Incidence Of Disruption Research Articles

Risk factors for supplementary posterior instrumentation after anterolateral decompression and instrumentation in thoracolumbar burst fractures

BackgroundIn spite of the established benefits of anterolateral decompression and instrumentation (ALDI) for thoracolumbar burst fractures (TLBF), the indications for supplementary posterior instrumentation remain unclear. MethodsA retrospective review of clinical and radiographic data of a prospective cohort of 73 patients who underwent ALDI for TLBF from T12 to L4. ResultsThe mean age of the cohort was 42±15 years, with 49 males and 24 females. Forty-six patients had neurological deficit, and 27 were intact. Owing to symptomatic settling, supplemental posterior instrumentation was performed in 7 out of 73 patients. The age of patients requiring supplemental posterior instrumentation (59±14 years) exceeded that of patients who did not (41±16, p=0.004). Otherwise, the patients who required posterior instrumentation were comparable to those treated with ALDI in terms of body mass index (BMI), American Spinal Injury Association (ASIA) scores on admission and follow-up, residual spinal canal, and local kyphosis on admission and follow-up.The posterior ligamentous complex (PLC) integrity was assessed in 38 patients in whom the MRI scans were retrievable, 31 successfully treated with ALDI, and all 7 undergoing supplementary posterior instrumentation. Subgroup analysis demonstrated that there was no difference in the incidence of PLC disruption between the 2 groups (p=0.257). ConclusionsSecondary supplemental posterior instrumentation was deemed necessary in 10% of cases following ALDI. Age was the only significant risk factor predicating supplemental posterior instrumentation.

Prophylactic lamivudine to improve the outcome of HBsAg-positive lymphoma patients during chemotherapy: A systematic review and meta-analysis

Hepatitis B viral (HBV) reactivation in lymphoma patients undergoing chemotherapy is associated with significant morbidity and mortality. Increasingly, lamivudine is being used to prevent hepatitis B reactivation. To assess the effects of prophylactic lamivudine on reactivation and mortality following chemotherapy in lymphoma patients who are hepatitis B surface antigen (HBsAg)-positive, we searched Medline/PubMed, Ovid MEDLINE, EMBASE, Web of Knowledge and the Cochrane Library for studies through November 2013. Statistical analysis was performed using REVMAN. Fourteen studies consisting of 636 patients were included in the analysis. The rate of HBV reactivation, incidence of hepatitis and incidence of hepatitis due to HBV reactivation in patients with lamivudine prophylaxis was significantly lower than those with no prophylaxis. Risk ratios [RRs] were 0.25 (95% confidence intervals [CI] 0.13-0.51; P=0.0001), 0.40 (95% CI 0.26-0.63; P<0.0001), and 0.21 (95% CI 0.09-0.51; P=0.0005) respectively. In addition, patients given prophylactic lamivudine had significant reductions in overall mortality and mortality attributable to HBV reactivation compared with control group. Risk ratios [RRs] were 0.45 (95% CI 0.29-0.70; P=0.0004) and 0.41 (95% CI 0.20-0.84; P=0.01) respectively. Chemotherapy disruption was not significantly different between the two groups. Risk ratios [RRs] were 0.34 (95% CI 0.09-1.26; P=0.11). Prophylactic therapy with lamivudine for HBsAg-positive lymphoma patients who are undergoing chemotherapy may reduce the risk for HBV reactivation, hepatitis due to HBV reactivation, overall mortality and mortality attributable to HBV reactivation. Additionally, patients with preventive lamivudine had a trend towards the decreased incidence of chemotherapy disruption.

Feasibility of second-generation bioresorbable vascular scaffold implantation in complex anatomical and clinical scenarios.

