Hand Inventory Research Articles

Methodological considerations in PISCES 3: a randomized, placebo-controlled study of intracerebral stem cells in subjects with disability following an ischemic stroke

Background and hypothesisAt present, there are no medical interventions proven to improve functional recovery in patients with subacute stroke. We hypothesize that the intraparenchymal administration of CTX0E03, a conditionally immortalized neural stem cell line, linked with a standardized rehabilitation therapy regimen for the upper limb, would improve functional outcomes in patients 6–12 months after an index ischemic stroke.Study designPISCES III was designed as a multicenter prospective, sham-controlled, outcome-blinded randomized clinical trial. Eligibility required a qualifying ischemic stroke 6–12 months prior to surgical intervention. Patients must be between 35 and 75 years of age and have residual moderate or moderately severe disability (mRS 3 or 4), with the preservation of some residual upper limb movement. All patients received a standardized regimen of home physical therapy following the intervention.Study outcomesThe primary outcome measure is improvement in the modified Rankin Scale (mRS) of disability at 6 months post treatment. Secondary outcomes include assessment of activities of daily living (Barthel Index), functional mobility (Timed Up and Go; Fugl Meyer Assessment), neurological impairment (NIHSS), upper limb function (Chedoke Arm and Hand Inventory), as well as patient related quality of life and global rating scales.DiscussionPISCES III was designed as a randomized trial directly comparing the effects of intraparenchymal injection of a conditional stem cell line vs. sham procedure in patients with subacute stroke. This is one of the first studies of this type to include a standardized minimum rehabilitation protocol. As there are a limited number of studies evaluating invasive stem cell administration in the chronic setting of CNS injury, study design considerations are discussed.

Correlation of Fatigue with Cognition and Motor Performance among Stroke Patients

Introduction: Post-Stroke Fatigue (PSF) is the most common debilitating and persistent symptom after a stroke.The impact of fatigue increases during the first year of post-stroke. When most of the recovery has taken place,fatigue could remain an important problem with disabling consequences for everyday life. Understanding theeffect of PSF on cognition and mobility outcomes will help to better manage existing fatigue symptoms in strokepatients and develop strategies to optimize mobility and cognitive performance in patients with the chronic stageof stroke. With this background in mind, the present study aims at establishing a relationship between post-strokefatigue and cognitive and motor performance among persons with stroke.Aim: To correlate fatigue with cognition and motor performance in stroke patientsMaterials and Method: This is the pilot study where 15 post-stroke patients fulfilling the inclusion and exclusioncriteria were included by using the purposive sampling technique. Fatigue was assessed using Fatigue Scale forMotor and Cognitive Function. Motor Function was assessed by using Fugl Meyer Scale for upper and lowerextremity, Chedokes Arm and Hand Inventory, Lower Extremity Functional Scale, and Berg Balance Scale.Cognition was assessed by using the Montreal Cognitive Assessment Scale. Using the scores of these scales, fatiguewas correlated with motor and cognitive functions using Karl Pearson’s correlation test.Result: The study found a moderately significant correlation between Fatigue and Cognition (r=-0.605 p<0.05) anda highly significant correlation between fatigue and motor performance (r=-0.804 p<0.001).Conclusion: This study provides evidence that post-stroke fatigue has significant relationships with both motorperformance and cognitive performance. It is important to consider the influence of fatigue when planning anddelivering interventions for individuals with stroke.

EVALUASI KINERJA RANTAI PASOK MENGGUNAKAN PENDEKATAN SUPPLY CHAIN OPERATION REFERENCE (SCOR) (STUDI KASUS PT ABC)

Performance measurement is a way to monitor organizational activities to ensure that the organization has achieved the goals to be achieved. Performance measurement problems can be solved using the SCOR approach because it lies in the focus of the measurement area, which is measuring the company's activities from upstream to downstream which includes reliability, responsiveness, flexibility, cost, and asset. The purpose of this study, namely to measure the level of performance in the supply chain, determine the performance attributes that need to be improved, and provide suggestions and solutions as consideration for managing measurement problems. The results of the performance calculation using the SCOR a pproach, are the metrics on the performance attributes of responsiveness, cost, and asset are 100% in accordance with the company's target, but on the reliabilityperformance attribute there are metrics that are not in accordance with the company's target, are perfect condition, inventory inaccuracy for finish products, inventory accuracy, % orders received defect free, incoming product quality, and customer complaint, while the flexibility performance attribute has a metrics that is not in accordance with the company's target, is current on hand inventory. Suggestions for improvements needed by the company, are improvements in finished product inspections and document checks, as well as additional space for raw material warehouse.

