Summary Project objectives This study fits into a larger research project on logistics collaboration and outsourcing decisions. The final objective of this larger project is to analyze the logistics collaboration decision in more detail to identify thresholds in these decisions. To reach the overall objectives, the first step is to get a clearer picture on the chemical and logistics service providers industry, sectors of our study, and on logistics collaboration in these sectors. The results of this first phase are presented in this report. Project Approach The study consists of two parts: literature review and five case studies within the chemical industry. The literature covers three topics: logistics collaboration, logistics outsourcing and purchasing of logistics services. The five case studies are used to refine the theoretical findings of the literature review. Conclusions Main observations during the case studies can be summarized as follows: Most analyzed collaborative relationships between shippers and logistics service providers in the chemical industry are still focused on operational execution of logistics activities with a short term horizon. Supply management design and control are often retained by the shippers. Despite the time and cost intensive character of a logistics service buying process, shippers tendering on a very regular basis. The decision to start a new tender project should more often be based on an integral approach that includes all tender related costs. A lower frequency of tendering could create more stability in supply chains. Beside, it will give both, shippers and LSPs, the possibility to improve the quality of the remaining projects. Price is still a dominating decision criterion in selecting a LSP. This is not an issue as long as the comparison of costs is based on an integral approach, and when shippers balance the cost criterion within their total set of criteria for sourcing logistics services. At the shippers' side there is an increased awareness of the need of more solid collaboration with logistics service providers. Nevertheless, in many cases this increased awareness does not actually result in the required actions to establish more intensive collaboration. Over the last years the logistics service providers industry was characterized by low profit margins, strong fragmentation and price competition. Nowadays, the market for LSPs is changing, because of an increasing demand for logistics services. To benefit from this situation a more pro-active role of the service providers is required in building stronger relationships with their customers. They should pay more attention on mid and long term possibilities in a collaborative relation, in stead of only be focused on running the daily operation.
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The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescriptionchanges over a 3-month period. A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient.We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start.
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In 2005 and 2006, almost sixty Dutch National Sport Federations (NSFs) participated in a special program for creating a marketing strategy for the next four years. This program was initiated and organized by NOC*NSF (the Dutch Olympic Umbrella Sports Organization). The NSFs had to joint the project to receive funds. For most of them it was the first time they seriously analyzed the market with the aim of developing new programs. The purpose of this paper is to explore to what extent Dutch NSFs are capable to change their structures to become more market oriented and more market responsive in order to write strategic plans. The changed structures are investigated using the "institutional theory" (Tolbert & Zucker, 1996) and are explained by exogenous (market context and institutional context) and endogenous (interests, values, power dependencies, and capacity for action) dynamics from the neo-institutionalist framework (Greenwood & Hinings, 1996). In 2005 NSFs were expected to be in a pre-institutionalized stage, i.e. they were supposed to develop new organizational structures in response to specific problems (Kikulis, 2000). Now, approximately 1½ years after finishing their strategies, the question arises whether they have reached the semi-institutional stage, i.e. whether the new structures or actions are diffused across organizations, yet still subject to change and whether old structures are yet eroding (Kikulis, 2000). Methods Studying the intended structural change of NSFs requires an in-depth study of their social reality and the reactions and interpretations of involved actors, including their applied meanings to certain situations. Greenwood & Hinings (1996) plead for detailed comparative case-studies when studying institutional changes. Therefore three NSFs has been selected: The Royal Dutch Korfball Federation (KorfFed); The Royal Dutch Billiards Federation (BillFed); and the Dutch Jeu de Boules Federation (JeuFed). These three federations differ on size, amount of housed sports, number of associated clubs, sorts of intermediary decision making bodies, employed FTE's, and more. Therefore it is expected that the tempo of institutionalization of the new, market oriented, structures, will differ among them. Sugden & Tomlinson (2002) developed a multi-method style of qualitative research for making sense of the deep, inside information below the surface of everyday life. They call it the "Brighton method. Applying the Brighton method for this research implies that the three cases will be