BackgroundBioresorbable vascular scaffolds (BVS) have become an emerging tool to treat coronary artery disease. However, the current use of BVS is still widely restricted to stable patients and non-complex lesions. In real-world practice patients are far more complex than those with simple type A lesions and the extended use of BVS to complex lesions and high-risk patients needs to be evaluated. Therefore, we sought to investigate the feasibility and performance of BVS in a broad spectrum of patients.Methods106 patients underwent in total 193 BVS implantations. We assessed the device-related (cardiac death, target vessel myocardial infarction, ischemia-driven target lesion revascularization) and patient-related (all-cause death, any reinfarction and any revascularization) composite outcomes.Results90 % of patients (n = 95) had at least one of the following characteristics: >65 years (35 %), ACS (42 %), tortuous vessels (13 %), calcified (17 %) or thrombotic lesions (12 %), lesions defined as AHA type B2/C (42 %), bifurcations (16 %), chronic total occlusions (9 %) or restenosis (14 %). There was no evidence of significant edge dissection, huge thrombus load or incidence of scaffold dislodgement or scaffold disruption in optical coherence tomography pullbacks. Out of 10,157 struts evaluated within 1,117 cross-sections, 302 were classified as malapposed (2.9 %). During a mean follow-up of 147 ± 119 days the rate of device-related events was 2.0 %, whereas patient-related composite events occurred in 6.1 %.ConclusionsOur results strongly suggest that BVS implantation is feasible in a wide spectrum of patients and complex anatomy of coronary lesions. Long-term outcome of BVS should be further investigated in unrestricted settings in randomized controlled trials.Electronic supplementary materialThe online version of this article (doi:10.1007/s00392-014-0757-4) contains supplementary material, which is available to authorized users.

An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery

Most studies and national programs aggregate the different types of surgical site infections (SSIs) potentially masking and misattributing risk. Determining that risk factors for superficial, deep, and organ space SSIs are unique is essential to improve SSI rates. This cohort study utilized data of 59,365 patients who underwent colon resection at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2009. Four independent, multivariable, predictive models were developed to assess the unique associations between risk factors and each SSI group: Superficial, deep, organ space, and an aggregate of all 3 types of SSIs. Overall, 13% of colon cases developed SSIs: Superficial (8%), deep (1.4%), and organ space (3.8%). Each model was different. Morbidly obese patients were more likely to develop SSIs than normal weight patients across all models; however, risk factors common to all models (eg, body mass index [BMI], duration of operation, wound class, laparoscopic approach) had very different levels of risk. Unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea. Deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption (19.8%). Organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder, suggesting a physically frail or compromised patient may put the anastomosis at risk. Risk factors for superficial, deep, and organ space SSI differ. More effective prevention strategies may be developed by reporting and examining each type of SSI separately.

Endoscopy in the Early Postoperative Setting after Primary Gastrointestinal Anastomosis

IntroductionGastrointestinal anastomoses may require early evaluation and treatment via flexible endoscopic techniques when complications arise. There is reticence, however, to perform endoscopy given the applied mechanical forces. We aimed to identify the incidence of gastrointestinal anastomotic perforation or disruption resulting from endoscopy performed ≤6 weeks of anastomoses. MethodsReview of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate. ResultsTwenty-four patients met our criteria (age 69 years [IQR 54–77], 54 % men]). Endoscopy was performed at a median postoperative time of 18 days (IQR 8–30). Indications for endoscopy included bleeding (66 %), obstruction (13 %), pain (13 %), concern for pancreatic duct leak (4 %), and concern for ischemia (4 %). Six patients underwent therapeutic endoscopic procedures including coagulation (8 %), balloon dilation (8 %), tube decompression (8 %), and stent placement (4 %). There were no anastomotic perforations or disruptions as a result of endoscopy. ConclusionDespite theoretical risks of adverse events of flexible endoscopy in the early postoperative period, no endoscopic perforations or disruptions occurred in recently created surgical anastomoses.

Vortioxetine, a novel antidepressant with multimodal activity: review of preclinical and clinical data.