Ordering decisions under supply uncertainty and inventory record inaccuracy: An experimental investigation

AbstractUncertainty on the supply side is a common issue planners face. How do decision‐makers incorporate inventory uncertainty when placing orders? We investigate ordering decisions under two forms of uncertainty regarding total inventory available to satisfy demand: supply uncertainty (SU; unreliability in incoming shipments) and inventory record inaccuracy (IRI; internal inefficiencies leading to a discrepancy between physical and recorded inventories). The experimental results reveal behavioral regularities in ordering decisions under both forms of total inventory uncertainty. We find that subjects overstock in settings with low profit margins, and overstocking is more pronounced under IRI than under SU. This overstocking under low profit margins is similar to observed ordering decisions under demand uncertainty. In these settings, subjects show a stronger shortage aversion under IRI (which is internal uncertainty) than under SU (which is external uncertainty). Furthermore, we find that subjects chase past realizations of supply/on‐hand inventory, although the effect depends on the uncertainty type. Although SU and IRI are, in practice, often simultaneously present, their causes are different. By providing insight into the relative effect of the types of uncertainty on the quality of inventory replenishment decisions, this study highlights the importance of reducing SU and IRI for products with low profit margins.

Effect of SaeboTM Orthosis Along with Functional Electrical Stimulation on Hand Function in Patients with Subacute Stroke: A Randomized Controlled Trial

Background: In stroke, there is loss of basic hand function like straightening of the fingers, grip strength andgrasping of the item which make dependent for their basic activity of daily living. The Saebo-FlexTM orthoticis a mechanical device, which enables an individual to open hand, pick up the objects and release during tasksorientedexercises. It facilitating thumb and finger extension movements by recruiting voluntary thumb and fingerflexor movement.Objectives: To determine the effect of FES along with Saebo-FlexTM device on Fugl Meyer assessment score forupper extremity, on Grip Strength, on Pinch Strength and on Hand Dexterity.Methodology: 20 participants were randomly divided into experimental (Saebo-FlexTM hand orthosis + FES +Conventional physiotherapy) and control (FES + conventional physiotherapy) group. Intervention was given for45min/session, 5 session/ week for 6 weeks. Assessment was done using Fugl Meyer assessment-upper extremity,Chedock hand inventory programme, Nine-hole peg test, Hand dynamometer and Pinch gauge on Day 0,Day 12 and Day 42 of the intervention period.Results: The results were found to be non-significant (p>0.05) for all outcome measures. Statistically significantresults were obtained for FMA-UE (p=0.018) on comparison of mean difference scores at Day 0, and Day 42,CAHAI scores (p=0.011) on comparison of mean difference scores at Day 0 and Day 42.Conclusion: According to finding, the integrated intervention of Saebo-FlexTM device along with FunctionalElectrical Stimulation can be used effectively to improve the upper extremity motor functions in sub acute strokesurvivors.

Impact of delay in payment, shortage and inflation on an EOQ model with bivariate demand

The major challenge of inventory decision makers is to determine an inventory optimization strategy that ensures the right balance between keeping abundant on hand inventory to meet the demand of the customers and optimizing costs related to holding inventory. This article analyzes on providing a general deterministic inventory model in which the rate of demand is determined by price and time over the ordering cycle time. The traditional assumption of zero ending invento ry level is relaxed to a non-zero ending inventory level. Shortages are allowed which are partially backlogged. We develop models with partial backlogging and without backlogging. The aim is to maximize the profit per unit time, assuming delay in payment and inflation. An algorithm is proposed to find the optimal selling price, optimal stockout period, optimal replenishment cycle time and the optimal ending inventory level. All the possible special cases of these two models are also discussed. The numerical examples, graphical representation, and sensitivity analysis are given to illustrate the practical application of the proposed model.

