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Locher, Ione, Marika Waselewski, Kendrin Sonneville, Ken Resnicow, and Tammy Chang. "Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study." JMIR Formative Research 4, no. 12 (December 24, 2020): e21602. http://dx.doi.org/10.2196/21602.
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Background Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy.
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Nebel, Carina, Petra Sumasgutner, Shane C. McPherson, Gareth J. Tate, and Arjun Amar. "Contrasting parental color morphs increase regularity of prey deliveries in an African raptor." Behavioral Ecology 31, no. 5 (July 9, 2020): 1142–49. http://dx.doi.org/10.1093/beheco/araa063.
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Abstract Disassortative mating in color-polymorphic raptors is a proposed mechanism for the maintenance of color polymorphism in populations. Selection for such a mating system may occur if there are fitness advantages of mating with a contrasting morph. In the black sparrowhawk (Accipiter melanoleucus), mixed-morph pairs may have a selective advantage because they produce offspring that have higher survival rates. Two hypotheses, which may explain the mechanism, are the “avoidance-image” and “complementarity” hypotheses. The first suggests that, within a predator’s territory, prey develop a search image for the more commonly encountered parental morph, for example, the male morph during incubation and brooding. Females of a contrasting morph to their partner would then have higher capture rates once they commence hunting in the later nestling phase. Thus, the “avoidance-image” hypothesis predicts higher provisioning rates for mixed-morph pairs. Alternatively, the “complementarity” hypothesis posits that different color morphs exploit different environmental conditions, allowing mixed-morph pairs to hunt under a wider range of conditions and predicts that food is delivered more consistently. We test these hypotheses using nest cameras to record prey delivery rates during the late nestling phase when both parents are hunting. We found support for the “complementarity” hypothesis, with mixed-morph pairs delivering food more consistently but not at a higher rate. This higher consistency in prey deliveries may explain the improved survival of the offspring of mixed-morph pairs and could, therefore, play a role in maintaining the stability of color polymorphism in this system.
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Hanczar, Paweł. "An Inventory-Distribution System with LTL Deliveries – Mixed Integer Approach." Procedia - Social and Behavioral Sciences 20 (2011): 207–16. http://dx.doi.org/10.1016/j.sbspro.2011.08.026.
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Chao, John, Matty Chen, Aileen Deng, Harold Miao, Alexandra Newman, Sophia Tseng, and Candace Arai Yano. "Safeway Designs Mixed-Product Pallets to Support Just-in-Time Deliveries." Interfaces 35, no. 4 (August 2005): 294–307. http://dx.doi.org/10.1287/inte.1050.0144.
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Amine Masmoudi, Mohamed, Katarzyna Anna Kuzmicz, Erwin Pesch, Emrah Demir, and Manar Hosny. "Container truck transportation routing as a Mixed Fleet Heterogeneous Dial-a-Ride Problem." MATEC Web of Conferences 312 (2020): 02005. http://dx.doi.org/10.1051/matecconf/202031202005.
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In this paper, a new variant of the Heterogeneous Dial-a-Ride Problem (HDARP) is innovatively applied to a routing problem of trucks picking up and delivering full and empty containers in the logistic chain, including container depots, importers demanding full containers and exporters requesting empty containers. On the route different types of trucks pick-up and deliver full and empty 20- and 40-foot containers. We consider trucks that are operated by alternative fuel, as well as the need for refuelling of trucks in any alternative fuel station to eliminate the risk of running out of fuel during its route. The objective of the paper is to contribute to the optimization of container truck transport routing with multiple pick¬ups and deliveries by providing a mathematical programming model aiming at minimizing the transportation cost as well as the negative environmental impacts.
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Wassan, Niaz A., Gábor Nagy, and Samad Ahmadi. "A heuristic method for the vehicle routing problem with mixed deliveries and pickups." Journal of Scheduling 11, no. 2 (February 8, 2008): 149–61. http://dx.doi.org/10.1007/s10951-008-0055-y.
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White VanGompel, Emily C., Susan L. Perez, Avisek Datta, Francesca R. Carlock, Valerie Cape, and Elliott K. Main. "Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries." Annals of Family Medicine 19, no. 3 (May 2021): 249–57. http://dx.doi.org/10.1370/afm.2675.