Vortioxetine, a novel antidepressant for the treatment of major depressive disorder (MDD), is a 5-HT3, 5-HT7 and 5-HT1D receptor antagonist, 5-HT1B receptor partial agonist, 5-HT1A receptor agonist and serotonin (5-HT) transporter (SERT) inhibitor. Here we review its preclinical and clinical properties and discuss translational aspects. Vortioxetine increases serotonergic, noradrenergic, dopaminergic, cholinergic, histaminergic and glutamatergic neurotransmission in brain structures associated with MDD. These multiple effects likely derive from its interaction with 5-HT-receptor-mediated negative feedback mechanisms controlling neuronal activity. In particular, 5-HT3 receptors may play a prominent role, since their blockade i) increases pyramidal neuron activity by removing 5-HT3 receptor-mediated excitation of GABA interneurons, and ii) augments SSRI effects on extracellular 5-HT. However, modulation of the other 5-HT receptor subtypes also likely contributes to vortioxetine's pharmacological effects. Preclinical animal models reveal differences from SSRIs and SNRIs, including antidepressant-like activity, increased synaptic plasticity and improved cognitive function. Vortioxetine had clinical efficacy in patients with MDD: 11 placebo-controlled studies (including one in elderly) with efficacy in 8 (7 positive, 1 supportive), 1 positive active comparator study plus a positive relapse prevention study. In two positive studies, vortioxetine was superior to placebo in pre-defined cognitive outcome measures. The clinically effective dose range (5-20mg/day) spans ~50 to >80% SERT occupancy. SERT and 5-HT3 receptors are primarily occupied at 5mg, while at 20mg, all targets are likely occupied at functionally relevant levels. The side-effect profile is similar to that of SSRIs, with gastrointestinal symptoms being most common, and a low incidence of sexual dysfunction and sleep disruption possibly ascribed to vortioxetine's receptor modulation.

Dynamics of nitric oxide, altered follicular microenvironment, and oocyte quality in women with endometriosis

To study follicular microenvironment in terms of free radical dynamics, oocyte quality, and assisted reproductive technology (ART) outcomes among women with (group A) and without (group B) endometriosis. Prospective cohort study. University ART center. Women with and without endometriosis undergoing ART (n=28). Follicular fluid (FF), granulosa cells (GCs), immature oocytes (IOs), and ART data on sibling cohort oocytes in groups A and B were compared. ART live birth outcomes, maturation, and aging among in vitro matured (IVM) oocytes, nitrate levels in FF, and nitrotyrosine (NT) footprints and apoptosis in the GCs. Clinical characteristics and ART live birth outcomes were no different between groups A and B. Women from group A had significantly lower peak serum E2 (2,068.8±244.6 pg/mL vs. 2,756.2±205.0 pg/mL) and higher apoptosis (80.0% vs. 22.2%) and NT staining (70.0% vs. 22.2%) in GCs compared with group B. Fewer IOs underwent IVM to MII (0.6±0.3) in group A compared with group B (1.4±0.2). IVM oocytes had significantly higher incidence of cortical granule loss (83.3% vs. 24.0%) and spindle disruption (66.7% vs. 16.0%) and higher zona pellucida dissolution timing (133.8±9.4 s vs. 90.5±5.8 s) in group A compared with group B. FF nitrate levels were significantly higher in women who failed to conceive in group A (478.2±43.1 nmol/L) compared with those that did conceive (173.3±19.0 nmol/L). Increased protein nitration, GC apoptosis, resistance to IVM, and oocyte aging indicate the involvement of oxidative dysregulation of NO in the pathophysiology of altered follicular milieu and poor oocyte quality in women with endometriosis.

Ästhetische Experimente. Zur Ereignishaf igkeit und Funktion von Störungen in den Künsten

Disruption is a phenomenon that has gained the attention of a broad and diverse range of academic disciplines. Building on this work we propose that disruptions are by no means solely destructive but rather have productive consequences. We aim to establish disruption as a starting point for the analysis of formulas of societal self-description. In this, epistemological and aesthetic aspects of disturbances will be focused since these moments of interruption or loss of order evoke efforts of theoretical or practical consolidation of the social sphere. After discussing the history of ex-perimentalization of the life sciences, we point out how art can be understood as an experimental system that integrates and explores the function of disruption. Second, the relationship between factual and fictional knowledge and how both impact on society through the fabrication of different worlds are to be questioned. Finally, we will argue that art such as literature, film, modern theatre, or performances use disruptions as a tool, with which the perception of the past, present and future and of the society itself can be shaped. They achieve this by employing powerfully repercussive narratives that construct political and socio-cultural coherence through the symbolic re-integration of imaginary or real disruptive incidents.

