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Concept: Logistics


Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess ‘too cold’ temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to ‘too cold’ temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children.

Concepts: Vaccine, Temperature, Influenza, Segment, Cold, Logistics, Supply chain management, Supply chain


Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood.

Concepts: Management, Design management, Hygiene, Planning, Plan, Logistics, Latrine, Externality


{}This paper investigates a practical variant of the vehicle routing problem (VRP), called VRP with simultaneous delivery and pickup and time windows (VRPSDPTW), in the logistics industry. VRPSDPTW is an important logistics problem in closed-loop supply chain network optimization. VRPSDPTW exhibits multiobjective properties in real-world applications. In this paper, a general multiobjective VRPSDPTW (MO-VRPSDPTW) with five objectives is first defined, and then a set of MO-VRPSDPTW instances based on data from the real-world are introduced. These instances represent more realistic multiobjective nature and more challenging MO-VRPSDPTW cases. Finally, two algorithms, multiobjective local search (MOLS) and multiobjective memetic algorithm (MOMA), are designed, implemented and compared for solving MO-VRPSDPTW. The simulation results on the proposed real-world instances and traditional instances show that MOLS outperforms MOMA in most of instances. However, the superiority of MOLS over MOMA in real-world instances is not so obvious as in traditional instances.

Concepts: Management, Operations research, Transport, Problem solving, Logistics, Supply chain management, Supply chain, Vehicle routing problem


We describe polymer-stabilized droplets capable of recognizing and picking up nanoparticles from substrates in experiments designed for transporting hydroxyapatite nanoparticles that represent the principal elemental composition of bone. Our experiments, which are inspired by cells that carry out materials transport in vivo, used oil-in-water droplets that traverse a nanoparticle-coated substrate driven by an imposed fluid flow. Nanoparticle capture is realized by interaction of the particles with chemical functionality embedded within the polymeric stabilizing layer on the droplets. Nanoparticle uptake efficiency is controlled by solution conditions and the extent of functionality available for contact with the nanoparticles. Moreover, in an elementary demonstration of nanoparticle transportation, particles retrieved initially from the substrate were later deposited “downstream,” illustrating a pickup and drop-off technique that represents a first step toward mimicking point-to-point transportation events conducted in living systems.

Concepts: Petroleum, Chemistry, Liquid, Transport, Natural gas, Graphic design, Transportation, Logistics


Objectives This study investigated the association between organizational downsizing and purchases of prescribed drugs by private sector employees in Norway. Methods A natural experiment was constructed using individual-level employer and employee data linked to the national prescription database for the period 2004-2012. The study population comprised 144 089 employees who had been exposed to major downsizing in the same period. Random effects logistic regression models were used to investigate relative changes in drug purchases (antidepressants, hypnotics/sedatives, anxiolytics, and anti-psychotics, as well as anti-obesity, anti-diabetic, cardiovascular, and thyroid drugs, anti-inflammatory drugs, opioids, and analgesics/antipyretics) in the five-year-period before and after exposure to downsizing. Results Compared with the situation three years before exposure, the odds ratios (OR) of purchasing psychotropic drugs one year after exposure increased for antidepressants (OR 1.44, 95% CI 1.34-1.55), hypnotics/sedatives (OR 1.39, 95% CI 1.29-1.49), anxiolytics (OR 1.32, 95% CI 1.22-1.43), and antipsychotics (OR 1.34, 95% CI 1.19-1.52). Similar associations were found for cardiovascular, anti-diabetic, and thyroid drugs. Stratified analyses showed that the odds of purchasing psychotropic, anti-diabetic, and cardiovascular drugs in the years around downsizing was more pronounced in men compared with women. Elevated odds were also found for employees in the oldest age group and those with less than tertiary education. Conclusions Exposure to organizational downsizing increased the odds of purchasing prescribed psychotropic, cardiovascular, anti-diabetic, and thyroid drugs. The clinical implications of these results might be systematic involvement from medical personnel and occupational health services in workforce reduction processes.

Concepts: Regression analysis, Logit, Drug, Opioid, Morphine, Psychoactive drug, Recreational drug use, Logistics


The basement membrane (BM) is a thin layer of extracellular matrix (ECM) beneath nearly all epithelial cell types that is critical for cellular and tissue function. It is composed of numerous components conserved among all bilaterians [1]; however, it is unknown how all of these components are generated and subsequently constructed to form a fully mature BM in the living animal. Although BM formation is thought to simply involve a process of self-assembly [2], this concept suffers from a number of logistical issues when considering its construction in vivo. First, incorporation of BM components appears to be hierarchical [3-5], yet it is unclear whether their production during embryogenesis must also be regulated in a temporal fashion. Second, many BM proteins are produced not only by the cells residing on the BM but also by surrounding cell types [6-9], and it is unclear how large, possibly insoluble protein complexes [10] are delivered into the matrix. Here we exploit our ability to live image and genetically dissect de novo BM formation during Drosophila development. This reveals that there is a temporal hierarchy of BM protein production that is essential for proper component incorporation. Furthermore, we show that BM components require secretion by migrating macrophages (hemocytes) during their developmental dispersal, which is critical for embryogenesis. Indeed, hemocyte migration is essential to deliver a subset of ECM components evenly throughout the embryo. This reveals that de novo BM construction requires a combination of both production and distribution logistics allowing for the timely delivery of core components.

