Learning from Experts on Disaster Management

When it comes to learning and education there is nothing like hearing from front-line expert practitioners. When the topics to be covered include emergency preparedness and disaster response some of the top experts who have played a role in responding to emergencies both local and global are right here in the Pioneer Valley in western Massachusetts. This is a public thank you acknowledging their contributions and willingness to share their wealth of experiences with students in a course on Humanitarian Logistics and Healthcare that I taught this semester at the Isenberg School of Management.

The course, which has students from the Isenberg School, the College of Engineering, and the School of Public Health at UMass Amherst, covers all phases of disaster management from preparedness and mitigation to response and recovery. Those of us in western Massachusetts will never forget such recent “natural” disasters as the Springfield tornado on June 1, 2011, the once in a 500 year flood in Deerfield and surrounding areas due to Hurricane Irene in late August 2011, followed by the snowstorm in late October, 2011, which resulted in massive power outages, and Superstorm Sandy, which hit landfall in the U.S. on October 29, 2012, and is the second most costly natural disaster in the U.S. after Hurricane Katrina. And, of course, we will always remember the shocking Boston Marathon bombing of April 15, 2013, the suffering of the victims, and the heroism of responders.

On February 4, 2015, Ms. Debbie Wilson, a registered nurse from Lenox, MA, who is also a student at UMass Amherst, spoke on her experiences, over a 6 week period last Fall in Liberia, working with Doctors without Borders in battling the biggest outbreak of Ebola in history. She talked about helping to set up an Ebola treatment facility for 120 patients, the importance of medical supplies and equipment, which would have to be delivered from Geneva, Switzerland. She spoke about her personal experiences donning the special protective gear with hygienists who would then spray the chlorine on her after which she could carefully disrobe. She dealt with temperatures of 100 degrees, horrible rains, insufficient food for the staff - essentially making do with bread and mayonnaise with some ketchup for many meals. She described how they got rid of the medical waste by burning it in a pit. She emphasized the importance of logisticians, known as “logs” and her travel there, in itself, was a logistical feat. Ms. Wilson traveled by plane, truck, and canoe. Through her efforts and those of her fellow healthcare workers, the survival rate of Ebola patients was increased. She asks now that we not forget western African countries since the healthcare infrastructure there has been decimated since so many doctors and nurses died battling Ebola.

On February 11, 2015, Mr. Jeffrey Hescock, the Director for Emergency Management and Business Continuity at UMass Amherst since September 2013, spoke about protecting education, research, and the reputation of the university and how careful planning for sports events and other events on campus and periphery can enhance community building and minimize negative outcomes. In his previous position as the Emergency Management and Business Continuity Manager for the UMass President’s Office, Mr. Hescock was responsible for safely evacuating students and staff from UMass Dartmouth during the search for one of the Boston marathon bombers there. He described the shelters that were set up so that students, most of who are commuters, could reconnect with family members and friends. He also described the challenges of dealing with the immense media response to the events. Of course, given that we have had two university closings on Mondays this semester, due to major snowfalls, the students were also very interested in finding out who makes the decision to close the university. The emergency notification system, in particular, works very well. UMass has an excellent organization structure consisting of an emergency operations team as well as a business continuity and recovery committee and conducts not only table-top exercises but also field exercises such as the emergency sheltering exercise last spring at the Mullins Center, which also involved the town of Amherst.

Ms. Kim Goulette, the new Executive Director of the Pioneer Valley Red Cross spoke on February 23, 2015. The Red Cross provides immediate response to people in need because of disasters. Whether it is food, blankets, drinks, or even teddy bears for children in the near term, or shelter, food, and resources during the recovery phase, Red Cross volunteers are there to help. Ms. Goulette spoke about the big fire in Amherst last summer in an apartment complex at which she assisted after only about 1 week on the job. She described the role of the Red Cross in feeding the National Guardsmen who were deployed to eastern MA because of the multiple immense snowfalls this winter that disrupted lives, transportation, and other infrastructure. The Red Cross, which consists of 97% volunteers, provided soup, peanut butter & jelly sandwiches, coffee and hot chocolate to the Guardsmen. A group of volunteers began their journey from the new Springfield headquarters with all the red cross activities now consolidated under one rook at 2AM to delivery nourishment.

On February 25, 2015, Mr. Brian Rust, the Director of Security Services at Cooley Dickinson Hospital spoke. He had originally been scheduled to speak the week before, but had to deal with emergencies at the hospital, and they were not patient emergencies! Nothing like some real-life practice in disruption management. Cooley Dickinson Hospital, which was recently acquired by Mass General Hospital, is one of our community hospitals, serving about 200,000 people. It seeks to provide the best possible healthcare in an appropriate setting. He noted that the population always assumes that hospitals will be available, when needed. He emphasized how a hospital is supposed to be prepared to be self-sufficient post a disaster for 96 hours. This, of course, entails backup power generators, the stockpiling of essential supplies, which is challenging given a model of just-in-time daily deliveries of medicines, and possible needs for additional food. Hazard analyses are conducted each year to prepare for possible natural disasters, human hazards, and technological ones. He emphasized the importance of communications and building strong relationships with other hospitals, first responders, etc.