Solving a continuous periodic review inventory-location allocation problem in vendor-buyer supply chain under uncertainty

In this work, a mixed-integer binary non-linear two-echelon inventory problem is formulated for a vendor-buyer supply chain network in which lead times are constant and the demands of buyers follow a normal distribution. In this formulation, the problem is a combination of an (r, Q) and periodic review policies based on which an order of size Q is placed by a buyer in each fixed period once his/her on hand inventory reaches the reorder point r in that period. The constraints are the vendors’ warehouse spaces, production restrictions, and total budget. The aim is to find the optimal order quantities of the buyers placed for each vendor in each period alongside the optimal placement of the vendors among the buyers such that the total supply chain cost is minimized. Due to the complexity of the problem, a Modified Genetic Algorithm (MGA) and a Particle Swarm Optimization (PSO) are used to find optimal and near-optimum solutions. In order to assess the quality of the solutions obtained by the algorithms, a mixed integer nonlinear program (MINLP) of the problem is coded in GAMS. A design of experiment approach named Taguchi is utilized to adjust the parameters of the algorithms. Finally, a wide range of numerical illustrations is generated and solved to evaluate the performances of the algorithms. The results show that the MGA outperforms the PSO in terms of the fitness function in most of the problems and also is faster than the PSO in terms of CPU time in all the numerical examples.

Modelling and solving a novel gardener problem under an emergency order and stochastic storage space

The objective of this research is to determine the optimum order quantity such that the expected total profit will be maximised while some constraints such as the service level and stochastic storage space will be satisfied in the gardener problem. The main contribution is to utilise the emergency order in case of shortage, in order to achieve more profits where the demand is more than the on hand inventory. In this case, the vendor should pay the cost of customer waiting time to receive the required products either purchasing the products or losing the sale condition. As the proposed problem is NP-hard, using meta-heuristic method is our methodology for solving. Two meta-heuristic algorithms, namely differential evolution and invasive weed optimisation, are utilised to solve the problem in which their parameters are tuned. Finally, some numerical experiments and statistical comparisons are performed to evaluate the applicability of both proposed model and the algorithms. The computational results show that the proposed differential evolution has a desirable performance in favour of the expected total profits.

Modelling and solving a novel gardener problem under an emergency order and stochastic storage space

The objective of this research is to determine the optimum order quantity such that the expected total profit will be maximised while some constraints such as the service level and stochastic storage space will be satisfied in the gardener problem. The main contribution is to utilise the emergency order in case of shortage, in order to achieve more profits where the demand is more than the on hand inventory. In this case, the vendor should pay the cost of customer waiting time to receive the required products either purchasing the products or losing the sale condition. As the proposed problem is NP-hard, using meta-heuristic method is our methodology for solving. Two meta-heuristic algorithms, namely differential evolution and invasive weed optimisation, are utilised to solve the problem in which their parameters are tuned. Finally, some numerical experiments and statistical comparisons are performed to evaluate the applicability of both proposed model and the algorithms. The computational results show that the proposed differential evolution has a desirable performance in favour of the expected total profits.

Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents.

Background To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. Purpose The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. Materials and Methods We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE). Results Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome. Conclusion Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings. Level of Evidence Level IV, therapeutic case series.

Dynamic inventory rationing: How to allocate stock according to managerial priorities. An empirical study

In spare part distribution, contracts characterized by different unit prices, lead times, minimum order quantities are usually offered to different types of customers. In this context, one of the main problems is the decision on the allocation of the on–hand inventory to the different customers in order to minimize the total back–order cost. In this paper, we propose two allocation policies that use a dynamic critical level to reserve on-hand inventory for high priority customers. The first policy sets the critical level according to a target service level for high priority demand, while the other sets the critical level according to the back-order costs for the different classes of customers. The effectiveness of the two policies with respect to no rationing or stock piling polices is shown using the data of a European spare part company. Moreover, the relationship between the two policies is evaluated from a managerial perspective.

Optimal production policies for reverse logistic model under time value of money

One of the important dimensions of environmental protection is the reuse and/or recycling of the items that are returned by the customers for various reasons. Such recycling and reuse prevents the flow of these unusable items into the environment and as such prevents environmental degradation. This paper deals with reverse logistic production inventory model in inflationary conditions and permissible delay in payment over finite planning horizon. The demand rate is a function of on hand inventory, production rate is a linear function of demand and thus nonlinear function of on hand inventory, items are returnable and returnable items are remanufactured. The proposed model considers the two systems simultaneously forward manufacturing system and reverses manufacturing system and derives the optimal production policy. The effects of various parameters involved are discussed. The results are discussed with a numerical example to illustrate the theory and particular cases of the model are discussed in brief.