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Whitley, Patricia, Hossain Shahriar, and Sweta Sneha. "Impact of Health Information Technologies on the Quality of Healthcare Deliveries." International Journal of Applied Research on Public Health Management 6, no. 1 (January 2021): 30–44. http://dx.doi.org/10.4018/ijarphm.2021010103.
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Through a literary review of recent research, this paper examines the mixed impact of health information technology (HIT) on patient care, medical errors, and the quality of healthcare delivery in selected hospital settings such as emergency departments. Specific technologies examined include the electronic health record (EHR), medical devices, artificial intelligence, and robotics. The paper identifies that some healthcare technologies are increasingly valuable in reducing medical errors, improving healthcare quality, and in producing better patient-centered outcomes. It also determines that technologies have complicated the delivery of quality patient care, increased the incidences of clinician burnout, and made receiving quality healthcare in America's hospital systems possibly less sure. The paper concludes with some suggestions for improving HIT's implementations and confirms the need for further evaluation of the impact of HIT in increasing patient safety and clinician well-being.
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Avci, Mustafa, and Seyda Topaloglu. "An adaptive local search algorithm for vehicle routing problem with simultaneous and mixed pickups and deliveries." Computers & Industrial Engineering 83 (May 2015): 15–29. http://dx.doi.org/10.1016/j.cie.2015.02.002.
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Aarnio, Karoliina, Mika Gissler, Ulrike Grittner, Bob Siegerink, Markku Kaste, Turgut Tatlisumak, Minna Tikkanen, and Jukka Putaala. "Outcome of pregnancies and deliveries before and after ischaemic stroke." European Stroke Journal 2, no. 4 (July 28, 2017): 346–55. http://dx.doi.org/10.1177/2396987317723795.
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Introduction Limited data exist on the outcome of pregnancies and deliveries in women with ischaemic stroke. We investigated the incidence of pregnancy- and delivery-related complications in women with ischaemic stroke before and after pregnancy compared with stroke-free matched controls. Patients and methods Of our 1008 consecutive patients aged 15–49 years with first-ever ischaemic stroke, 1994–2007, we included women with pregnancy data before or after stroke recorded in the Medical Birth Register (MBR) ( n = 152), and for them searched stroke-free controls matched by age, parity, year of birth, residential area and multiplicity ( n = 608). Data on hospital admissions and deaths (1987–2014) came from national health registries. Poisson regression mixed models allowed comparison of the incidence of complications. Results A total of 124 stroke mothers had 207 singleton pregnancies before and 45 mothers 68 pregnancies after stroke. The incidence rate ratio (IRR) for the composite outcome of pregnancy and delivery complications adjusted for socioeconomic status and maternal smoking was 1.43 (95% confidence interval [CI] 1.00–2.03, p = 0.05) for pre-stroke mothers, and 1.09 (95% CI 0.66–1.78) for post-stroke mothers, compared with matched controls. Similarly, the adjusted IRR for post-stroke hospital admission during pregnancy was 1.85 (95% CI 1.03–3.31). The IRR for perinatal death of the child was 3.43 (95% CI 0.57–20.53) before and 8.88 (95% CI 0.81–97.95) after stroke. Discussion and conclusions Compared with stroke-free mothers, we found a higher incidence of pregnancy- and delivery-related complications in mothers with ischaemic stroke. Larger studies are needed to verify our results.
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Dávid, Balázs, Olivér Ősz, and Máté Hegyháti. "Robust Scheduling of Waste Wood Processing Plants with Uncertain Delivery Sources and Quality." Sustainability 13, no. 9 (April 29, 2021): 5007. http://dx.doi.org/10.3390/su13095007.
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While the study of reverse wood value chains has become an important topic recently, optimization-focused studies usually consider network-level problems and decisions, and do not address the individual processes in the network. In the case of waste wood, one such important process is the scheduling of the various machines in a waste wood processing facility to treat incoming wood deliveries with multiple sources and varying quality. This paper proposes a robust multi-objective mixed-integer linear programming model for the optimization of this process that considers the uncertain origins and compositions of the incoming deliveries, while aiming to minimize both lateness and energy consumption. An exhaustive study is performed on instance sets of different sizes and structures to show the efficiency and the limits of the proposed model both in single- and multi-objective cases.