During the snowstorms this past winter, 70 staff slept at the hospital to make sure that there was appropriate patient coverage, since a storm could affect transportation. And, the week prior to his lecture at the Isenberg School, Mr. Rust had to deal with multiple emergencies, beginning with a computer failure on Monday, followed by complete communication failure on Wednesday (not related to the Monday one) with no Internet or phone lines available. Hence, medical records could not be accessed electronically, and X-rays could not be read. Back to documentation on paper. This major disruption was fixed on Wednesday but then Wednesday afternoon a sprinkler pipe burst and flooded the back of the Emergency Room with thousands of gallons of water pouring in. There is a new cancer facility being constructed above the Emergency Room area and it seems that the pipe was not properly insulated. With facility experts on hand (luckily, he said, not everything has been outsourced) in a few hours the area was cleaned up and disinfected. During that period, however, 4 ambulances had to be diverted to other hospitals.

On March 25, 2015, we had the pleasure of hearing Mr. Jeff Meyer, the CEO of Blood Services for the Red Cross in Massachusetts and Connecticut, who told us how he had been a consultant for the Red Cross and was offered a job with this organization the day before 9/11. After the terrorist attacks that horrific day, he decided that he wanted to help communities and accepted the job offer from the Red Cross. With an outstanding background in operations, including an MBA, he has helped the Red Cross in balancing supply and demand of this life-saving product that is also highly perishable and has dealt with many challenges in the changing economic landscape of blood supply chains.

On April 8, 2015, the students got to hear from SMSgt Thomas Orifice of the 104^th Fighter Wing of the Air National Guard in Westfield. He came dressed in fatigues and had the students at the edge of their seats as he spoke about the response to Superstorm Sandy. Because NOAA had forecasted Superstorm Sandy one week before landing, major planning could be done in a timely manner and, within 24 hours, the Air National Guard had mobilized and delivered water, food, and fuel, which was direly needed since, with the loss of electricity, the gas pumps were not functioning and public transportation in NYC was at a standstill. Mr. Orifice has had an over thirty year career with the National Guard and has served in France Italy, Germany, and Kyrgyztan, and also took part in the liberation of Bosnia and Iraq Operation Freedom. 

And, on April 22, 2015, last,  but not least, the "other" Professor Nagurney (my husband), Dr. Ladimer S. Nagurney, who is a Professor of Electric and Computer Engineering and Biomedical Engineering, at the University of Hartford, spoke to the class on Disaster Communications, including the challenges of technology in this important domain, along with FirstNet.

Many thanks to the above Hometown Heroes, who took time out of their very busy schedules to share experiences with students – we are very lucky to have you in our midst.

Also, given that the number of disasters is growing, as well as the number of people affected by them, I have made the lectures, as well as many of the guest lecture presentations, available online.

Thank You to the Vienna University of Economics and Business

Last night I flew back to Gothenburg, Sweden from Vienna, Austria (through Munich). In Vienna, I had the distinct pleasure of teaching an intensive short course Humanitarian Logistics and Healthcare at the Vienna University of Economics and Business (WU). I also delivered a seminar in the Supply Chain Management Research Seminar Series.

WU is one of the largest universities in Europe.

The 25 students in my course were all in their final term  in the Supply Chain Master's degree program and represented Austria, Germany, Moldova, Bulgaria, Mexico, Turkey, and even the US (a student from Iowa)! They are also writing their dissertations.

I had prepared 9 lectures for the intensive short course and with all the discussions I did not have sufficient time to cover the final two topics but I have posted the lectures, including the syllabus online on the supernetworks center website:

I learned so much from the students -- the role of the Red Cross in Austria, for example, which is responsible for all the ambulances;  how males in Austria have to complete either 6 months of military service or 9 months of civil service -- with quite a few serving for the Red Cross. Females do not do military service but may elect to do civil (community) service and there were students in my course that were ambulance drivers as well as Red Cross volunteers who had helped communities during major snowfalls in Austria  by shoveling, along with the fire brigades, snow off of citizens' rooftops.

The student from Mexico had worked in rail operations when a major disaster struck there and she told me about the challenges in rerouting freight. A student from Bulgaria who lives near a nuclear power plant and her father works there told us about the emergency preparedness drills there and the alert systems.

It was also fascinating to hear about the kinds of warning systems that exist in their communities and countries (some have real shortfalls in this dimension and some are very advanced and sophisticated).

