Multi-Objective Genetic Algorithms for the Single Allocation Hub Location Problem

Hub Location Problems play vital economic roles in transportation and telecommunication networks where goods or people must be efficiently transferred from an origin to a destination point whilst direct origin-destination links are impractical. This work investigates the single allocation hub location problem, and proposes a genetic algorithm (GA) approach for it. The effectiveness of using a single-objective criterion measure for the problem is first explored. Next, a multi-objective GA employing various fitness evaluation strategies such as Pareto ranking, sum of ranks, and weighted sum strategies is presented. The effectiveness of the multi-objective GA is shown by comparison with an Integer Programming strategy, the only other multi-objective approach found in the literature for this problem. Lastly, two new crossover operators are proposed and an empirical study is done using small to large problem instances of the Civil Aeronautics Board (CAB) and Australian Post (AP) data sets.

A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.

Interprofessional Collaboration: The Experience of Nursing and Medical Students’ Interprofessional Education

In this hermeneutic phenomenological study, we examined the experience of interprofessional collaboration from the perspective of nursing and medical students. Seventeen medical and nursing students from two different universities participated in the study. We used guiding questions in face-to-face, conversational interviews to explore students’ experience and expectations of interprofessional collaboration within learning situations. Three themes emerged from the data: the great divide, learning means content, and breaking the ice. The findings suggest that the experience of interprofessional collaboration within learning events is influenced by the natural clustering of shared interests among students. Furthermore, the carry-forward of impressions about physician–nurse relationships prior to the educational programs and during clinical placements dominate the formation of new relationships and acquisition of new knowledge about roles, which might have implications for future practice.

Notice of Location of Grave - Wailly Orchard Cemetery

Two notices from the Director of Graves Registration and Enquiries, London, England noting the location of the grave as Wailly Orchard Cemetery near Arras. One of the certificates incorrectly notes the name as S.G. Woodruff while the other correctly has S. D. Woodruff. The number listed for Lieut. S. D. Woodruff's grave site photograph is CCM/9/4433.

Report sent to the President and Director of the Port Dalhousie and Thorold Railway stating that the location of the line extension of the railway is completed

Report sent to the President and Director of the Port Dalhousie and Thorold Railway stating that the location of the line extension of the railway is completed. The distance from Thorold Station to Port Colborne is 20 miles. The estimate provides for construction of a permanent structure across the Chippewa and Welland River. Estimates for building a first class road, culverts and bridges will be of permanent and durable masonry. This includes estimates for various station buildings such as a warehouse in Port Colborne and a warehouse in Port Dalhousie. Surveys and plans are ready and will be registered this week. This is signed by S.D. Woodruff (2 copies) [one appears to be a rough copy] (The rough copy is 5 pages, handwritten and the other copy is 6 pages, handwritten), Apr. 8, 1857.

Pelham Cares Inc. fonds, 1980-2015

The beginnings of Pelham Cares occurred in 1982 when the Mayor of Pelham, Eric Bergenstein, received a letter from Janet Hassall, a social worker with Niagara Regional Home Care. Hassall requested that a Social Service Committee be established in Pelham to address gaps in community services, a practice that several other communities in the Region had adopted. Such committees were commonly composed of church parishioners, so Bergenstein contacted Canon J. Nowe of the Holy Trinity Anglican Church, who expressed an interest in participating in such a committee. Bergenstein arranged a meeting in June, 1982 at the United Church Hall in Fonthill, for any interested parties to learn more about the existing Social Service Committees in the Region. The meeting was not part of a Town Council project, but rather an initiative undertaken by Mayor Bergenstein in a personal capacity. Subsequent meetings chaired by Eric Bergenstein were held throughout the remainder of that year, during which the name of Pelham Cares was decided, a steering committee established, and services to be offered were determined. These initially included “visits with the lonely, the shut-ins, at home, hospital or on an outing ; run errands for those who are “stuck”; step in, in emergencies, or regularly, to free a parent or spouse who can’t otherwise get a “break”; in emergencies, provide food, clothing, furniture, medicine and other necessities”. The first official meeting of Pelham Cares occurred in January 1983. Currently, the main services offered by Pelham Cares are a food bank; transportation services to medical appointments; and sponsorship programs to allow youth with limited financial means to participate in sports, recreational and educational activities. The organization also provides emergency food, supplies or short term accommodation due to fire or other catastrophic loss, as well as providing referrals to appropriate organizations or agencies. Pelham Cares is dependent on the funding from community partners such as service clubs, citizens, local businesses, financial institutions and churches. These services are provided by volunteers and one part-time employee. A permanent location for Pelham Cares was established in 2014 with the purchase of a property on Highway 20 East in Fonthill, after a 30 years search for a permanent facility.

Standards for the academic veterinary medical library

The Standards Committee of the Veterinary Medical Libraries Section was appointed in May 2000 and charged to create standards for the ideal academic veterinary medical library, written from the perspective of veterinary medical librarians. The resulting Standards for the Academic Veterinary Medical Library were approved by members of the Veterinary Medical Libraries Section during MLA ’03 in San Diego, California. The standards were approved by Section Council in April 2005 and received final approval from the Board of Directors of the Medical Library Association during MLA ’04 in Washington, DC.

In Search of Advice for Physicians in Entry-Level Medical Markets

We consider entry-level medical markets for physicians in the United Kingdom. These markets experienced failures which led to the adoption of centralized market mechanisms in the 1960's. However, different regions introduced different centralized mechanisms. We advise physicians who do not have detailed information about the rank-order lists submitted by the other participants. We demonstrate that in each of these markets in a low information environment it is not beneficial to reverse the true ranking of any two acceptable hospital positions. We further show that (i) in the Edinburgh 1967 market, ranking unacceptable matches as acceptable is not profitable for any participant and (ii) in any other British entry-level medical market, it is possible that only strategies which rank unacceptable positions as acceptable are optimal for a physician.

Solidarity in Choosing a Location on a Cycle

We study the implications of two solidarity conditions on the efficient location of a public good on a cycle, when agents have single-peaked, symmetric preferences. Both conditions require that when circumstances change, the agents not responsible for the change should all be affected in the same direction: either they all gain or they all loose. The first condition, population-monotonicity, applies to arrival or departure of one agent. The second, replacement-domination, applies to changes in the preferences of one agent. Unfortunately, no Pareto-efficient solution satisfies any of these properties. However, if agents’ preferred points are restricted to the vertices of a small regular polygon inscribed in the circle, solutions exist. We characterize them as a class of efficient priority rules.

A medical Handbook: for the use of practitioners and students

UANL