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Phillips, Craig, and Jacqueline O'Flaherty. "Evaluating nursing students' engagement in an online course using flipped virtual classrooms." Student Success 10, no. 1 (March 7, 2019): 59–71. http://dx.doi.org/10.5204/ssj.v10i1.1098.
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Flipped classroom models allocate more time for active learning approaches compared with more traditional pedagogies, however what is less clear with the utilisation of flipped learning is evidence to support whether students in flipped classes are given more opportunities to develop higher order thinking skills (HOTs) to effect deep learning compared with the traditional ways of teaching. Focussing on this gap, this study compares on campus and off campus student engagement in two courses using different deliveries: online face-to-face (f2f) mixed mode (on campus students attend traditional f2f on campus classes and off campus students study exclusively online) versus fully online mode, utilising flipped classes (all student study off campus engaging in flipped virtual classes). Final course grades were similar for both deliveries; however, the study suggests flipped classes offered students more opportunities to develop HOTs and engage more deeply in the learning process. Students’ evaluations of the online flipped delivery were mixed, with those students previously enrolled exclusively as on campus, particularly dissatisfied with fully online delivery and virtual class tutor experience. Recommendations are made concerning both the timing of the introduction of fully online delivery in a program and the need for continual up-skilling of staff who teach in online environments.
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Fraselle, Justin, Sabine Louise Limbourg, and Laura Vidal. "Cost and Environmental Impacts of a Mixed Fleet of Vehicles." Sustainability 13, no. 16 (August 22, 2021): 9413. http://dx.doi.org/10.3390/su13169413.
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Urban parcel delivery is increasingly restricted by regulations limiting access to certain heavy or high emitting vehicles to reduce emissions and noise pollution in cities. Cargo bikes represent an alternative solution that enables deliveries with low environmental impact, but they may represent a higher economic cost and come with constraints like battery autonomy or small loading capacity. As a transport scheme relying on bikes for the last miles with fewer externalities, it is regarded as an environmentally friendly choice, and economic sustainability is assessed. This paper aims to present the environmental and economic aspects of different delivery means of transport in European urban areas. Life cycle assessment (LCA) methodology is selected to analyse the environmental impact of several vehicles, allowing us to quantify the emissions according to the loading factor. The electricity mix is an important parameter and makes the results vary according to the country studied. For the economic aspect, the cost price allows us to quantify the operational cost of each means of transport. A trade-off can thus be made between the two.
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Larsson, Agneta, Mats Westerberg, Lena Karlqvist, and Gunvor Gard. "Teamwork and Safety Climate in Homecare: A Mixed Method Study." International Journal of Environmental Research and Public Health 15, no. 11 (November 8, 2018): 2495. http://dx.doi.org/10.3390/ijerph15112495.
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A rapidly changing homecare service sector implies difficulties to control safety and health risks for staff and to guarantee standardised deliveries of services to recipients. This study aimed to describe staff perceptions of safety climate and practices in homecare service teams, and suggestions for improvements. A second aim was to identify if and how the appraisals of safety climate were related to individual perceptions of safety, mental strain and adverse events/injury. A convergent parallel mixed methods design was used. Nursing assistants and care aides (133 in total, representing 11 work teams) in the north of Sweden replied to a survey and participated in focus group interviews. Results were analysed with ANOVA (inter-team differences) and by qualitative content analysis. Significant diversity was identified between the teams in five of seven dimensions of safety climate. Important areas for improvement were: a need to define and agree on criteria for a safe working environment; leadership prioritising safety at work; and management able to provide trust, support and time. A prerequisite for these agreements was improved authority and communication between all parties involved. The safety climate dimensions were related to personal perceptions of safety and mental strain and, partly, to adverse events/injuries.
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Karki, Bindu Kumari, and Guenter Kittel. "Neonatal mortality and child health in a remote rural area in Nepal: a mixed methods study." BMJ Paediatrics Open 3, no. 1 (September 2019): e000519. http://dx.doi.org/10.1136/bmjpo-2019-000519.