Fuzzy Inoperability Input-output Analysis of Mandatory Biodiesel Blending Programs: The Philippine Case

Biofuels are regarded as one of the major low-carbon energy options currently available for large-scale use. Many countries have implemented biofuel programs that involve blending of bioethanol with gasoline, or biodiesel with diesel, at varying proportions. These programs are designed to address pressing concerns such as climate change, environmental quality, energy security and rural development. However, recent works suggest that biofuel resources may be at risk due to aberrant climatic events that are anticipated in the near future. Potential climate-induced disruptions include changes in precipitation levels, pest infestation, plant diseases, or increased frequency of extreme weather events. The incidence of such disruptions not only affects biofuel producers, but also energy-dependent economic sectors, resulting to “ripple effects” that further increase economic losses. We apply the inoperability input-output model (IIM) proposed by Haimes and Jiang (2001) and later enhanced by Santos and Haimes (2004) to assess the economic effects of implementing mandatory biodiesel blending programs in the Philippines. The IIM is based on the well-established technique of input-output analysis that quantifies risk through the inoperability metric, which is a dimensionless index whose value ranges from 0 (for a system functioning normally) to 1 (for a system in a state of total failure). Using the IIM, we determine the adverse effects of climate-induced biofuel disruptions on interdependent economic sectors. We estimate the resulting crop losses using the storm damage scenario from Stromberg et al. (2011) under no blending and a proposed blending rate of 5% as considered by the Department of Energy. Different ranking strategies are evaluated to determine sector vulnerability using inoperability levels, economic losses and weighted inoperability levels. For the latter scenario, equal weights are considered. Uncertainties within the modelling framework are captured through the use of fuzzy numbers.

Cement Leakage after Vertebroplasty; Correlation with Patterns of Compression Fractures and Bone Mineral Density (BMD)

Objectives: To analyze the influence of fracture patterns and the result of bone mineral density on cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Summary of Literature Review: Leakage of bone cement after vertebroplasty has known to be related with the direction of cortical disruption of fractured vertebral body and low bone mineral density (BMD). Materials and Methods: One hundred eighty-two patients with osteoporotic vertebral compressions were studied from January 2009 to August 2013. The patients’ fracture levels and patterns were compared. Among them, the cement leakage patterns were analyzed in 105 patients who had undergone vertebroplasty. The findings were compared with fracture patterns including cortical disruption and BMD. Results: Seventy-five cases of cement leakage were observed. Among them, intradiscal leakage was the most common type of leakage. In the patient group with low BMD, there was a high incidence of lower and posterior cortical disruption in the fractures. Patients with posterior cortical disruption demonstrated a higher incidence of leakage into the spinal canal and anterior cortex. No significant correlation was observed between fracture patterns and leakage. Conclusions: A surgeon should use caution in performing vertebroplasty in patients with low BMD and posterior disruption of the vertebral cortex.

The educational gradient in marital disruption: A meta-analysis of European research findings

A large number of empirical studies have investigated the effects of women's education on union dissolution in Europe, but results have varied substantially. This paper seeks to assess the relationship between educational attainment and the incidence of marital disruption by systematizing the existing empirical evidence. A quantitative literature review (a meta-analysis) was conducted to investigate the temporal change in the relationship, net of inter-study differences. The results point to a weakening of the positive educational gradient in marital disruption over time and even to a reversal in the direction of this gradient in some countries. The findings also show that the change in the educational gradient can be linked to an increase in access to divorce. Finally, the results suggest that women's empowerment has played an important role in changing the educational gradient, while the liberalization of divorce laws has not.