The students in the course are now working on their team project papers -- 5 teams of 5 students each with their papers due in 2 weeks.

Yesterday, the students gave short presentation to overview their projects, which were fascinating and so professionally well-done. I will be posting them on the class website once they all arrive.

We heard about the Fukushima triple disaster, with a focus on the nuclear disaster component, on the Gujarat Indian earthquake, the Indian tsunami, Hurricane Mitch, and the Chernobyl nuclear disaster.

I asked the students to focus on a humanitarian organization and what it did do well in terms of disaster relief and what, perhaps, it did not and the lessons that were learned.


We covered all phases of disaster relief with vivid case studies as well as performance metrics and even some mathematical models and disaster communications. We covered the differences between commercial and humanitarian supply chains and what possible synergies between the two exist.

I commend the Vienna University of Economics and Business on its great programs in terms of both education and research!

And it was wonderful to see how my former doctoral student, Dr. Tina Wakolbinger, who is now a Full Professor at WU, is flourishing there. She is the Director of the Research Institute for Supply Chain Management  and with her supervision of doctoral students, our academic genealogical "family" tree will be growing. 

The title of my seminar, which I gave this past Tuesday, was Perishable Product Supply Chains in Healthcare: Models, Analysis, and Computations. I  received fabulous questions and feedback and especially enjoyed hearing about the regulations surrounding the pharmaceutical industry in Europe (as opposed to the US). Given the news surrounding drug shortages, especially now in Greece, the seminar was quite timely. Several research directions that are promising will most likely be outgrowths from the discussions.

The seminar was based, primarily on our paper, A Supply Chain Generalized Network Oligopoly Model for Pharmaceuticals Under Brand Differentiation and Perishability, Amir H. Masoumi, Min Yu, and Anna Nagurney, Transportation Research E 48: (2012) pp 762-780 but I also related the model to our work on blood supply chains,Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, Anna Nagurney, Amir H. Masoumi, and Min Yu, Computational Management Science 9(2): (2012) pp 205-231,  and medical nuclear supply chains, Medical Nuclear Supply Chain Design: A Tractable Network Model and Computational Approach, Anna Nagurney and Ladimer S. Nagurney, International Journal of Production Economics 140(2): (2012) pp 865-874.

I thank my wonderful hosts: Professor Manfred Fischer, Professor Petra Staufer-Steinnocher, and, of course, Professor Tina Wakolbinger for the outstanding hospitality extended to me!

We even ate some classic Viennese cuisine and I returned with so many delicious Austrian chocolates, some of which I will be sharing with my Swedish colleagues this afternoon when we celebrate paper acceptances in journals!

Danke schon!

My Number 17 PhD Student to Successfully Defend Dissertation with Photos of the Celebration

In my previous post, I wrote about how to construct a great model with insights from Dr. Hal Varian, the Chief Economist of Google, who had also spent many years at UC Berkeley.

I noted that the doctoral dissertation defense of my 17th PhD student would soon be taking place. Indeed, I had chaired 16 doctoral dissertations to that point and am very proud of my former students!

So, for all of those out there who are dying of suspense as to the outcome -- the news is great!

Amir H. Masoumi successfully defensed his doctoral dissertation on Friday, February 1, 2013 at the Isenberg School of Management at UMass Amherst. His concentration was Management Science and the title of his dissertation: Supply Chain Management of Perishable Products with Applications to Healthcare. In his research,  he focused on centralized and decentralized supply chains with the former consisting of blood supply chains and the latter -- oligopolistic competition with brand differentiation of pharmaceutical products. His work is also related to medical nuclear supply chains and to food supply chains.

Coincidentally, after his defense, he told me that his lucky number has always been 17!

His dissertation committee consisted of Professor Hari Balasubramian of the Department of Mechanical and Industrial Engineering at UMass Amherst, Professor Senay Solak of the Isenberg School, and Professor June Dong of the School of Business of SUNY Oswego.

The dissertation committee members are in the above photo with Amir H. Masoumi. (Professor June Dong teleconferenced in and we had to practice some disruption management since the communications went down for a few minutes -- Always have a backup plan!)

What really impressed me was not only how Amir thanked his fellow associates at the Virtual Center for Supernetworks that I direct but also how he acknowledged his colleagues at the award-winning UMass Amherst INFORMS Student Chapter, many of which showed up on a freezing Friday afternoon to listen to his presentation and waited outside the room until the committee finished asking him their questions.

Later, that evening, we celebrated his successful defense at Moti, a Persian restaurant in downtown Amherst. The food was delicious and the conversations had us roaring with laughter.

 

Thanks to all those who have supported a student in his journey to achieve his dream of becoming Dr. Amir H. Masoumi!

And, yes, his mother, back in his birthplace, had been praying for him all day and, when he texted her at 1:30AM her time with the good news, she was very relieved and very happy!

