Management of premature menopause

There has been some confusion among women and health professionals since the publication of the Women's Health Initiative and Million Women studies about the management of premature ovarian failure (POF). Both studies were undertaken in women aged 50 and over, and cannot be extrapolated to their younger counterparts, who would normally be producing their endogenous estrogen, since they have functioning ovaries. Estrogen-based replacement therapy is the main stay of treatment for women with POF and is recommended at least until the average age of natural menopause (52 years in the UK). This view is endorsed by regulatory bodies such as the Committee on Safety of Medicines (now the Commission on Human Medicines) in the UK. No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women, and women with POF do not need to start mammographic screening early unless other risk factors are present, such as family history.     

Supervising Mental Health Clinicians in The Context of Complex Organisational Dynamics

This article discusses the complex dynamics and challenges of providing supervision to mental health clinicians working within an organisational context when the supervisor is not part of the organisation and has no formal managerial or accountability responsibility. It considers two models of supervision and their application to three supervisory relationships in an organisational context. It concludes that for supervision to be effective there needs to be a consideration of the social defences in operation within the organisation and how they are met by the anxieties and defences of the supervisor and supervisee. This requires a mixed approach by the supervisor of the technical with the inter-subjective as a reliance on one model of supervision risks limiting the effectiveness of the intervention. The role of the supervisor can enable the supervisee to establish a clinical framework and the necessary environment essentials for their practice.     

Lean Control for Make‐to‐Order Companies: Integrating Customer Enquiry Management and Order Release

A lead time that is short, predictable, and reliable is an increasingly important criterion in supplier selection. Although many companies may achieve this through lean implementation, high‐variety manufacturers, for example, small and medium‐sized make‐to‐order companies, have found that lean's planning and control techniques do not apply. This article outlines a planning and control concept known as workload control (WLC) that integrates customer enquiry management, including a due‐date setting rule, with order release control. Simulation is then used to assess its impact on shop performance. Results demonstrate that an integrated WLC concept can reduce the percentage of tardy jobs—so short lead times can be realistically quoted—while also reducing and stabilizing workloads. WLC can level demand and production over time when work is not standardized and it is not possible to synchronize flows on the shop floor. Results are shown to be robust to changes in routing characteristics, the mix of orders with due dates specified by the customer and proposed internally, and the strike rate (or order‐winning probability). Hence, an integrated approach to WLC represents an important step toward achieving lean in make‐to‐order companies.     

Population and land use change in the California Mojave: Natural habitat implications of alternative futures

Demographic and land use dynamics have important implications for the natural environment within both developed and developing nations. Within the context of developed nations, popular and policy debates surrounding contemporary patterns of suburbanization attest to the salience of demographic and development issues. We examine the implications of land-use patterns as related to population and development within the context of the California Mojave Desert ecosystem. In a general sense, we aim to better understand the land requirements inferred by varying levels of population growth and density, as well as the natural habitat implications of those requirements. We develop a GIS including remotely sensed imagery, and demographic, economic, and biophysical data to examine of the implications of various demographic scenarios on species diversity. Spatial and statistical models are designed to develop possible alternative land use `futures'. Within the context of the California Mojave region, our results suggest that high-density development could reduce conflict with regions providing potential habitat for threatened or endangered species by over 80 percent. The process of model development demonstrates a potentially useful tool for policymakers, allowing for estimation and visualization of the land use implications of policy decisions.     

Analysis and Approximation of a JIT Production Line: A Comment

A recent Decision Sciences article by Jordan [9] presented a Markov-chain model of a just-in-time (JIT) production line. This model was used to estimate average inventories and production rates to find the optimal number of kanbans. Results for expected production rate were found to be consistently lower than those obtained by Huang, Rees, and Taylor [8] in a previous Decision Sciences article. Jordan attributed this unexpected outcome to some procedural problems in Huang et al.'s simulation methodology. In this paper, Markov-numerical analysis is used to compare the performance of Jordan's and Huang et al.'s methods of production control. Simulation analysis is then used to determine the effects of finite withdrawal cycle times. Results show that, for equal numbers of kanbans, Huang et al.'s two-card method of production control provides substantially greater expected production rates than Jordan's method. These results suggest that the Jordan model should not be applied to the problem of setting kanban numbers on manual JIT lines. Finally, we comment on the efficiency of Jordan's iterative method to obtain performance measures of tandem queues.