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ObjectiveTo assess neonatal and under-five mortality and the health situation for children in Dolpa, a remote rural area of Nepal.Study designMixed methods: quantitative (retrospective cross sectional) and qualitative (semistructured interviews).RationaleProgress in reducing child and newborn mortality in Nepal has reached the remote areas to a limited extent. Furthermore, there may be substantial under-reporting and data may be unreliable.Setting and participantsThe population of Dolpa district is approximately 35 000. We visited 10 randomly selected villages (plus one settlement) with approximately 12 000 inhabitants.MethodologyRecords of the number of deliveries, neonatal and under-five deaths were collected. 100 children (10 different villages) were evaluated for common diseases present during the month prior to the investigation. 20 interviews were conducted about the cultural perceptions of neonatal death and morbidity; in each village at least one interview was undertaken.ResultsThe population of the 10 villages (plus one settlement) under investigation was 12 287. 300 deliveries have taken place during the last 12 months before the study. There were 30 children reported to have died; out of those 20 were in the neonatal period. This reflects an estimated neonatal mortality rate in Dolpa district of 67/1000 live births (95% CI 41-101/1000) and an estimated under-five mortality rate of 100/1000 (95% CI 70-140/1000). In the previous month, out of 100 children surveyed there had been 11 cases of acute lower respiratory infection (ALRI), 7 cases of diarrhoea, 3 cases of isolated malnutrition and 5 cases of malnutrition combined with ALRI or diarrhoea.Based on qualitative interviews traditional beliefs still play a major role, and are partly a hindrance to progress in health. There is also mistrust in the health services and misconceptions about ‘modern’ medicine and treatment facilities.ConclusionDespite progress in child morbidity and mortality in Nepal, some areas remain underserved by health services and neonatal mortality is far above the Nepalese average, which is 29/1000 live births. There is a substantial need to increase and train health staff. Health promotion should be encouraged but cultural perceptions have to be understood if positive behavioural change is to be achieved.
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Lu, Ming, Fei Dai, and Wu Chen. "Real-time decision support for planning concrete plant operations enabled by integrating vehicle tracking technology, simulation, and optimization algorithms." Canadian Journal of Civil Engineering 34, no. 8 (August 1, 2007): 912–22. http://dx.doi.org/10.1139/l07-029.
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By integrating the vehicle tracking system, discrete-event simulation algorithm, and evolutionary optimization algorithm, we developed HKCONSIM-Realtime, a decision-support platform created specifically for handling ready-mixed concrete operations. This platform is capable of (1) tracking the positions of concrete trucks and monitoring the motion and status of concrete deliveries in real time, (2) transforming the tracking records into data that provide updated input to simulation, and (3) optimizing the operations and logistics of concrete production based on simulation of the production system using the most current data. This paper presents an overview of the design and development of (1) the hardware and software modules, (2) the data flow and processing throughout the system, and (3) the role of the system in providing interactive, effective support for the human operator to attain cost efficiency. Case studies are given to demonstrate the functionality and application of the prototype system. Key words: simulation, optimization, vehicle tracking, construction planning, ready-mixed concrete, Hong Kong.
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Biruk, Sławomir. "Dispatching concrete trucks using simulation method." Budownictwo i Architektura 14, no. 2 (June 9, 2015): 005–10. http://dx.doi.org/10.35784/bud-arch.1638.
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Ready mixed concrete (RMC) is the primary material required for buildings and public infrastructure work. RMC is produced to meet customer’s demands and its deliveries must conform to construction site and technological operating constraints – the material cannot be prepared in advance and stored. Concrete production scheduling and truck dispatching is mainly handled manually by experienced RMC batching plants staff. The paper presents simulation model which can be used to asses alternative strategies for truck allocation and production planning in stochastic environment. The models’ operation is illustrated by a notional case – the model prompted solutions of improved transhipment efficiency and reduced plant operating cost under assumed operating constraints.
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Keller, J., M. Runzi, H. Goebell, and P. Layer. "Duodenal and ileal nutrient deliveries regulate human intestinal motor and pancreatic responses to a meal." American Journal of Physiology-Gastrointestinal and Liver Physiology 272, no. 3 (March 1, 1997): G632—G637. http://dx.doi.org/10.1152/ajpgi.1997.272.3.g632.