Our Highly Downloaded Blood Supply Chain Network Paper is Now Available for Free Download -- Thanks to Computational Management Science and Springer

I do like it when a journals and publishers are proactive and innovative.

It also feels good, as a researcher, that the papers that you write and are published are actually read!

The paper, "Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization," that I co-authored with my doctoral students, Amir H, Masoumi, and Min Yu, is now one of the most highly downloaded articles in the journal Computational Management Science.

And Springer, the journal's publisher, has made the article available for free download.


Min Yu has received her PhD, since the article was published, and is now an Assistant Professor and Pamplin Fellow at the Pamplin School of Business at the University of Portland in Oregon.

Amir and I also co-authored the paper, Supply Chain Network Design of a Sustainable Blood Banking System,which appears in the book,  Sustainable Supply Chains: Models, Methods and Public Policy Implications (2012), T. Boone, V. Jayaraman, and R. Ganeshan, Editors, Springer, London, England, pp 49-72.

In these papers, we use some of the ideas on generalized network models going back to the work that I did on dynamic spatial price equilibrium models with gains and losses with Jay Aronson in which the product flow volumes  can change over space and time because of product perishability (losses) or successful investments (gains).

Optimizing Blood Supply Chains for Healthcare

Our paper, Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, Anna Nagurney, Amir H. Masoumi, and Min Yu, now appears in the journal, Computational Management Science 9(2): (2012) pp 205-231.

It is in the April 2012 issue of Computational Management Science and is in a special issue edited by Professor Georg Pflug.

In this paper, we focus on a specific perishable product – that of human blood – and the optimization of a blood banking network system. Nahmias (1982) claimed that: “The interest among researchers in perishable inventory problems has been sparked primarily by problems of blood bank management. Some of the possible reasons for this interest might be that blood bank research has been supported by public funds.” Prastacos (1984) provided a review, to that date, of blood inventory management, from both theoretical and practical perspectives. Whether or not Nahmias’ statement is still valid – considering all the recent concerns about the safety of perishable products, blood bank management from a supply chain network perspective merits a fresh and updated approach.

This topic is especially timely today, since it has been reported that the number of disasters and the number of people affected by disasters has been growing over the past decade and blood is certainly a life-saving product (cf. Nagurney and Qiang (2009)). Blood service operations are a key component of the healthcare system all over the world. According to the American Red Cross, over 39,000 donations are needed everyday in the United States, alone, and the blood supply is frequently reported to be just 2 days away from running out. Of 1,700 hospitals participating in a survey in 2007, a total of 492 reported cancellations of elective surgeries on one or more days due to blood shortages. While for many hospitals, the reported number of blood-related delays was not significant, hospitals with as many days of surgical delays as 50 or even 120 have been observed. Furthermore, in 2006, the national estimate for the number of units of whole blood and all components outdated by blood centers and hospitals was 1,276,000 out of 15,688,000 units (Whitaker et al. (2007)). Considering also the ever-increasing hospital cost of a unit of red blood cells with a 6.4% increase from 2005 to 2007 further highlights the criticality of this perishable, lifesaving product.

 
In the US, this criticality has become more of an issue in the Northeastern and Southwestern states since this cost is meaningfully higher compared to that of the Southeastern and Central states. Moreover, hospitals were responsible for approximately 90% of the outdates, with this volume of medical waste imposing discarding costs to the already financially-stressed hospitals (The New York Times (2010)).

In this paper, we developed a generalized network optimization model for the complex supply chain of human blood, which is a life-saving, perishable product. In particular, we considered a regionalized blood banking system consisting of collection sites, testing and processing facilities, storage facilities, distribution centers, as well as points of demand, which, typically, include hospitals.

Our multicriteria system-optimization approach on generalized networks with arc multipliers captures many of the critical issues associated with blood supply chains such as the determination of the optimal allocations, and the induced supply-side risk, as well as the induced cost of discarding the waste, while satisfying the uncertain demands as closely as possible.

The framework that we present in this paper is also applicable, with appropriate modifications, to the
optimization of other supply chains of perishable products.


The complete analysis, along with references, can be found in our paper.

Blood Supply Chains and Humanitarian Logistics

In my previous post, I pointed to a guest lecture on Disaster Communications, given in my Humanitarian Logistics and Healthcare class at the Isenberg School of Management, by "the other" Professor Nagurney, my husband.

My students also had the privilege of learning about blood supply chains last week, both from an operations management perspective, as well as from a design (or redesign) operations research one.

The guest speaker on blood supply chains was one of my advanced doctoral students, Amir H. Masoumi, with whom I have co-authored two papers on blood supply chains. Amir has also taught the required Management Science course for our Operations Management majors and was nominated for a university-wide teaching award by the students.