H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke

Purpose: To investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke. Methods: A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure. Results: Eight individuals with stroke were recruited and six participants completed the exercise program. All but one of the six participants met the exercise target of 60 minutes/day, 6 days/week. Participants were stable across the baseline period. The following post-treatment effect sizes were observed: CAHAI (0.944, p = 0.046); MALQ (0.789, p = 0.03) grip strength (0.947, p = 0.046); COPM (0.789, p = 0.03). Improvements were maintained at three and six month follow ups. Conclusions: Community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use.Implications for RehabilitationA repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following strokeThis program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercisesAn exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities

Functional Outcomes After Treatment of Scaphoid Fractures in Children and Adolescents

Little is known about longer-term functional outcomes of children treated for scaphoid fractures. We hypothesized that with appropriate treatment, functional outcomes would be consistent with population norms and would not vary between patients treated with cast-immobilization versus surgery. We further hypothesized that osteonecrosis and chronic nonunion would each be independent predictors of worse functional outcomes. Sixty-three of 312 patients (20%), age 8 to 18 years at the time of treatment, completed the Disability of the Arm, Shoulder, and Hand (DASH) inventory, DASH work and sports modules, and the Modified Mayo Wrist Score (MMWS) at a median follow-up time of 6.3 years (range, 2.6 to 17.7 y) from injury. Thirty-nine patients presented initially with acute scaphoid fractures, and 24 patients presented with chronic nonunions. Six of the 39 acute fractures and 20 of 24 nonunions were treated surgically. Univariate analysis and multivariate linear regression were used to identify predictors of MMWS and DASH scores. All patients went on to successful bony healing. The median DASH score for the cohort was 1 (interquartile range [IQR]: 0 to 4), with more than 95% of respondents reporting functional status equivalent to or better than the general population. Multivariate analysis demonstrated that chronic fracture presentation (P<0.001) and osteonecrosis (P=0.013) were each independent predictors of a worse outcome. Results of the DASH Work and Sports Modules as well as the MMWS corroborated the results found using the DASH. Surgical treatment was not found to influence functional status. The median MMWS for both surgical and nonsurgical patients was 100, representing excellent functional outcome. Children and adolescents with scaphoid fractures that achieve union have excellent outcomes at mid-term follow-up, with no difference in outcomes between casting and surgery. Although patients treated for nonunions and osteonecrosis have significantly decreased wrist function compared with acute fractures, the median level of function for these patients is in accordance with general population means. Level III—Therapeutic.

Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents—technique and results

The purpose of this study was to report our preliminary results after arthroscopically-assisted repair of peripheral triangular fibrocartilage complex (TFCC) tears in adolescent patients. All children and adolescents who underwent arthroscopically-assisted repair of a Palmer 1B tear were identified and prospectively evaluated after a mean follow-up of 1.3 years. The postoperative assessment included documentation of clinical parameters, pain score (visual analogue scale, VAS), grip strength and completion of validated outcome scores (Modified Mayo Wrist Score, MMWS; Disabilities of the Arm, Shoulder and Hand Inventory, DASH). A total of 12 patients (four males, eight females) with a mean age of 16.3 years at the time of surgery were evaluated. The mean VAS decreased significantly from 7.0 to 1.7 after the procedure. We observed a significant increase of the MMWS after surgery; however, MMWS was still significantly lower at final follow-up when compared to the contralateral side. A mean postoperative DASH score of 16 indicated an excellent outcome after the procedure. DASH Sports and Work Modules showed fair and good overall outcomes in the short-term, respectively. Grip strength averaged 86 % of the contralateral side at final follow-up, with no significant difference being found between both sides. Arthroscopically-assisted repair of peripheral TFCC tears in adolescents provided predictable pain relief and markedly improved functional outcome scores. Concomitant pathologies may have to be addressed at the same time to eventually achieve a satisfactory outcome. Sports participation, however, may be compromised in the short-term and should therefore be resumed six months postoperatively.

