The impact of slow steaming on the carriers’ and shippers’ costs: The case of a global logistics network

We propose an analytical modeling methodology for quantifying the impact of slow steaming on the carrier's voyage cost and on the shipper's total landed logistics costs. The developed methodology can be employed by a carrier and a shipper in their contract negotiations, in order for the two parties to determine how they could divide between them the savings resulted from slow steaming. We demonstrate that the impact of slow steaming and speed adjustment policies on the shippers’ total landed logistics costs tend to increase as the vessel travels towards the end of its voyage

The emerging role of water footprint in supply chain management: A critical literature synthesis and a hierarchical decision-making framework

Freshwater overexploitation and scarcity have led to extensive shifts in demand patterns for water-friendly products. As several agricultural and industrial activities are closely intertwined with water consumption, the availability of sufficient freshwater resources constitutes a significant precondition for covering global consumer needs. In this context, the design and management of sustainable supply chains in terms of freshwater resources' preservation have emerged as major challenges in the corporate agenda. As such, the concept of water footprint as a key performance indicator of freshwater utilization has been introduced at national, corporate and product levels. In this manuscript, we first provide a critical literature synthesis concerning product water footprint assessment in order to map the state-of-the-art research related to freshwater consumption and pollution in the agricultural and industrial sectors. Our analysis demonstrates that although water footprint assessment is a rapidly evolving research field, scientific publications focusing on a holistic approach concerning freshwater exploitation at a supply chain extent are rather limited. The findings further verify that the agrifood sector dominates global water use. In this respect, we analyse both corporate and academic literature in order to identify emerging issues on freshwater resources' management for agrifood products. Finally, we propose a first-effort hierarchical decision-making framework that includes water footprint mitigation policies for agrifood supply chains in order to support all stakeholders in developing a comprehensive water stewardship strategy.Public Benefit Foundation Alexander S. Onassis, European Community 7th Framework Programme (FP7-REGPOT- 2012-2013-1) GREEN-AgriChains project (Grant ID: 316167

Sustainable supply chain management in the digitalisation era: The impact of Automated Guided Vehicles

Internationalization of markets and climate change introduce multifaceted challenges for modern supply chain (SC) management in the today's digitalisation era. On the other hand, Automated Guided Vehicle (AGV) systems have reached an age of maturity that allows for their utilization towards tackling dynamic market conditions and aligning SC management focus with sustainability considerations. However, extant research only myopically tackles the sustainability potential of AGVs, focusing more on addressing network optimization problems and less on developing integrated and systematic methodological approaches for promoting economic, environmental and social sustainability. To that end, the present study provides a critical taxonomy of key decisions for facilitating the adoption of AGV systems into SC design and planning, as these are mapped on the relevant strategic, tactical and operational levels of the natural hierarchy. We then propose the Sustainable Supply Chain Cube (S2C2), a conceptual tool that integrates sustainable SC management with the proposed hierarchical decision-making framework for AGVs. Market opportunities and the potential of integrating AGVs into a SC context with the use of the S2C2 tool are further discussed

Design of sustainable supply chains for the agrifood sector: a holistic research framework

Agrifood sector is one of the most important economic and political areas within the European Union, with key implications for sustainability such as the fulfillment of human needs, the support of employment and economic growth, and its impact on the natural environment.  Growing environmental, social and ethical concerns and increased awareness of the impacts of the agrifood sector have led to increased pressure by all involved supply chain stakeholders, while at the same time the European Union has undertaken a number of relevant regulatory interventions.  This paper aims to present a methodological framework for the design of green supply chains for the agrifood sector.  The framework aims towards the optimization of the agrifood supply chain design, planning and operations through the implementation of appropriate green supply chain management and logistics principles.  More specifically, focus is put on the minimization of the environmental burden and the maximization of supply chain sustainability of the agrifood supply chain.  The application of such a framework could result into substantial reduction of CO2 emissions both by the additional production of other biofuels from waste, as well as the introduction of a novel intelligent logistics network, in order to reduce the harvest and transportation energy input.  Moreover, the expansion of the biomass feedstock available for biofuel production can provide adequate support towards avoidance of food/fuel competition for land use.   Keywords: supply chain management, green supply chains, sustainable development, agrifood secto

Water Footprint Mitigation Strategies for Agrifood Products: The Application of System Dynamics in Green Marketing

Water scarcity (WS), which leads to multiple environmental, social and economic ramifications, has emerged as an indisputable concern for both public and private stakeholders. In this context, the water footprint (WF) concept has been introduced for assessing freshwater consumption and pollution at national, corporate or product level. In the agrifood industry, freshwater is a pivotal constituent since agricultural activities consume 70 % of the global freshwater resources, while food processing operations account for significant freshwater utilization. To that effect, environmentally aware consumers are sensitive to the total product WF generated during agrifood supply chain (SC) operations, as well as to the manner in which the related freshwater exploitation impacts regional WS. Consequently, an increasing number of companies are implementing WF management policies across their agrifood SCs for mitigating freshwater utilization and promoting water-friendly commodities in order to enhance green corporate image and business financial performance. This study proposes a policy-making system dynamics (SD) model for monitoring both the WF of agrifood products and the profitability of the related SCs in terms of net present value (NPV). The model investigates the effect of various market behaviours in the relation between green image factor (GIF) and regional WS, when WF management strategies are implemented. The SD simulation results reveal that WF mitigation policies have a considerable impact on GIF in environmentally sensitive markets, thus increasing the relevant market share and the agrifood SC stakeholders’ profitability. Finally, this research provides managerial insights concerning green marketing interventions in the agrifood sector