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It is assumed that in humans pancreatic and gastrointestinal motor responses to a meal are coordinated and regulated mainly by duodenal nutrient exposure. On the other hand, there is evidence that the distal intestine may participate in the regulation of gastrointestinal functions. The aim of this study was to compare human pancreatic and intestinal motility responses to a meal and to correlate them with nutrient exposure of the proximal and distal intestine. After intubation with an oroileal multilumen tube for marker perfusion, duodenal and ileal aspiration, and intestinal manometry, 14 healthy subjects received a mixed test meal (1,257 kJ). Intraluminal nutrient concentrations, enzyme activities, and small intestinal motility were analyzed for 6 h postprandially. Duration of duodenal nutrient exposure was 3.4 +/- 0.2 h, and duration of pancreatic enzyme response and fed motor pattern was 2.5 +/- 0.2 and 3.5 +/- 0.3 h, respectively. Durations of pancreatic secretory and motor responses were correlated (P < 0.05), but neither duration of digestive secretory nor of motor activity correlated with that of prandial duodenal nutrient concentrations. By contrast, they were associated with the relative increase in ileal nutrient delivery late postprandially (P < 0.05). Physiological late postprandial delivery of nutrients to distal intestinal sites is correlated with the termination of digestive pancreatic and motor responses and may participate in their control.
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Bonnin, Martine, Frédéric J. Mercier, Olivier Sitbon, Sandrine Roger-Christoph, Xavier Jaïs, Marc Humbert, François Audibert, René Frydman, Gérald Simonneau, and Dan Benhamou. "Severe Pulmonary Hypertension during Pregnancy." Anesthesiology 102, no. 6 (June 1, 2005): 1133–37. http://dx.doi.org/10.1097/00000542-200506000-00012.
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Background Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only. Methods The authors reviewed the charts of all pregnant women with severe PH who were followed up at their institution during the past 10 yr, to assess the multidisciplinary treatment and outcome of these patients. Results Fifteen pregnancies in 14 women with severe PH were managed during this period: There were 4 cases of idiopathic pulmonary arterial hypertension (PAH), 6 cases of congenital heart disease-associated PAH, 1 case of fenfluramine-associated PAH, 1 case of mixed connective tissue-associated PAH, 1 case of human immunodeficiency virus-associated PAH, and 2 cases of chronic thromboembolic PH. PH presented during pregnancy in 3 patients. Two patients died before delivery at 12 and 23 weeks' gestation. Four patients had vaginal deliveries with regional anesthesia: One died 3 months postpartum, one worsened, and two remained stable. Four had cesarean deliveries during general anesthesia: One died 3 weeks postpartum, one worsened, and two remained stable. Five had cesarean deliveries during low-dose combined spinal-epidural anesthesia: One died 1 week postpartum, and four remained stable. There were two fetal deaths: one related to therapeutic abortion at 21 weeks' gestation and one stillbirth at 36 weeks' gestation followed by the death of the mother 1 week later. Conclusions Despite the most modern treatment efforts, the maternal mortality was 36%. Scheduled cesarean delivery during combined spinal-epidural anesthesia seemed to be an attractive approach, but there was no evidence of actual benefit. Therefore, pregnancy must still be discouraged in patients with severe PH.
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Heinecke, G., S. Lamparter, R. Lepratti, and A. Kunz. "Advanced Supply Chain Information for Rule-Based Sequence Adaptions on a Mixed-Model Assembly Line with Unreliable Just-In-Sequence Deliveries." IFAC Proceedings Volumes 46, no. 9 (2013): 1902–7. http://dx.doi.org/10.3182/20130619-3-ru-3018.00095.
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Battle, Julia D., Leonie Farrow, Jalia Tibaijuka, and Marc Mitchell. "mHealth for Safer Deliveries: A mixed methods evaluation of the effect of an integrated mobile health intervention on maternal care utilization." Healthcare 3, no. 4 (December 2015): 180–84. http://dx.doi.org/10.1016/j.hjdsi.2015.10.011.