Inventory Model for Decaying Items with Multivariate Demand and Variable Holding Cost under the Facility of Trade-Credit

study, an inventory model for deteriorating items with multivariate demand and variable holding cost is developed. The facility of allowable delay in payment is also taken into consideration. During this period retailer can use the ensued money from sales of the supplied goods to earn interest. Demand rate is a function of on hand inventory and selling price of the item and it is considered that the stock affects the demand rate up to an assured time. Therefore, retailer will order more quantity to stimulate demand rate and to earn more money. Different cases of allowable delay in payment are discussed. The objective of this study is to maximize the retailer's total profit per unit time. The results are illustrated with some numerical examples and sensitivity analysis for each case is also carried out. KeywordsModel, Sensitivity Analysis, and consumption rate

Patient-related factors influencing ulnar-shortening osteotomy outcomes using the trimed dynamic compression plate.

Ulnocarpal impingement can be surgically managed with various shortening osteotomy techniques. The purpose of this study was to retrospectively examine the outcomes of the ulnar-shortening osteotomy technique using the Trimed dynamic compression plate (Valencia, California) and to determine whether results vary among patient-related factors, including smoking status, occupation, preoperative diagnosis, and workers' compensation status. Twenty-seven patients (28 wrists) operated by a single surgeon underwent ulnar shortening over a 4-year span. Radiographic analysis was obtained preoperatively and at an average 24-month follow-up. A subset of 12 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory; the Patient-Rated Wrist Evaluation (PRWE); and the visual analog scale for pain and underwent clinical evaluation for range of motion and strength. Ulnar variance improved in all cases between pre- and postoperative imaging (P<.05). Grip strength and range of motion were found to be 79% and 90% of the contralateral extremity, respectively. Among the examined patient-related factors, patients involved in a workers' compensation claim demonstrated significantly different DASH (average, 56.8 claim vs 26.8 no claim; P=.037) and PRWE (average, 66.0 claim vs 32.8 no claim; P=.008) scores while also showing a trend toward nonunion (3/10 claim vs 1/18 no claim; P=.105). Results of ulnar-shortening osteotomy using the Trimed system at 2-year follow-up show consistent objective improvements in radiographic ulnar variance. Workers' compensation claims may negatively influence outcomes of ulnar shortening, and this factor should be considered in preoperative patient selection and counseling.

EFFECTIVENESS OF MOTOR RELEARNING PROGRAMME AND MIRROR THERAPY ON HAND FUNCTIONS IN PATIENTS WITH STROKE-A RANDOMIZED CLINICAL TRIAL

Present study aims to see effectiveness of mirror therapy and Motor Relearning Programme for improving hand functions in stroke.Present study was an experimental study conducted on 12 stroke patients using convenient sampling method .Subjects were divided into two equal groups (n=6). Group A was given conventional physiotherapy and Motor Relearning Programme exercises for the affected hand and Group B received conventional physiotherapy for the affected hand and mirror therapy for the unaffected hand. Chedoke arm and hand inventory (CAHAI) was used as primary outcome measure for evaluation of hand function before and after application of therapeutic Intervention Data was analysed using Mann – Whitney U Test and wilcoxon signed rank test.

On the distribution of an (r, Q) inventory with lead time via multi server queues

We consider a multi-server Markovian queuing model where the servers can be considered as an inventory with standard (r, Q) policy and positive lead time. The demands are considered as arrivals and the time for serving the inventory is considered as the service time. Here we consider the model in which a fixed order quantity Q is ordered each time when the on hand inventory reaches the reorder point r. Behaviour of this system is studied using a two state quasi birth and death (QBD) process. Condition for checking ergodicity, the steady state solutions, the distribution of inventory recycle time and an optimisation problem are presented. Numerical illustrations are also given.

Functional Outcomes Following Treatment of Scaphoid Fractures in Children and Adolescents: Level 4 Evidence

Pediatric scaphoid fractures predominantly involve the waist, and almost one third of patients present late with established nonunions, most which require surgical treatment. Little is known about the long-term functional outcomes of children treated for scaphoid fractures. We hypothesized that with appropriate treatment, functional outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory and the Modified Mayo Wrist Score (MMWS) would not vary significantly between patients with acute fractures and nonunions.