An Integrated System Dynamics and Discrete Event Supply Chain Simulation Framework for Supply Chain Resilience with Non-Stationary Pandemic Demand

COVID-19 resulted in some of the largest supply chain disruptions in recent history. To mitigate the impact of future disruptions, we propose an integrated hybrid simulation framework to couple nonstationary demand signals from an event like COVID-19 with a model of an end-to-end supply chain. We first create a system dynamics susceptible-infected-recovered (SIR) model, augmenting a classic epidemiological model to create a realistic portrayal of demand patterns for oxygen concentrators (OC). Informed by this granular demand signal, we then create a supply chain discrete event simulation model of OC sourcing, manufacturing, and distribution to test production augmentation policies to satisfy this increased demand. This model utilizes publicly available data, engineering teardowns of OCs, and a supply chain illumination to identify suppliers. Our findings indicate that this coupled approach can use realistic demand during a disruptive event to enable rapid recommendations of policies for increased supply chain resilience with controlled cost

Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting

Author Manuscript: 2011 April 14Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary intervention (PCI). Multiple studies have shown that DM is a strong risk factor for restenosis following successful balloon angioplasty or coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Early data suggest that drug eluting stents reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality. For many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy. PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with medical therapy. However, selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial. Randomized trials comparing multivessel PCI with balloon angioplasty or bare metal stents to coronary artery bypass grafting (CABG) consistently demonstrated the superiority of CABG in patients with treated DM. In the setting of diabetes CABG had greater survival, fewer recurrent infarctions or need for re-intervention. Limited data suggests that CABG is superior to multivessel PCI even when drug-eluting stents are used. Several ongoing randomized trials are evaluating the long-term comparative efficacy of PCI with drug-eluting stents and CABG in patients with DM. Only further study will continue to unravel the mechanisms at play and optimal therapy in the face of the profoundly virulent atherosclerotic potential that accompanies diabetes mellitus.National Institutes of Health (U.S.) (GM 49039

Synchronous parathyroid adenoma and thyroid papillary carcinoma: a case report

A 51-year-old female patient presented with atypical chest pain, laryngo-oesophageal reflux, increased levels of serum calcium and parathyroid hormone. Ultrasonography showed a multinodular goiter with a prominent solid nodule in the lower left thyroid lobe and a solid hypoechoic nodule outside this area

BAlloon expandable vs. SElf expanding transcatheter vaLve for degenerated bioprosthesIs: design and rationale of the BASELINE trial

Background: Surgical aortic valve bioprostheses may degenerate over time and require redo intervention. Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to redo surgery. The BAlloon Expandable vs. SElf Expanding Transcatheter VaLve for Degenerated BioprosthesIs (BASELINE) trial was designed to compare the performance of the balloon-expandable SAPIEN-3 Ultra and the self-expanding EVOLUT PRO+ valve systems in symptomatic patients with a failing surgical bioprosthesis. Methods: The BASELINE trial is an investigator-initiated, non-funded, prospective, randomized, open-label, superiority trial enrolling a total of 440 patients in up to 50 sites in 12 countries in Europe and North-America. The primary endpoint is device success at 30-days defined by the Valve Academic Research Consortium-3 Criteria as the composite of technical success, freedom from mortality, freedom for surgery or intervention related to the device or to a major vascular or access-related or cardiac structural complication with an intended performance of the valve (mean gradient <20 mmHg and less than moderate aortic regurgitation). The co-primary endpoint at 1 year is defined as the composite of all-cause death, disabling stroke, rehospitalization for heart failure or valve related problems. Independent Core Laboratories will conduct uniform analyses of echocardiography (pre-, post-, 1-year post-procedure), multi-sliced computed tomography (pre-, and if available post-procedure) and cine-fluoroscopy studies. Conclusions: The BASELINE trial is a head-to-head comparative trial investigating the 2 most used contemporary transcatheter heart valves for the treatment of a failing surgical aortic bioprosthesis. (ClinicalTrials.gov number NCT04843072)

The impact of electronic versus paper-based data capture on data collection logistics and on missing scores in thyroid cancer patients.

The purpose of this study was to investigate the impact of the type of data capture on the time and help needed for collecting patient-reported outcomes as well as on the proportion of missing scores. In a multinational prospective study, thyroid cancer patients from 17 countries completed a validated questionnaire measuring quality of life. Electronic data capture was compared to the paper-based approach using multivariate logistic regression. A total of 437 patients were included, of whom 13% used electronic data capture. The relation between data capture and time needed was modified by the emotional functioning of the patients. Those with clinical impairments in that respect needed more time to complete the questionnaire when they used electronic data capture compared to paper and pencil (OR <sub>adj</sub> 24.0; p = 0.006). This was not the case when patients had sub-threshold emotional problems (OR <sub>adj</sub> 1.9; p = 0.48). The odds of having the researcher reading the questions out (instead of the patient doing this themselves) (OR <sub>adj</sub> 0.1; p = 0.01) and of needing any help (OR <sub>adj</sub> 0.1; p = 0.01) were lower when electronic data capture was used. The proportion of missing scores was equivalent in both groups (OR <sub>adj</sub> 0.4, p = 0.42). The advantages of electronic data capture, such as real-time assessment and fewer data entry errors, may come at the price of more time required for data collection when the patients have mental health problems. As this is not uncommon in thyroid cancer, researchers need to choose the type of data capture wisely for their particular research question