Risk Factors for Wound Complications After Surgery for Gynecologic Malignancies

Factors in wound complications such as surgical duration and suture methods are surgeon-side problems. The purpose of the present study was to retrospectively evaluate the incidence of wound complications in patients who underwent wound closure with stainless steel staples or subcuticular sutures in surgery for gynecologic malignancies and to retrospectively determine the risk factors for wound complications. From April 2007 through March 2012, a cohort of 317 consecutive patients undergoing surgery for gynecologic malignancies was evaluated in the retrospective study. The skin was closed with stainless steel staples before March 2010 (staples group). From April 2010, the skin was closed by subcuticular suturing (subcuticular group). We compared the incidence of wound complications between 2 groups and evaluated independent multivariate associations with the effect of clinical parameters on occurrence of wound complications. The incidence of wound disruption was 7.3% (23/317): 12.1% (17/140) in the staples group and 3.4% (6/177) in the subcuticular group (P = 0.0029). The incidence of wound infection was 2.5% (8/317): 5.0% (7/140) in the staples group and 0.6% (1/177) in the subcuticular group (P = 0.0124). Multivariate analyses performed with wound disruption as the end point revealed long-term steroid treatment, subcutaneous thickness, and skin staples as independent predictors. Subcutaneous thickness and skin staples were independent factors significantly associated with the possibility of wound infection. The findings of the present study indicated that risk factors for wound complications after surgeries for gynecologic malignancies include, as a surgeon-side problem, the use of staples for skin closure, and as a patient-side problem, a subcutaneous thickness of more than 30 mm.

TCT-592 Incidence, imaging and clinical outcomes of acute scaffold disruption and late structural discontinuity after implantation of the Absorb everolimus-eluting fully bioresorbable vascular scaffold: Optical coherence tomography assessment in the ABSORB Cohort B trial

Fully bioresorbable scaffolds (BRS) are a novel approach of treatment for coronary narrowing that provides transient vessel support with drug delivery capability without the long-term limitations of metallic drug-eluting stents. However, a potential drawback of the bioresorbable scaffold is the

Sleep disruption in patients with chronic leg ulcers

To investigate the incidence of sleep disruption in people with chronic leg ulcers and to explore which factors may contribute to sleep problems. A questionnaire survey was completed by a convenience sample of 52 leg ulcer patients attending community-based Leg Clubs in England and Wales. The questionnaire assessed wound pain, quality of sleep, factors contributing to sleep disruption and general health. Sixty-nine per cent (n=36) of leg ulcer patients reported sleep disruption, with 88% stating that they wake at least once during the night. General wound pain was the most frequently-cited cause (58%), while pain associated with treatment affected the sleep of 38% of respondents. Additionally, nearly a third (n=14) expressed that worrying about their wound impacted on their sleep. A significant correlation was found between wound pain and sleep disruption. The findings suggest that the majority of leg ulcer patients suffer sleep disruption, either as a direct consequence of wound pain or due to treatment-related or psychological issues associated with the wound. This has important implications for patient quality of life and also for the healing process; therefore, assessment and management of sleep problems in leg ulcer patients is essential. This study was supported by a financial grant from Mölnlycke Health Care. The authors have no commercial or social conflicts of interest with respect to the article or its content.

GW24-e3022 Erythropoietin prevent plaque disruption in apolipoprotein E-knockout mice

ObjectivesErythropoietin (EPO) have received considerable interest in immunity and inflammation. The increasing number of evidences have shown that inflammation is involved in the initial and development of atherogenesis. We hypothesised...