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Chan, Emily W., Stephen R. Gannon, Chevis N. Shannon, Jeffrey E. Martus, Gregory A. Mencio, and Christopher M. Bonfield. "The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis." Neurosurgical Focus 43, no. 4 (October 2017): E4. http://dx.doi.org/10.3171/2017.7.focus17321.
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OBJECTIVEAdolescent idiopathic scoliosis (AIS), the most common type of scoliosis, often presents immediately prior to a woman’s childbearing years; however, research investigating the impact of AIS on women’s health, particularly pregnancy delivery outcomes, is sparse, with existing literature reporting mixed findings. Similarly limited are studies examining the change in scoliotic curve during or after pregnancy. Therefore, this study aims to determine 1) the impact of scoliotic curvature on obstetric complications (preterm births, induction of labor, and urgent/emergency caesarean section delivery), 2) regional anesthetic decision making and success during delivery for these patients, and 3) the effect of pregnancy on curve progression.METHODSRecords of all pregnant patients diagnosed with AIS at the authors’ institution who delivered between January 2002 and September 2016 were retrospectively reviewed. Demographic information, pre- and postpartum radiographic Cobb angles, and clinical data for each pregnancy and delivery were recorded and analyzed. The Wilcoxon rank-sum test and the Wilcoxon signed-rank test were used for statistical analyses.RESULTSFifty-nine patients (84 deliveries) were included; 14 patients had undergone prior posterior spinal fusion. The median age at AIS diagnosis was 15.2 years, and the median age at delivery was 21.8 years. Overall, the median major Cobb angle prior to the first pregnancy was 25° (IQR 15°–40°). Most births were by spontaneous vaginal delivery (n = 45; 54%); elective caesarean section was performed in 17 deliveries (20%). Obstetric complications included preterm birth (n = 18; 21.4%), induction of labor (n = 20; 23.8%), and urgent/emergency caesarean section (n = 12; 14.0%); none were associated with severity of scoliosis curve or prior spinal fusion. Attempts at spinal anesthesia were successful 99% of the time (70/71 deliveries), even among the patients who had undergone prior spinal fusion (n = 13). There were only 3 instances of provider refusal to administer spinal anesthesia. In the subset of 11 patients who underwent postpartum scoliosis radiography, there was no statistically significant change in curve magnitude either during or immediately after pregnancy.CONCLUSIONSThe results of this study suggest that there was no effect of the severity of scoliosis on delivery complications or regional anesthetic decision making in pregnant patients with AIS. Moreover, scoliosis was not observed to progress significantly during or immediately after pregnancy. Larger prospective studies are needed to further investigate these outcomes, the findings of which can guide the prenatal education and counseling of pregnant patients with AIS.
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Njoku, Charles O., Amarachukwu N. Njoku, Cajethan I. Emechebe, Andrew E. Okpe, and Christopher I. Iklaki. "Pattern and risk factors of non-fistulous urinary incontinence among gynaecological clinic attendees in a Nigeria tertiary health institution." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 6 (May 27, 2020): 2323. http://dx.doi.org/10.18203/2320-1770.ijrcog20202305.
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Background: Urinary incontinence is the involuntary loss of urine. It is rarely disclosed by the patients and usually under-reported. Objective of this study was to determine the prevalence, pattern and risk factors of non-fistulous urinary incontinence among women attending gynaecological clinics in Calabar, Nigeria.Methods: This was a cross-sectional study of 658 women attending gynecological clinic from June 2018 to June 2019. English version of International consultation on incontinence questionnaire-urinary incontinence-short form (ICIQ-UI-SF) was used to obtain data. Statistical analysis was done using SPSS version 22.Results: The prevalence of urinary incontinence was 16.1%. Stress incontinence was the commonest of urinary incontinence (73.3%), other types were urge incontinence (17.2%) and mixed incontinence (9.5%). Independent risk factors for urinary incontinence were 40 years and above (AOR = 5.610; p<0.001), parity ≥3 (AOR = 4.454; p<0.001), lower educational level (primary) (AOR = 2.588; p<0.001), vaginal/instrumental deliveries (AOR = 4.358; p<0.001), carrying heavy load (AOR = 3.688; p<0.001) and farming (AOR = 3.510; p<0.001).Conclusions: Non-fistulous urinary incontinence is common among women in our environment. Stress urinary incontinence was the most common type. Advanced age, higher parity, vaginal and instrumental deliveries and farming were independent risk factors for urinary incontinence.