studied with respect to their history, their present marketing actions, their results and the changes in their organization. In-depth interviews, document analysis (policy plans, marketing plans and more), and where possible observations and participations are used to create a critical and investigative view of the organizations in change. Results The KorfFed used the marketing program to further develop existing programs. Although the outcomes of these programs were not new, the program has opened the eyes of the president, director and staff members. They are now conscious of the urgency of a market orientation, and a marketing orientation (a marketing position has already been introduced), and they see opportunities in attracting non-competition playing korfball players. They have, however, not yet reached the phase of semi-institutionalization of the market oriented structures. This can be concluded from the following: - The organization still has an ad-hoc character; - Some board members still make decisions based on their own insights rather than on information from the professional part of the organization; - Decisions to start programs are still grounded on subsidy possibilities rather than on market possibilities. Interest dissatisfaction and power dependencies are the main dynamics that form barriers in the planned organizational change. The BillFed is a federation that covers four disciplines, i.e. pool, snooker, carom, and billiard 3 cushions. The federation used to act upon these four disciplines. The marketing program has made clear that the BillFed should act upon target groups instead of on these disciplines. Therefore, the federation created a vision to reach youth, young adults, as also elderly people. Carrying out this new vision requires a market orientated structure (focus on target groups) instead of an internal orientated structure (focus on discipline groups). This new vision is created on an upper level (general board together with professional staff) in the organization. This federation also introduced a professional marketing position. Unfortunately, the underlying layers remain slightly passive and are not willing to work along the new structures, which mean that the new structures have not been diffused across the whole organization. Interest dissatisfaction, value commitments and power dependencies are the problematic dynamics. The JeuFed used to have a strong competition and tournament (internal) orientation, while many jeu-de-boules players play the game just for fun. The marketing program has created the insight that the just-for-fun players are also an important target group. Hence, 3 projects are developed to make club membership more attractive for all jeu-de-boules players. Since the federation never worked with projects before, they just found out that implementing projects such as these requires new structures. The JeuFed has just arrived in the pre-institutionalized phase, still far away from the semi-institutionalized chapter. Power dependencies and a lack of capacity for change are influencing dynamics in this case. Discussion Although it is already 1½ years ago that Dutch NSFs finished their marketing program, in none of the described cases the new structures have reached the semi-institutional stage. These new structures or actions are not yet diffused across the organizations, and the old structures are not eroding. In all three cases another combination of endogenous dynamics are influencing the process of organizational change. Continuing research is needed to find out whether these federations will ever reach the next stage of institutionalization and which dynamics will play an important role.
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Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs.HypothesisAthletes after ACLR would achieve LSI > 90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes.Materials and MethodsFifty-two patients (38 males mean age 23.9 ±3.5 yrs; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7.0 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes.ResultsThe differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH p=0.003, TLH p=0.003 , SH p=0.018). For females, only significant between limb differences were found in the SLH (p=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH p<0.001, TLH p<0.001; females; SLH p<0.001, TLH p=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH p<0.001, TLH p<0.001; females; SLH p=0.003, TLH p=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (p=0.033).ConclusionAthletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR.
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This paper presents a case study where a model predictive control (MPC) logic is developed for energy flexible operation of a space heating system in an educational building. A Long Short-Term Memory Neural Network (LSTM) surrogate model is trained on the output of an EnergyPlus building simulation model. This LSTM model is used within an MPC framework where a genetic algorithm is used to optimize setpoint sequences. The EnergyPlus model is used to validate the performance of the control logic. The MPC approach leads to a substantial reduction in energy consumption (7%) and energy costs (13%) with improved comfort performance. Additional energy costs savings are possible (7–16%) if a sacrifice in indoor thermal comfort is accepted. The presented method is useful for developing MPC systems in the design stages where measured data is typically not available. Additionally, this study illustrates that LSTM models are promising for MPC for buildings.