Amir's presentation, "Supply Chain Network Operations Management and Design of a Sustainable Blood Banking System," was based on the two papers with additional material added to broaden the scope for the students and to bring issues of disasters and humanitarian logistics into this context. The framework that we developed for this most important perishable product in healthcare handles risk as well as demand uncertainty.

Our paper, Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, Anna Nagurney, Amir H. Masoumi, and Min Yu, is now published online in the journal, Computational Management Science. Our paper, Supply Chain Network Design of a Sustainable Blood Banking System, Anna Nagurney and Amir H. Masoumi, is in press in the edited volume, Sustainable Supply Chains: Models, Methods and Public Policy Implications, T. Boone, V. Jayaraman, and R. Ganeshan, Editors, Springer, London, England, 2012. This book is in the International Series in Operations Research & Management Science.

The new course on Humanitarian Logistics and Healthcare has been a wonderful experience for the students, the instructor, as well as the guest speakers.

Medical Waste, Sustainability, and Operations Resarch

For many months now, we have been researching health care supply chains, with a focus on perishable products ranging from blood supply chains to medical nuclear supply chains.

In our research, we have, specifically, emphasized the impact of improper disposal of medical wastes on the environment. Our mathematical models are generalized network models in which the arc multipliers capture features of the perishable, but, life-saving, products that we are studying.

Today, CBS News is reporting on an investigation by a human rights official of the United Nations that noted that: nations pay "too little attention" to their tons of waste each year — waste that contains pathogens, blood, low levels of radioactivity, discarded needles, syringes, scalpels, expired drugs and vaccines. In many poorer nations, discarded chemicals and pharmaceutical wastes go straight to city dumps, down hospital toilets into water systems, or are burned in cement kilns that just add to dioxide emissions.

Our research on blood supply chains, from the operations management aspects, to the design, is written up in our papers:

Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization
Anna Nagurney, Amir H. Masoumi, and Min Yu, to appear in Computational Management Science.

Supply Chain Network Design of a Sustainable Blood Banking System
Anna Nagurney and Amir H. Masoumi, in Sustainable Supply Chains: Models, Methods and Public Policy Implications, T. Boone, V. Jayaraman, and R. Ganeshan, Editors, Springer, London, England, 2011, in press.

Our research, to-date, on medical nuclear supply chains, which I presented recently at the INTRIM Conference at McGill University, is reported in the paper:

Medical Nuclear Supply Chain Design: A Tractable Network Model and Computational Approach
Anna Nagurney and Ladimer S. Nagurney.

According to the report, the UN investigator, Cailin Georgescu, recommended that all nations adopt better laws for managing medical waste and replace incinerators with "more environmentally friendly and safe methods of disposal" such as autoclaving, which uses pressurized steam and superheated water to disinfect waste and medical equipment.

Next week I will be speaking on Sustainability: Methodologies with Some Applications at the SAMSI Workshop, which is part of the 2011-2012 Program on Uncertainty Quantification.

One thing that I am certain about is that we need to take better care of our environment not only for us and our children but for future generations as well.

Clearly, we, in the Operations Research community, understand this, and are doing something about it. Just read Dr. Ian Frommer's wonderful blog post on the course that he has taught on Sustainability.

On my list of new courses that I am developing are courses entitled:

Humanitarian Logistics and Healthcare and

Sustainable Systems.

Our Blood Supply Chain Paper is Now Published and Reflections on Dr. Bernadine P. Healy -- RIP

I was struck by the recent death of Dr. Bernadine P. Healy, who not only was the first female head of the National Institutes of Health (NIH) but also was the second female (after Elizabeth Dole) to head the American Red Cross and did so during 9/11.

She recently passed away at the age of 67 and had an amazing career as a researcher (over 200 papers), educator, and top administrator both in academe, including Johns Hopkins University, as well as the above-noted major organizations.

She was also a wife and mother to two daughters.

The New York Times ran an obituary on her, as did many other leading newspapers and, despite some controversial decisions, she clearly brought attention to women's health care and the importance of teamwork in organizations.

Our first blood supply chain paper, in which discussions with the Red Cross were essential and are acknowledged, entitled,Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, has now been published by the journal Computational Management Science. With it, we honor her memory.

Dr. Frank Collins, the present Director of the NIH, in his moving tribute to Dr. Healy, acknowledged her words, which she made during an NIH exhibit on pioneering women doctors:

“All of us, I believe, in our hearts are humanitarian. And how wonderful to be in a career that in almost any dimension of it—whether you're the doctor at the bedside, or the scientist in the laboratory, or the public health doc tracking down the latest epidemic—that you are doing something that is pure in its fundamental purpose, which is helping another human being.”

Thank you, Dr. Healy, for your gutsy leadership and R.I.P.

We hope that, through research and education, we can also make a difference.

University Press Release on Our Blood Supply Chain Research

The University of Massachusetts Amherst has issued a nice press release on our research on blood supply chains.