Regulatory T cells prevent plaque disruption in apolipoprotein E-knockout mice

CD4(+)CD25(+) regulatory T cells (Tregs) have received considerable interest in atherogenesis. We hypothesized that Tregs treatment may dose-dependently stabilize atherosclerotic plaques by inhibiting inflammatory cytokine secretion and matrix metalloproteinases (MMPs) expression and enhancing P4Hα1 expression in atherosclerotic lesions. We established a vulnerable carotid plaque model in apolipoprotein E- knockout mice (ApoE-/-). Mice were divided into control, phosphate buffered saline (PBS), small-dose Tregs, moderate-dose Tregs, large-dose Tregs and PC groups. Histopathological analysis showed that the plaque disruption rate was 50%, 50%, 43.8%, 12.5%, 12.5% and 43.8% in the control, PBS, small-dose Tregs, moderate-dose Tregs, large-dose Tregs and PC groups. Tregs treatment resulted in a significant decrease in the relative contents of macrophages and lipids and a substantial increase in those of SMCs and collagen in the carotid plaque, leading to an almost 50% reduction of plaque vulnerability index. Furthermore, Tregs treatment decreased the expression of proinflammatory cytokines, MMP-2 and MMP-9 but increased the expression of P4Hα1 both in vivo and in vitro. Most of these therapeutic effects of Tregs were found to be mediated by transforming growth factor and interleukin-10. Adoptive transfer of Tregs dose-dependently changed plaque composition to a stable plaque phenotype and lowered the incidence of plaque disruption in ApoE-/- mice. The major mechanisms involved reduced expression of inflammatory cytokines and MMP-2 and MMP-9, and enhanced expression of P4Hα1 in the carotid plaque. Tregs may provide a novel approach to the treatment of vulnerable plaques.

The Breaking-Down of Marriage in Italy: Trends and Trendsetters

During the last decades, since the mid-1970s, marriage has lost much of its centrality in Southern European Countries, such as Italy and Spain. However, the general incidence of consensual unions and marital disruption is still low compared to general European standards. Some scholars argue that the long tradition of a rigid familistic system in such countries will lay the phenomenon at very low levels. But our results reject a static picture of the Italian context and, despite persisting geographical differences, they confirm a rising breaking-down of marriage. Overall, our work places Italy at a crucial stage, in which the trends indicate a strong increase in divorce and consensual unions, and the new behaviours are no longer confined to certain trendsetters. Spain and Italy seem to be moving together in the European context.

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

PurposeTo investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD).MethodsWe reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT.ResultsThe mean duration of macular detachment was 15.5 ± 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 ± 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017).ConclusionsEyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.

Predictive Validity of the MMPI-2 Clinical, PSY-5, and RC Scales for Therapy Disruptive Behavior

Impulsive acts, parasuicidal behavior, and other therapy disruptive incidents occur frequently in the treatment of patients with personality disorders and increase the risk that patients will drop out of treatment. This study examined the predictive validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 Restructured Clinical (RC) and Psychopathology Five (PSY-5) Scales for therapy disruptive behavior and compared them with the original clinical scales. Using an inventory, the treatment staff recorded the therapy disruptive behavior of 104 patients with personality disorders who were receiving inpatient psychotherapy. Both the RC and the PSY-5 scales predicted several categories of therapy disruptive behavior, and both scales predicted more categories of therapy disruptive behavior than the original clinical scales. Anger outbursts were predicted especially well by a combination of two of the RC scales. The information about the MMPI-2 obtained in this study may be helpful in case formulation when initiating inpatient treatment for patients with personality disorders.

A continuous-review model for dual intercontinental and domestic outsourcing

When making sourcing decisions, many firms consider only the direct and most visible supply-chain costs, such as unit production costs and ocean-shipping costs. Often ignored are the hidden direct and indirect costs in long supply chains, and their impact on profitability. As supply chains lengthen, supply-chain disruptions undercut the ability of manufacturers and retailers to satisfy market demands. Supply-chain disruptions add costs by forcing companies to increase inventories, to juggle production and shipping schedules, to incur excessive backordering, and to airfreight or discount the prices of goods that were not in the right place at the right time. The question is, can higher incidence of supply-chain disruptions in intercontinental supply chains justify keeping the domestic suppliers? To address the question, this paper presents a hybrid continuous-review inventory model for dual intercontinental and domestic outsourcing. The conditions for domestic outsourcing only, for intercontinental outsourcing, and for dual outsourcing were established. The problem of minimising the long-run average cost of outsourcing was investigated, and mathematical optimisation was used to illustrate the model. It is shown that if the cost of service failure outweighs the cost differential between domestic and intercontinental outsourcing, keeping domestic suppliers may be a good option.