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OBJECTIVES: To describe the types and prevalence of chronic conditions in an ICU population and a population-based control group during the year before ICU admission and to quantify the risk of developing new chronic conditions in ICU patients compared with the control group.DESIGN: We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Claims data in the timeframe 2012-2014 were combined with clinical data of patients who had been admitted to an ICU during 2013. To assess the differences in risk of developing new chronic conditions, ICU patients were compared with a population-based control group using logistic regression modeling.SETTING: Eighty-one Dutch ICUs.PATIENTS: All patients admitted to an ICU during 2013. A population-based control group was created, and weighted on the age, gender, and socio-economic status of the ICU population.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: ICU patients (n = 56,760) have more chronic conditions compared with the control group (n = 75,232) during the year before ICU admission (p < 0.0001). After case-mix adjustment ICU patients had a higher risk of developing chronic conditions, with odds ratios ranging from 1.67 (CI, 1.29-2.17) for asthma to 24.35 (CI, 14.00-42.34) for epilepsy, compared with the control group.CONCLUSIONS: Due to the high prevalence of chronic conditions and the increased risk of developing new chronic conditions, ICU follow-up care is advised and may focus on the identification and treatment of the new developed chronic conditions.
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Analyse the results from a representative selection of the supply chain studies for school feeding programmes in Kenya, Ghana and Mali, and make specific suggestions for interventions that can efficiently include SHF in the supply chains.
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Designers have grown increasingly interested in social consequences of new technologies. As social impacts become increasingly important it might be fruitful to understand how social impacts develop and how a designer can anticipate these consequences. In health care practices, for instance, it is important to control unintended social impacts at forehand. Social impact is an outcome of the mediating effect of a technology with its social environment. Human behaviour in a social environment can be analysed from the perspective of a social ecological system. To anticipate social impacts simulations of social practices are needed. To simulate practices the persona approach has been adapted to a screenplay approach in which the elements of a social ecology are used to gain a rich description of a social environment. This has been applied for a 'Heart Managers' case. It was concluded that the screenplay approach can be used for a systematic simulation of future social impacts.
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In this thesis several studies are presented that have targeted decision making about case management plans in probation. In a case management plan probation officers describe the goals and interventions that should help offenders stop reoffending, and the specific measures necessary to reduce acute risks of recidivism and harm. Such a plan is embedded in a judicial framework, a sanction or advice about the sanction in which these interventions and measures should be executed. The topic of this thesis is the use of structured decision support, and the question is if this can improve decision making about case management plans in probation and subsequently improve the effectiveness of offender supervision. In this chapter we first sketch why structured decision making was introduced in the Dutch probation services. Next we describe the instrument for risk and needs assessment as well as the procedure to develop case management plans that are used by the Dutch probation services and that are investigated in this thesis. Then we describe the setting of the studies and the research questions, and we conclude with an overview of this thesis.
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Epistemological relativism in tourism studies has been conceivably paralyzed by the concept of a, or, the "paradigm." In this review article, Platenkamp metaphorically identifies these paradigms with the islands that Odysseus visited (all those centuries ago) during his well-recorded journey to Ithaca. In this context, therefore, Ithaca is changed (by Platenkamp) from being just an idyllic Greek homeland into a contemporary, hybridized world like-in our time-of the multilayered network society in Africa of the capital of Ghana, Kumasi. The basic question for Platenkamp, then, is that of how tourism studies researchers can (or ought?) leave their safe islands (i.e., their paradigms) and organize their own paradigm dialog (after Guba) with others around them on their uncertain and risky voyage to Kumasi. In an attempt to clarify this vital kind of dialog, Platenkamp introduces Said's principles of reception and resistance, but also focuses on the distinction between different modes of "knowledge production" that have been introduced into the social sciences since the 1990s. In this light, to Platenkamp, the uncertainty of this ongoing/unending epistemological quest remains crucial: to him, all (almost all?) believers in a, or any, paradigm within tourism studies are unhealthily "overimmunized" by the tall claims and the perhaps undersuspected strategies of the particular "paradigm" they follow. (Abstract by the Reviews Editor).
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