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Mathur, Raj Kumar, Kunal Vikram Singh, and Poonam Mathur. "Etiological correlation of common urinary problems in females in a tertiary care centre in central India." International Surgery Journal 4, no. 7 (June 22, 2017): 2251. http://dx.doi.org/10.18203/2349-2902.isj20172776.
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Background: Urinary problems are common in female population of India which adversely affect their quality of life. Urinary problems add to chronic suffering of Indian females. The objective of this study was to find etiological correlation of common urinary problems in Indian females.Methods: This is an epidemiological study which includes all adult female patients coming to surgery and gynecology OPDs of M.Y. Hospital, Indore, Madhya Pradesh, India.Results: 58.4% of patients of middle age (31-55) years. Burning micturition was most common urinary complaint (86.2%) followed by lower abdominal pain (51.6%). About 66.8% of females took months or even years to take first consultation after appearance of their symptoms. 63.2% females were suffering from urinary tract infection which was confirmed by urinary culture reports. E. Coli was the most common organism causing urinary tract infection. UTI was closely correlated with urinary tract calculi & low use of sanitary napkins. Only 14.6% females suffered from urinary incontinence (stress, urge, mixed). Incontinence was closely correlated with multiple deliveries. In our study about 88% of women had education level below fifth standard.Conclusions: Urinary problems are common in women of low socioeconomic society with lower education, poor urogenital hygiene and multiple births especially unassisted vaginal deliveries.
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Peeler, Mary, Munish Gupta, Patrice Melvin, Allison S. Bryant, Hafsatou Diop, Ronald Iverson, Katherine Callaghan, et al. "Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother–Infant Dyads in Massachusetts (2017–2019)." American Journal of Public Health 110, no. 12 (December 2020): 1828–36. http://dx.doi.org/10.2105/ajph.2020.305888.
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Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity. Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge. Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes. Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother–infant dyads.
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Dean, C., R. J. Williams, and I. F. Brockington. "Is puerperal psychosis the same as bipolar manic-depressive disorder? A family study." Psychological Medicine 19, no. 3 (August 1989): 637–47. http://dx.doi.org/10.1017/s0033291700024235.
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SynopsisThe first degree relatives of three groups of women were interviewed; 51 women who had had an illness within two weeks of childbirth and no non-puerperal episodes (the puerperal group), 33 who had puerperal and non-puerperal episodes (the mixed group), and 19 women with bipolar manic-depressive disorder who had non-puerperal episodes only (the manic-depressive group).Over 60% of the affected relatives in all three groups had affective illnesses; in the main these were not puerperal. There were significantly more first degree relatives who had had general practitioner or hospital treatment for psychiatric illness in the puerperal group and in the mixed group than in the manic-depressive group. The puerperal patients had a better prognosis in terms of their illness (number of relapses and time on medication), work functioning and social functioning than the manic-depressive group and the mixed group. The mixed group had an earlier age of onset than the manic-depressive group and the puerperal group. The hypothesis that puerperal psychosis is the same as bipolar manic-depressive disorder was not upheld. The mixed group and the puerperal group were similar with respect to the risk in first degree relatives but differed in terms of prognosis.There were no significant differences between the groups with respect to puerperal episodes in first-degree relatives, although the rate of puerperal psychosis in the first-degree relatives of the puerperal patients was significantly greater than in the general population. The hypothesis that there is a specific genetically determined puerperal psychosis was not supported. Women who had had an illness with an onset within two weeks of childbirth (mixed and puerperal) subsequently had an illness following 36% of their childbirths. In women who had had puerperal and non-puerperal episodes (mixed) the risk was higher; over 50 % of deliveries in these women were followed by psychiatric illness.
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Orangi, Stacey, Angela Kairu, Lucas Malla, Joanne Ondera, Boniface Mbuthia, Nirmala Ravishankar, and Edwine Barasa. "Impact of free maternity policies in Kenya: an interrupted time-series analysis." BMJ Global Health 6, no. 6 (June 2021): e003649. http://dx.doi.org/10.1136/bmjgh-2020-003649.
