Heuristic algorithms for the Capacitated Location-Routing Problem and the Multi-Depot Vehicle Routing Problem

The Capacitated Location-Routing Problem (CLRP) is a NP-hard problem since it generalizes two well known NP-hard problems: the Capacitated Facility Location Problem (CFLP) and the Capacitated Vehicle Routing Problem (CVRP). The Multi-Depot Vehicle Routing Problem (MDVRP) is known to be a NP-hard since it is a generalization of the well known Vehicle Routing Problem (VRP), arising with one depot. This thesis addresses heuristics algorithms based on the well-know granular search idea introduced by Toth and Vigo (2003) to solve the CLRP and the MDVRP. Extensive computational experiments on benchmark instances for both problems have been performed to determine the effectiveness of the proposed algorithms. This work is organized as follows: Chapter 1 describes a detailed overview and a methodological review of the literature for the the Capacitated Location-Routing Problem (CLRP) and the Multi-Depot Vehicle Routing Problem (MDVRP). Chapter 2 describes a two-phase hybrid heuristic algorithm to solve the CLRP. Chapter 3 shows a computational comparison of heuristic algorithms for the CLRP. Chapter 4 presents a hybrid granular tabu search approach for solving the MDVRP.

Guidelines of Special Care Dentistry in Patients with Chromosomal and Genetic syndromes

Chromosomal and genetic syndromes are frequently associated with dental and cranio-facial alterations. The aim of our study is to identify and describe the dental and craniofacial alterations typical of six genetic and chromosomal syndromes examined. Materials and Methods- A dental visit was performed to 195 patients referred from Sant’Orsola Hospital of Bologna, University of Bologna, to Service of Special Need Dentistry, Dental Clinic, Department of Biomedical and Neuromotor Science, University of Bologna. The patients recruited were 137 females and 58 males, in an age range of 3-49 years (mean age of 13.8±7.4). The total sample consisted of subjects affected with Down Syndrome (n=133), Familiar Hypophosphatemic Ricket (n=10), Muscular Dystrophies (n=12), Noonan Syndrome (n=13), Turner Syndrome (n=17), Williams Syndrome(n=10). A questionnaire regarding detailed medical and dental history, oral health and dietary habits, was filled by parents/caregivers, or patients themselves when possible. The intra-oral and extra-oral examination valued the presence of facial asymmetries, oral habits, dental and skeletal malocclusions, dental formula, dental anomalies, Plaque Index (Silness&LÖe Index), caries prevalence (dmft/DMFT index), gingivitis and periodontal disease, and mucosal lesions. Radiographic examinations (Intraoral radiographies, Orthopanoramic, Skull teleradiography) were executed according to patient’s age and treatment planning. A review of literature about each syndrome and its dental and cranio-facial characteristics and about caries, hygiene status and malocclusion prevalence on syndromic and non-syndromic population was performed. Results - The data of all the patients were collected in the “Data Collection Tables” created for each syndrome. General anamnesis information, oral hygiene habits and dmft/DMFT, PI, malocclusion prevalence were calculated and compared to syndromic and non-syndromic population results found in literature. Discussions and conclusions - Guidelines of Special Care dentistry were indicated for each syndrome, in relation to each syndrome features and individual patient characteristics.

Homeland security: IgA immunity at the frontiers of the body

IgA is the most abundant immunoglobulin produced in mammals, and is mostly secreted across mucous membranes. At these frontiers, which are constantly assaulted by pathogenic and commensal microbes, IgA provides part of a layered system of immune protection. In this review, we describe how IgA induction occurs through both T-dependent and T-independent mechanisms, and how IgA is generated against the prodigious load of commensal microbes after mucosal dendritic cells (DCs) have sampled a tiny fraction of the microbial consortia in the intestinal lumen. To function in this hostile environment, IgA must be induced behind the 'firewall' of the mesenteric lymph nodes to generate responses that integrate microbial stimuli, rather than the classical prime-boost effects characteristic of systemic immunity.