Concepts: Cell, Extracellular matrix, Cell membrane, Cell biology, Epithelium, Basement membrane, Logistics, The Matrix Reloaded


International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world’s public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.

Concepts: Immune system, Public health, Vaccine, Vaccination, Smallpox, Logistics, Supply chain management, Supply chain


An online survey was conducted to determine associations between transport management and transport-related injuries and diseases in horses in Australia. The survey was composed of three sections: respondents' demographic information, transport management strategies or procedures (before, during and after transportation) and transport diseases experienced in the previous two year period. Univariate and multivariate modelling was performed exploring associations between variables (respondents' details and transport management strategies) and the following transport-related diseases as outcomes: traumatic injuries, diarrhoea, heat stroke, muscular problems, laminitis, transport pneumonia and colic. The survey generated 797 responses. Traumatic injuries were the most common transport-related problem, with a reported incidence of 45.0%. Younger respondents (<40 years old) caring for large numbers of horses (>30 in a week) were more likely to report transport-related injuries. Injury risk was also linked to the use of protections and tranquilizers prior to transport, and checking horses after the journey. Diarrhoea (20.0%) and heat stroke (10.5%) were reported more by amateur than professional horse carers. Increased risk of heat stroke was linked to the restriction of hay and water prior to transportation. Muscular problems (13.0%) appeared to be exacerbated when horse health was not assessed before journey; whilst the risk of laminitis (2.9%) was around three fold greater when post transport recovery strategies were not applied. Associations were made between transport pneumonia (9.2%) and duration of journey, and with activity (horses involved in racing at greater risk). No associations were seen between the incidence of colic (10.3%) and the variables examined. Study findings should be interpreted with caution as they represent participant perceptions and recall. Nevertheless, results support many current recommendations for safe transportation of horses. They also highlight the need to further investigate many of identified management factors to refine existing policies and practices in equine transportation.

Concepts: Demography, Injury, Horse, Transport, Horse colic, Logistics, Working animal, Equine nutrition


The need to keep vaccines cold in the face of high ambient temperatures and unreliable access to electricity is a challenge that limits vaccine coverage in low and middle-income countries (LMICs). Greater vaccine thermostability is generally touted as the obvious solution. Despite conventional wisdom, comprehensive analysis of the value proposition for increasing vaccine thermostability has been lacking. Further, while significant investments have been made in increasing vaccine thermostability in recent years, no vaccine products have been commercialized as a result. We analyzed the value proposition for increasing vaccine thermostability, grounding the analysis in specific vaccine use cases (e.g., use in routine immunization [RI] programs, or in campaigns) and in the broader context of cold chain technology and country level supply chain system design. The results were often surprising. For example, cold chain costs actually represent a relatively small fraction of total vaccine delivery system costs. Further, there are critical, vaccine use case-specific temporal thresholds that need to be overcome for significant benefits to be reaped from increasing vaccine thermostability. We present a number of recommendations deriving from this analysis that suggest a rational path toward unlocking the value (maximizing coverage, minimizing total system costs) of increased vaccine thermostability, including: (1) the full range of thermostability of existing vaccines should be defined and included in their labels; (2) for new vaccines, thermostability goals should be addressed up-front at the level of the target product profile; (3) improving cold chain infrastructure and supply chain system design is likely to have the largest impact on total system costs and coverage in the short term-and will influence the degree of thermostability required in the future; (4) in the long term, there remains value in monitoring the emergence of disruptive technologies that could remove the entire RI portfolio out of the cold chain.

Concepts: Immune system, Vaccine, Vaccination, Influenza, Logistics, Supply chain management, Cold chain, Supply chain


Recent advances in the science and technology of global supply chain management offer near-real-time demand-response systems for decision-makers across production networks. Technology is helping propel “fast fashion” and “lean manufacturing,” so that companies are better able to deliver products consumers want most. Yet companies know much less about the environmental and social impacts of their production networks. The failure to measure and manage these impacts can be explained in part by limitations in the science of sustainability measurement, as well as by weaknesses in systems to translate data into information that can be used by decision-makers inside corporations and government agencies. There also remain continued disincentives for firms to measure and pay the full costs of their supply chain impacts. I discuss the current state of monitoring, measuring, and analyzing information related to supply chain sustainability, as well as progress that has been made in translating this information into systems to advance more sustainable practices by corporations and consumers. Better data, decision-support tools, and incentives will be needed to move from simply managing supply chains for costs, compliance, and risk reduction to predicting and preventing unsustainable practices.

Concepts: Scientific method, Measurement, Management, Sustainability, Logistics, Supply chain management, Production and manufacturing, Supply chain