It is really exciting when theory, modeling, and computations all come together synergistically to contribute to an application that can help humanity.

It is also special when the research is done with students who are passionate about the topic.

The press release: UMass Researchers Seek Improvement in Blood Supply Chain.

Blood is a critical life-saving product that is frequently in scarce supply. Blood service operations are also a key component of the health care system all over the world. The U.S. averages 38,000 blood donations daily, but the supply is frequently two days away from running out. Blood is also perishable and estimates are that 8 percent becomes outdated and goes to waste.

Blood supplies are used in activities other than life-saving emergency care, and have an impact on whether hospitals can perform elective surgery and other non life-threatening procedures. The cost of each unit of blood has also been increasing in recent years, a factor in overall health care costs.

We built a model for a regionalized blood banking system consisting of collection sites, testing and processing facilities, storage facilities, distribution centers, as well as points of demand, which include hospitals.

The paper that describes the modeling and computational framework, co-authored with my doctoral students, Amir H. Masoumi and Min Yu, Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, will appear in Computational Management Science.

Alan Alda, Marie Curie, and an Update on Our Work on Supply Chains in Health Care

Problems to research are all around us -- now more than ever.

All that one has to do to identify the important and interesting problems in order to help make the world a better place, is to keep one's eyes open and to observe; to read a lot -- news, journal articles, and books; to communicate with others, through both local forums, as with students and colleagues, through conferences, email, social networking, etc., and to experience life. Travel helps, as well, in order to view the world outside of the silos and to better understand what are the major issues.

Successful research, however, requires incredible focus, dedication, and passion, and a book that captures the life of an amazing researcher and scientist, like no other, is Madame Curie, a biography of Marie Curie, written by her daughter, Eve Curie. I decided to read this beautiful biography of Marie Curie this summer, after hearing that Alan Alda (yes, of M*A*S*H* and other fame) had written a play about her that was performed at this year's World Science Festival (WSF) in early June in NYC. Coincidentally, Alda, also around that time, even managed to give a commencement address at a local prep school in our area, from which his granddaughter was graduating.

I feel as though Madame Curie was inspiring me throughout this summer, with a nudge from Alan Alda who loves science and has been an active proponent of the WSF (I had the terrific experience of speaking on the Traffic panel at the 2009 WSF). The WSF is the brainchild of Dr. Brian Greene, a renowned physicist at Columbia University, and his wife, the journalist, Tracy Day.

This summer, coincidentally, after purchasing the Curie biography, I became absolutely fascinated by medical nuclear supply chains and the shock that the US has not even been producing nor processing the most commonly used radioisotope for cancer and heart diagnostics led me to do research on this critical supply chain. But, I needed a collaborator who was skilled in the underlying physics and, luckily, my husband has a PhD in physics, with a concentration in low temperature experimental physics, and we needed to get the news out, which we did through an Op-Ed piece, along with the paper, Medical Nuclear Supply Chain Design: A Tractable Network Model and Computational Approach, Anna Nagurney and Ladimer S. Nagurney, which I will be presenting at a conference at McGill University in Montreal next week.

As noted in our paper, since molybdenum decays with a 66.7 hour half-life, approximately 99.9% of the atoms decay in 27.5 days, making its production, transportation, and processing all extremely time-sensitive. In fact, its production is quantified in Six-day curies end of processing denoting the activity of the sample 6 days after it was irradiated to highlight this (and, yes, named after the Curies). Note that not only did Marie Curie receive a Nobel prize but she actually received 2, in Physics and in Chemistry, and shared the former prize with her husband, Pierre Curie, and with Becquerel.
In our nuclear medical supply chain paper, we needed a theoretical result (our model is a generalized network optimization model in which the arc multipliers capture the various losses due to radioactive decay, etc.) in order to be able to obtain an elegant formulation for analysis and computations. Propitiously, and this also speaks to passion as being a necessary condition for good research, one of my doctoral students, who is very interested in health care, and another doctoral student, who is researching time-sensitive product supply chains, began working on blood supply chains.

Our paper, Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, Anna Nagurney, Amir H. Masoumi, and Min Yu, has now been accepted in the journal, Computational Management Science, and it contains a result that we needed in both in our medical nuclear supply chain modeling work as well as in a followon paper, Supply Chain Network Design of a Sustainable Blood Banking System, Anna Nagurney and Amir H. Masoumi, to appear in Sustainable Supply Chains: Models, Methods and Public Policy Implications, T. Boone, V. Jayaraman, and R. Ganeshan, Editors, Springer, London, England, 2011.

On an ending note, Marie and Pierre Curie's other daughter, Irene Curie, and her husband, also were awarded the Nobel prize in chemistry. Amazing accomplishments and among members of two generations of a family.