[Tobacco-associated lesions of the oral mucosa]

Consumption of tobacco can result not only in a multitude of different general health problems like carcinoma of the lung, ischaemic cardiac diseases, peripheral vascular diseases, stroke, chronic-obstructive pulmonary diseases or peptic ulcers, but also in pathologic lesions of the oral mucosa. Benign oral lesions from smoking or consumption of smokeless tobacco are the so-called smoker's palate and smoker's melanosis. On the other hand, tobacco-associated lesions like oral leukoplakia or oral squamous cell carcinoma are already potentially life-threatening diseases that in general require active treatment. The following review article will present and discuss the typical lesions of the oral mucosa that result from chronic tobacco consumption. The aim of this article is to demonstrate dental health care providers the needs and benefits of tobacco use cessation in a dental setting, especially regarding stomatologic sequelae and consequences. The present article is the first in a series of articles from the Swiss task force "Smoking - Intervention in the private dental office" on the topic "tobacco use and dental medicine".

Determinants of Experience of Discrimination in Minorities in Germany

This study examines perceived ethnic discrimination (as opposed to “objective” discrimination). It includes a discussion of definitions of discrimination and attempts to measure it, and a review of findings on the distribution of discrimination experiences among minorities. The aim of the study is to determine the influence of factors that increase the risk of exposure to situations in which discrimination can take place (exposure hypothesis), and those that sensitize perceptions and give rise to different frequencies of subjective feelings of discrimination (sensitization hypothesis). A standardized questionnaire was administered to a random sample of German-born persons of Turkish and Greek origin and Aussiedler (ethnic Germans born in the former Soviet Union) (total N = 301). Minorities of non-German, especially of Turkish origin reported significantly more discrimination than Aussiedler in a set of nineteen everyday situations. A bivariate correlation was found between number of incidents reported and employment status with homemakers reporting the fewest incidents. However, multiple regression analysis yielded no significant effect, thus lending no clear support to the exposure hypothesis. Frequency of contacts with German friends has no effect and seems not to entail an increase in exposure opportunities, but may lead to a desensitization to discrimination due to the erosion of the relevance of ethnic categories. On the other hand, an influence through intra-ethnic contacts clearly occurs, as frequency of contact with co-ethnic friends exerts a strong positive effect on experienced discrimination. A similar effect was found for ethnic self-awareness. The latter finding confirms the sensitization hypothesis.

Combination of Psychological Intervention and Phosphodiesterase-5 Inhibitors for Erectile Dysfunction: A Narrative Review and Meta-Analysis

INTRODUCTION Erectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments. AIM The aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED. MAIN OUTCOME MEASURES Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient. METHODS A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both. RESULTS Eight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects. CONCLUSIONS The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding. Schmidt HM, Munder T, Gerger H, Frühauf S, and Barth J. Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: A narrative review and meta-analysis. J Sex Med **;**:**-**.

Imaging of acute ischemic stroke.

BACKGROUND Over 80% of strokes result from ischemic damage to the brain due to an acute reduction in the blood supply. Around 25-35% of strokes present with large vessel occlusion, and the patients in this category often present with severe neurological deficits. Without early treatment, the prognosis is poor. Stroke imaging is critical for assessing the extent of tissue damage and for guiding treatment. SUMMARY This review focuses on the imaging techniques used in the diagnosis and treatment of acute ischemic stroke, with an emphasis on those involving the anterior circulation. Key Message: Effective and standardized imaging protocols are necessary for clinical decision making and for the proper design of prospective studies on acute stroke. CLINICAL IMPLICATIONS Each minute without treatment spells the loss of an estimated 1.8 million neurons ('time is brain'). Therefore, stroke imaging must be performed in a fast and efficient manner. First, intracranial hemorrhage and stroke mimics should be excluded by the use of computed tomography (CT) or magnetic resonance imaging (MRI). The next key step is to define the extent and location of the infarct core (values of >70 ml, >1/3 of the middle cerebral artery (MCA) territory or an ASPECTS score ≤ 7 indicate poor clinical outcome). Penumbral imaging is currently based on the mismatch concept. It should be noted that the penumbra is a dynamic zone and can be sustained in the presence of good collateral circulation. A thrombus length of >8 mm predicts poor recanalization after intravenous thrombolysis.

