy is primarily achieved by prompt and effective treatment of the acute episodes. Thus, to assure rapid diagnosis and treatment for pregnant women with malaria, one of the recommended strategy for low transmission areas by World Health Organization and as part of a strategy by the Ministry of Health, the National Malaria Control Program has focused on integrative measures with woman and reproductive health. Here, we discuss the approach for the prevention and management of malaria during pregnancy in Brazil over the last 10 years (2003-2012) using morbidity data from Malaria Health Information System. Improving the efficiency and quality of healthcare and education and the consolidation of prevention programmes will be challenges in the control of malaria during pregnancy in the next decade.

Management Of Severe Thoracic Impalement Trauma Against Two-wheeled Horse Carriage: A Case Report And Literature Review.

Thoracic injuries in general are of great importance due to their high incidence and high mortality. Thoracic impalement injuries are rare but severe due to the combination of cause, effect and result. This study's primary objective is to report the case of a young man who was impaled by a two-wheeled horse carriage shaft while crashing his motorcycle in a rural zone. An EMT-B ferry was called at the crash scene and a conscious patient was found, sustaining a severe impalement injury to the left hemithorax, suspended over the floor by the axial skeleton with the carriage shaft coming across his left chest. As a secondary objective, a literature review of thoracic impalement injuries is performed. Cases of thoracic impalement injury require unique and individualized care based on injury severity and affected organs. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management. In penetrating trauma, it is essential not to remove the impaled object, so that possible vascular lesions remain buffered by the object, avoiding major bleeding and exsanguination haemorrhage. Severed impaled thoracic patients should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment. High-energy thoracic impalement injuries are rare and hold a high mortality rate, due to the complexity of trauma and associated injuries such as thoracic wall and lung lesions. Modern medicine still seems limited in cases of such seriousness, not always with satisfactory results.

Key Issues In Inhibitor Management In Patients With Haemophilia.

12 Suppl 1

[consensus Of The Brazilian Society Of Rheumatology For The Diagnosis, Management And Treatment Of Lupus Nephritis].

To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. 1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.

Conservative Management For Lingual Thyroid Ectopic.

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc(99m) and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Dysphagia Progression And Swallowing Management In Parkinson's Disease: An Observational Study.

Dysphagia is relatively common in individuals with neurological disorders. To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

Comparative analysis of adverse events between infliximab and adalimumab in Crohn's disease management: a Brazilian single-centre experience

INTRODUCTION: Data is scarce regarding adverse events (AE) of biological therapy used in the management of Crohn's Disease (CD) among Brazilian patients. OBJECTIVES: To analyse AE prevalence and profile in patients with CD treated with Infliximab (IFX) or Adalimumab (ADA) and to verify whether there are differences between the two drugs. METHOD: Retrospective observational single-centre study of CD patients on biological therapy. Variables analysed: Demographic data, Montreal classification, biological agent administered, treatment duration, presence and type of AE and the need for treatment interruption. RESULTS: Forty-nine patients were analysed, 25 treated with ADA and 24 with IFX. The groups were homogeneous in relation to the variables studied. The average follow-up period for the group treated with ADA was 19.3 months and 21.8 months for the IFX group (p = 0.585). Overall, 40% (n = 10) of patients taking ADA had AE compared with 50% (n = 12) of IFX users (p = 0.571). There was a tendency towards higher incidence of cutaneous and infusion reactions in the IFX group and higher incidence of infections in the ADA treated group, although without significant difference. CONCLUSIONS: No difference was found in the AE prevalence and profile between ADA and IFX CD patients in the population studied.

Comparative analysis of the new guidelines and consensuses for the management of hypothyroidism, thyroid nodules, and differentiated thyroid cancer

233

Hegemonia e contra-hegemonia na construção de políticas de esporte e lazer : a experiência do Consórcio Brasília = Hegemony and counter-hegemony in the process of sport and leisure policy-making : the experience of the Consortium Brasilia

Universidade Estadual de Campinas . Faculdade de Educação Física

Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.