Keeping Our Blood Supply Chain Safe for Health Care Through Operations Management

My doctoral student, Amir Masoumi, and I have been deeply researching blood supply chains, a supply chain of a highly perishable product, with life-saving properties.

What makes the modeling and analysis of this health care supply chain so challenging is not only its perishability, but also that there is risk associated with its procurement (on bad weather days, for example, potential donors may decide not to give blood whereas during disasters there may be an outpouring of willing donors).

The safety of the blood supply also requires proper testing and, at times, it may be difficult to predict the demand, resulting in shortages, for example, with associated costs. An oversupply of blood, on the other hand, requires proper waste disposal of outdated blood.

There is now a blood supply shortage gripping the United States.

As noted in the Herald, under federal law, whole blood can be stored for up to 42 days. However, some studies have found that patients who receive blood stored even for a couple of weeks are more likely to suffer infections, cardiovascular problems and even organ failure, particularly those who use several units of older blood.

A new paper, published yesterday in the journal Critical Care Medicine, explaining why this is so -- found that stored red blood cells begin to lose the ability to release a key molecule called adenosine-5’-triphosphate (ATP), which helps prevent the cell from sticking to the walls of blood vessels.

However, before researchers determine how to boost levels of ATP in older blood to make such blood safer, it is important to be able to analyze the risk and perishability of blood in its complete supply chain along with the costs which must include potential unmet demand as well as waste.

We now have two papers on this subject, the first, Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization, Anna Nagurney, Amir H. Masoumi, and Min Yu, focuses on optimizing the operations of the blood supply chain, whereas the second, Supply Chain Network Design of a Sustainable Blood Banking System, Anna Nagurney and Amir H. Masoumi, to appear in Sustainable Supply Chains: Models, Methods and Public Policy Implications, T. Boone, V. Jayaraman, and R. Ganeshan, Editors, Springer, London, England, 2011, in press, demonstrates how to design (or redesign the blood supply chain).

By doing out best to optimize this life-saving, scarce resource, in a holistic manner, we can save lives.

Designing a Sustainable Blood Banking Supply Chain Network

Interestingly, health care facilities in the United States are second only to the food industry in producing waste, generating more than 6,600 tons per day, and more than 4 billion pounds annually. In addition, considerable amounts of drugs have been found in 41 million Americans' drinking water due to the improper disposal of unused or expired drugs placed in domestic trash or discarded in the waste water. In other countries, up to 4 pounds of waste per hospital bed per day is produced, out of which 0.5 percent might be categorized as risky / potentially hazardous waste.

Medical waste, also known as clinical waste, refers to the waste products that can not be considered as general waste, and that is produced, typically, at health care premises, including hospitals, clinics, and labs. Due to the potentially hazardous nature of medical waste, both the American Dental Association (ADA) and the Centers for Disease Control (CDC) recommend that medical waste be removed in accordance with regulations.

Disposal of medical waste is not only costly to the health care industry, but also may harm the environment. Consequently, poor management of such waste may lead to the contamination of water, the soil, and the atmosphere. While many hospitals choose to have their waste burned so as to avoid polluting the soil through landfills, the incinerators themselves are one of the nation's leading sources of toxic pollutants such as dioxins and mercury. Thus, minimizing the amount of medical waste throughout the health care supply chains will lead to a cleaner environment, which may, in turn, also reduce illnesses and death.

When it comes to blood supply chains, the scarcity and vitalness of this highly perishable health care product make such supply chains crucial. Hence, the effective design and control of such systems can support the health and well-being of populations and can also positively affect the sustainability of the environment by reducing the associated waste. Indeed, since blood waste is a significant hazard to the environment, a major step in attaining a sustainable blood supply chain is to be able to minimize the outdating of blood products while satisfying the demand.

In our paper, "Supply Chain Network Design of a Sustainable Blood Banking System," Anna Nagurney and Amir H. Masoumi, we developed a multicriteria system-optimization framework for the supply chain network design of a sustainable blood banking system. The framework allows for the simultaneous determination of optimal link capacities through investments, and the flows on various links, which correspond to such application-based supply chain network activities as: blood collection, the shipment of collected blood, its testing and processing, its storage, its shipment to distribution centers, and, finally, to the points of demand. The system-optimization approach is believed to be mandated for critical supplies in that the demand for such products must be satisfied as closely as possible at minimal total cost. The use of a profit maximization criterion is not appropriate for an organization such as, for example, the American Red Cross, due to its non-profit status.

In particular, the sustainable supply chain network design model for blood banking that we developed is novel for several reasons:

1. it captures the perishability of the product through the use of arc multipliers;
2. it handles the costs associated with the discarding of the medical waste, which could be hazardous,
3. it captures the uncertainty associated with the demand for the product along with the risk associated with procurement of the product, and
4. it allows for total cost minimization and the total risk minimization associated with the design and operation of the blood banking supply chain network.