Toward stratified treatments for bipolar disorders

In bipolar disorders, there are unclear diagnostic boundaries with unipolar depression and schizophrenia, inconsistency of treatment guidelines, relatively long trial-and-error phases of treatment optimization, and increasing use of complex combination therapies lacking empirical evidence. These suggest that the current definition of bipolar disorders based on clinical symptoms reflects a clinically and etiologically heterogeneous entity. Stratification of treatments for bipolar disorders based on biomarkers and improved clinical markers are greatly needed to increase the efficacy of currently available treatments and improve the chances of developing novel therapeutic approaches. This review provides a theoretical framework to identify biomarkers and summarizes the most promising markers for stratification regarding beneficial and adverse treatment effects. State and stage specifiers, neuropsychological tests, neuroimaging, and genetic and epigenetic biomarkers will be discussed with respect to their ability to predict the response to specific pharmacological and psychosocial psychotherapies for bipolar disorders. To date, the most reliable markers are derived from psychopathology and history-taking, while no biomarker has been found that reliably predicts individual treatment responses. This review underlines both the importance of clinical diagnostic skills and the need for biological research to identify markers that will allow the targeting of treatment specifically to sub-populations of bipolar patients who are more likely to benefit from a specific treatment and less likely to develop adverse reactions.

Modelo multifactorial para optimización de la productividad en el proceso de generación de energía eléctrica : aplicación al caso de las centrales hidroeléctricas venezolanas

