Background and ObjectivesRed blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is... Show moreBackground and ObjectivesRed blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is advised, encompassing not only the ABO-D blood groups but also the most clinically relevant minor antigens: C, c, E, e, K, Fya, Fyb, Jka, Jkb, S and s. This study incorporates patient-specific data and the clinical consequences of mismatching into the allocation process.Materials and MethodsWe have redefined the MINimize Relative Alloimmunization Risks (MINRAR) model to include patient group preferences in selecting RBC units from a finite supply. A linear optimization approach was employed, considering both antigen immunogenicity and the clinical impact of mismatches for specific patient groups. We also explore the advantages of informing the blood bank about scheduled transfusions, allowing for a more strategic blood distribution. The model is evaluated using historical data from two Dutch hospitals, measuring shortages and minor antigen mismatches.ResultsThe updated model, emphasizing patient group-specific considerations, achieves a similar number of mismatches as the original, yet shifts mismatches among patient groups and antigens, reducing expected alloimmunization consequences. Simultaneous matching for multiple hospitals at the distribution centre level, considering scheduled demands, led to a 30% decrease in mismatches and a 92% reduction in shortages.ConclusionThe reduction of expected alloimmunization consequences by incorporating patient group preferences demonstrates our strategy's effectiveness for patient health. Substantial reductions in mismatches and shortages with multi-hospital collaboration highlights the importance of sharing information in the blood supply chain. Show less
Ever since its constitution the ILO has developed and maintained a system of labour standards in order to create decent work all over the world. With the globalisation of the economy multinationals... Show moreEver since its constitution the ILO has developed and maintained a system of labour standards in order to create decent work all over the world. With the globalisation of the economy multinationals have gained an important position in furthering these labour standards throughout their value chains. From a regulatory point of view this development has resulted in a panoply of law and law-like initiatives within the global space in order to implement the labour standards. Much is already known about these initiatives from an individual and isolated perspective. Yet, little is known about their interactions in the global space. Whereas the concept of global space acknowledges the coexistence of different regulatory forms serving different roles, the concept of hybrid structures acknowledges the fact that these regulations interact in several configurations. The aim of this contribution is to map the main regulatory initiatives, to analyse their different roles in the global space of labour standards and to analyse in which configurations they interact. The findings of this analysis provide a more advanced and comprehensive understanding of the regulation of labour standards on the global level. Show less
Raak, A. van; Groothuis, S.; Aa, R. van der; Limburg, M.; Vos, L. 2010