Our framework is a contribution to the growing literature on sustainable supply chains and to the design of sustainable supply chains, in particular (cf. Nagurney and Nagurney (2010) and the references therein). However, our supply chain network design model for sustainable blood systems focuses not on the minimization of emissions but rather on the minimization of waste. Moreover, it captures the perishability of this product.

We thank the Red Cross for helpful discussions conducted by Amir H. Masoumi as we conducted this research.

Our paper is now in press in the Springer International Series in Operations Research & Management Science, entitled: Sustainable Supply Chains: Models, Methods and Public Policy Implications, T. Boone, V. Jayaraman, and R. Ganeshan.

Blood Supply Chains, Risk Minimization, and Healthcare Operations

Blood is a life-saving "product" and, at the same time, it is highly perishable. Its delivery is also time-sensitive. In addition, since blood is not manufactured, there is risk associated with the supply side of the blood supply chains; that is, the blood drive sites.

Blood service operations are a key component of the healthcare system all over the world. According to the American Red Cross, over 39,000 donations are needed everyday in the United States, alone, and the blood supply is frequently reported to be just 2 days away from running out. Of 1,700 hospitals participating in a survey in 2007, a total of 492 reported cancellations of elective surgeries on one or more days due to blood shortages. While for many hospitals, the reported number of blood-related delays was not significant, hospitals with as many days of surgical delays as 50 or even 120 have been observed. Furthermore, in 2006, the national estimate for the number of units of whole blood and all components outdated by blood centers and hospitals was 1,276,000 out of 15,688,000 units.

Considering also the ever-increasing hospital cost of a unit of red blood cells with a 6.4% increase from 2005 to 2007 further highlights the criticality of this perishable, life-saving product. The New York Times reported in 2010 that this criticality has become more of an issue in the Northeastern and Southwestern states in the United States since this cost is meaningfully higher compared to that of the Southeastern and Central states. Moreover, hospitals were responsible for approximately 90% of the outdates, with this volume of medical waste imposing discarding costs to the already financially-stressed hospitals.

In the paper, "Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization," my doctoral students, Amir Masoumi, and Min Yu, and I, developed a network optimization model for the complex supply chain of human blood. In particular, we considered a regionalized blood banking system consisting of collection sites, testing and processing facilities, storage facilities, distribution centers, as well as points of demand, which, typically, include hospitals.

Our multicriteria system-optimization approach on generalized networks with arc multipliers captures many of the critical issues associated with blood supply chains such as the determination of the optimal allocations, and the induced supply-side risk, as well as the induced cost of discarding the waste, while satisfying the uncertain demands as closely as possible. Indeed, since it may be difficult to predict the demand, it is essential to capture the uncertainty associated with the demand in an appropriate modeling and computational framework.

This research we will be presenting at the POMS Conference in Reno, Nevada, as well as at the Northeast Regional INFORMS Conference at UMass Amherst.

The supply chain network model for the optimization of blood supply chains is part of our growing body of research on healthcare-oriented supply chains with applications even in disasters. For example, results in the study, "Supply Chain Network Design for Critical Needs with Outsourcing," co-authored with Min Yu and Dr. Patrick Qiang, can also be applied in disaster relief.

It is especially gratifying to see students so engaged in research that can have a positive societal impact!

Time-Sensitive Products, Cost, and Cargo Security

Freight as the Weakest Link in the Chain was the title of my blogpost the other day and I see that today's New York Times has an article: In Air Cargo Business, It's Speed vs. Screening, Creating a Wink Link in Security.

The article focuses on time-sensitive products, a topic that we have conducted a lot of research on from fashion supply chains (not a life or death application but clothing is a basic right) to blood supply chains (another fascinating topic of research that we are completing a study on).

The Times article has several quotes from Professor Yossi Sheffi, a colleague of mine in transportation and logistics at MIT, whose center I visited when I held an NSF Faculty Award for Women.

Sheffi says: “You cannot stop the flow of time-sensitive air freight,” and “It is simply not realistic.” Professor Sheffi is the author of the book, Urban Transportation Networks, which is one of the books that I recommend to my students in the Transportation & Logistics course that I am instructing with help from my two wonderful Teaching Assistants, Nathan Kollett and Min Yu, who are doctoral students in Management Science at the Isenberg School of Management. Sheffi is also the author of The Resilient Enterprise.

Freight is a critical link in our global supply chains that produce and distribute products around the world. Hence, their security and viability are essential to our connected enterprises.

The air cargo system is built into the way many companies do business. However, the way that cargo is packed also makes it difficult to inspect, from special packaging, such as shrink-wrapping, which may provide exemption from inspections.

We are in an era of Fragile Networks in which multicriteria decision-making needs to be the norm for decision-making coupled with the identification of vulnerabilities and potential synergies in business.