Las organizaciones son sistemas o unidades sociales, compuestas por personas que interactúan entre sí, para lograr objetivos comunes. Uno de sus objetivos es la productividad. La productividad es un constructo multidimensional en la que influyen aspectos tecnológicos, económicos, organizacionales y humanos. Diversos estudios apoyan la influencia de la motivación de las personas, de las habilidades y destrezas de los individuos, de su talento para desempeñar el trabajo, así como también del ambiente de trabajo presente en la organización, en la productividad. Por esta razón, el objetivo general de la investigación, es analizar la influencia entre los factores humanos y la productividad. Se hará énfasis en la persona como factor productivo clave, para responder a las interrogantes de la investigación, referidas a cuáles son las variables humanas que inciden en la productividad, a la posibilidad de plantear un modelo de productividad que considere el impacto del factor humano y la posibilidad de encontrar un método para la medición de la productividad que contemple la percepción del factor humano. Para resolver estas interrogantes, en esta investigación se busca establecer las relaciones entre las variables humanas y la productividad, vistas desde la perspectiva de tres unidades de análisis diferentes: individuo, grupo y organización, para la formulación de un modelo de productividad humana y el diseño de un instrumento para su medida. Una de las principales fuente de investigación para la elección de las variables humanas, la formulación del modelo, y el método de medición de la productividad, fue la revisión de la literatura disponible sobre la productividad y el factor humano en las organizaciones, lo que facilitó el trazado del marco teórico y conceptual. Otra de las fuentes para la selección fue la opinión de expertos y de especialistas directamente involucrados en el sector eléctrico venezolano, lo cual facilitó la obtención de un modelo, cuyas variables reflejasen la realidad del ámbito en estudio. Para aportar una interpretación explicativa del fenómeno, se planteó el modelo de los Factores Humanos vs Productividad (MFHP), el cual se analizó desde la perspectiva del análisis causal y fue conformado por tres variables latentes exógenas denominadas: factores individuales, factores grupales y factores organizacionales, que estaban relacionadas con una variable latente endógena denominada productividad. El MFHP se formuló mediante la metodología de los modelos de ecuaciones estructurales (SEM). Las relaciones inicialmente propuestas entre las variables latentes fueron corroboradas por los ajustes globales del modelo, se constataron las relaciones entre las variables latentes planteadas y sus indicadores asociados, lo que facilitó el enunciado de 26 hipótesis, de las cuales se comprobaron 24. El modelo fue validado mediante la estrategia de modelos rivales, utilizada para comparar varios modelos SEM, y seleccionar el de mejor ajuste, con sustento teórico. La aceptación del modelo se realizó mediante la evaluación conjunta de los índices de bondad de ajuste globales. Asimismo, para la elaboración del instrumento de medida de la productividad (IMPH), se realizó un análisis factorial exploratorio previo a la aplicación del análisis factorial confirmatorio, aplicando SEM. La revisión de los conceptos de productividad, la incidencia del factor humano, y sus métodos de medición, condujeron al planteamiento de métodos subjetivos que incorporaron la percepción de los principales actores del proceso productivo, tanto para la selección de las variables, como para la formulación de un modelo de productividad y el diseño de un instrumento de medición de la productividad. La contribución metodológica de este trabajo de investigación, ha sido el empleo de los SEM para relacionar variables que tienen que ver con el comportamiento humano en la organización y la productividad, lo cual abre nuevas posibilidades a la investigación en este ámbito. Organizations are social systems or units composed of people who interact with each other to achieve common goals. One objective is productivity, which is a multidimensional construct influenced by technological, economic, organizational and human aspects. Several studies support the influence on productivity of personal motivation, of the skills and abilities of individuals, of their talent for the job, as well as of the work environment present in the organization. Therefore, the overall objective of this research is to analyze the influence between human factors and productivity. The emphasis is on the individual as a productive factor which is key in order to answer the research questions concerning the human variables that affect productivity and to address the ability to propose a productivity model that considers the impact of the human factor and the possibility of finding a method for the measurement of productivity that includes the perception of the human factor. To consider these questions, this research seeks to establish the relationships between human and productivity variables, as seen from the perspective of three different units of analysis: the individual, the group and the organization, in order to formulate a model of human productivity and to design an instrument for its measurement. A major source of research for choosing the human variables, model formulation, and method of measuring productivity, was the review of the available literature on productivity and the human factor in organizations which facilitated the design of the theoretical and conceptual framework. Another source for the selection was the opinion of experts and specialists directly involved in the Venezuelan electricity sector which facilitated obtaining a model whose variables reflect the reality of the area under study. To provide an interpretation explaining the phenomenon, the model of the Human Factors vs. Productivity Model (HFPM) was proposed. This model has been analyzed from the perspective of causal analysis and was composed of three latent exogenous variables denominated: individual, group and organizational factors which are related to a latent variable denominated endogenous productivity. The HFPM was formulated using the methodology of Structural Equation Modeling (SEM). The initially proposed relationships between latent variables were confirmed by the global fits of the model, the relationships between the latent variables and their associated indicators enable the statement of 26 hypotheses, of which 24 were confirmed. The model was validated using the strategy of rival models, used for comparing various SEM models and to select the one that provides the best fit, with theoretical support. The acceptance of the model was performed through the joint evaluation of the adequacy of global fit indices. Additionally, for the development of an instrument to measure productivity, an exploratory factor analysis was performed prior to the application of a confirmatory factor analysis, using SEM. The review of the concepts of productivity, the impact of the human factor, and the measurement methods led to a subjective methods approach that incorporated the perception of the main actors of the production process, both for the selection of variables and for the formulation of a productivity model and the design of an instrument to measure productivity. The methodological contribution of this research has been the use of SEM to relate variables that have to do with human behavior in the organization and with productivity, opening new possibilities for research in this area.

ANALISANDO A RELAÇÃO DOS VOLUMES DE EXPORTAÇÃO E DE IMPORTAÇÃO, PIB, TAXAS DE CÂMBIO E INFLAÇÃO NO PERÍODO DE 2004 A 2014.

Esta dissertação visa deslumbrar uma análise macroeconômica do Brasil, especialmente no que se refere à relação dos índices mensais dos volumes das exportações e das importações com os volumes mensais do PIB, da Taxa SELIC e as Taxas de Câmbio, conforme dados coletados no período de janeiro de 2004 a dezembro de 2014, através de pesquisa literária referente aos históricos sobre cada conceito envolvido no âmbito da macroeconomia das varáveis estudadas. Foi realizado um estudo de caso embasado em dados de sites governamentais, no período delimitado, empregando-se o método de regressão linear, com base na Teoria da correlação de Pearson, demonstrando os resultados obtidos no período do estudo para as varáveis estudadas. Desta maneira, conseguiu-se estudar e analisar como as variáveis dependentes (resposta): volume das exportações e volume das importações estão relacionadas com as varáveis independentes (explicativas): PIB, Taxa Selic e taxa de Câmbio. Os resultados apurados no presente estudo permitem identificar que existe correlação moderada e negativa, quando analisadas a Taxa Selic e a Taxa de Câmbio com os volumes das exportações e das importações, enquanto o PIB apresenta correlação forte e positiva na análise com os volumes das exportações e das importações

Análise do padrão IEEE 802.11g para a comunicação do sistema de controle distribuído de semáforos.

Este trabalho propõe a análise da comunicação sem fio para um sistema de controle distribuído de semáforos, a partir da revisão das literaturas, realização de simulações e experimentos, os quais consideram as especificações estabelecidas para o sistema de semáforos. As simulações e os experimentos se baseiam na avaliação do comportamento da comunicação perante a alteração de alguns parâmetros de configuração da rede. O estudo apresentado envolve análises relacionadas ao padrão IEEE 802.11g e às definições da camada física apresentadas nas especificações do padrão. Os métodos utilizados envolvem o estudo e experimentação de parâmetros relacionados à potência de transmissão e recepção, além de análise dos esquemas de modulação utilizados pelo padrão IEEE 802.11g. A metodologia aplicada a este trabalho envolve o conhecimento das características e capacidade dos esquemas de modulação responsáveis pela definição das taxas de transmissão. As análises mostram que a possibilidade de adequação dos parâmetros de configuração de rede, levando em consideração o cenário de aplicação, pode ser um fator essencial para o bom desempenho de todo o sistema.

Safety belt usage. A review of effectiveness studies. Suggestions for state programs.

Mode of access: Internet.

The brief encounter review : an investigation in graphic computer-based medical record reporting systems /

Bibliography: p. 85.

How useful is the genuine savings rate as a sustainability indicator for regions within countries? Australia and Queensland compared

This article shows how macroeconomic indicators of sustainable development can be applied to the Queensland economy. While recognising the complex and contentious theoretical and practical issues in deriving the Genuine Savings Rate (GSR) to serve as such an indicator, we use the World Bank's methodology, which includes only mineral depletion, deforestation and carbon dioxide emissions as environmental terms, to estimate GSRs for Queensland for the period 1989 to 1999, and compare these to World Bank estimates of Australia's GSR for the same period. We find that Queensland has a higher rate of natural resource depletion and a lower GSR than the whole of Australia. We also examine how well the World Bank GSR performs as a 'headline' measure of overall sustainability, review criticisms of the GSR, and compare its implicit policy implications with those of net state savings, and of the GSR plus a suite of other indicators.

Liposomal vaccine delivery systems

INTRODUCTION: Liposomes remain at the forefront of drug and vaccine design owing to their well-documented abilities to act as delivery vehicles. Nevertheless, the concept of liposomes as delivery vehicles is not a new one, with most works focusing on their use for the delivery of genes and drugs. However, in the last 10 years a significant amount of research has focused on using liposomes as vaccine adjuvants, not only as an antigen delivery vehicle but also as a tool to increase the immunogenicity of peptide and protein antigens. AREAS COVERED: This paper reviews liposomal adjuvants now in vaccine development, with particular emphasis on their adjuvant mechanism and how specific physicochemical characteristics of liposomes affect the immune response. The inclusion of immunomodulators is also discussed, with prominence given to Toll-like receptor ligands. EXPERT OPINION: The use of liposomes as vaccine delivery systems is evolving rapidly owing to the combined increase in technological advances and understanding of the immune system. Liposomes that contain and deliver immunostimulators and antigens are now being developed to target diseases that require stimulation of both humoral and cell-mediated immune responses. The CAF liposomal system, described in detail in this review, is one liposomal model that shows such flexibility.