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BackgroundUser fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama programme to expand access to private sector, expand the benefit package and change its management.MethodsAn interrupted time-series analysis on facility deliveries, antenatal care (ANC) and postnatal care (PNC) visits data between 2012 and 2019 was used to determine the effect of the two free maternity policies. These data were from 5419 public and 305 private and faith-based facilities across all counties, with data sourced from the health information system. A segmented negative binomial regression with seasonality accounted for, was used to determine the level (immediate) effect and trend (month-on-month) effect of the policies.ResultsThe 2013 free-maternity policy led to a 19.6% and 28.9% level increase in normal deliveries and caesarean sections, respectively, in public facilities. There was also a 1.4% trend decrease in caesarean sections in public facilities. A level decrease followed by a trend increase in PNC visits was reported in public facilities. For private and faith-based facilities, there was a level decrease in caesarean sections and ANC visits followed by a trend increase in caeserean sections following the 2013 policy.Furthermore, the 2017 Linda Mama programme showed a level decrease then a trend increase in PNC visits and a 1.1% trend decrease in caesarean sections in public facilities. In private and faith-based facilities, there was a reported level decrease in normal deliveries and caesarean sections and a trend increase in caesarean sections.ConclusionThe free maternity policies show mixed effects in increasing access to maternal health services. Emphasis on other accessibility barriers and service delivery challenges alongside user fee removal policies should be addressed to realise maximum benefits in maternal health utilisation.
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Ceschia, Sara, Luca Di Gaspero, and Antonella Meneghetti. "Extending and Solving the Refrigerated Routing Problem." Energies 13, no. 23 (November 26, 2020): 6214. http://dx.doi.org/10.3390/en13236214.
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In recent years, cold food chains have shown an impressive growth, mainly due to customers life style changes. Consequently, the transportation of refrigerated food is becoming a crucial aspect of the chain, aiming at ensuring efficiency and sustainability of the process while keeping a high level of product quality. The recently defined Refrigerated Routing Problem (RRP) consists of finding the optimal delivery tour that minimises the fuel consumption for both the traction and the refrigeration components. The total fuel consumption is related, in a complex way, to the distance travelled, the vehicle load and speed, and the outdoor temperature. All these factors depend, in turn, on the traffic and the climate conditions of the region where deliveries take place and they change during the day and the year. The original RRP has been extended to take into account also the total driving cost and to add the possibility to slow down the deliveries by allowing arbitrarily long waiting times when this is beneficial for the objective function. The new RRP is formulated and solved as both a Mixed Integer Programming and a novel Constraint Programming model. Moreover, a Local Search metaheuristic technique (namely Late Acceptance Hill Climbing), based on a combination of different neighborhood structures, is also proposed. The results obtained by the different solution methods on a set of benchmarks scenarios are compared and discussed.
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Yilmaz Eroglu, Duygu, Burcu Caglar Gencosman, Fatih Cavdur, and H. Cenk Ozmutlu. "Introducing the MCHF/OVRP/SDMP: Multicapacitated/Heterogeneous Fleet/Open Vehicle Routing Problems with Split Deliveries and Multiproducts." Scientific World Journal 2014 (2014): 1–14. http://dx.doi.org/10.1155/2014/515402.
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In this paper, we analyze a real-world OVRP problem for a production company. Considering real-world constrains, we classify our problem as multicapacitated/heterogeneous fleet/open vehicle routing problem with split deliveries and multiproduct (MCHF/OVRP/SDMP) which is a novel classification of an OVRP. We have developed a mixed integer programming (MIP) model for the problem and generated test problems in different size (10–90 customers) considering real-world parameters. Although MIP is able to find optimal solutions of small size (10 customers) problems, when the number of customers increases, the problem gets harder to solve, and thus MIP could not find optimal solutions for problems that contain more than 10 customers. Moreover, MIP fails to find any feasible solution of large-scale problems (50–90 customers) within time limits (7200 seconds). Therefore, we have developed a genetic algorithm (GA) based solution approach for large-scale problems. The experimental results show that the GA based approach reaches successful solutions with 9.66% gap in 392.8 s on average instead of 7200 s for the problems that contain 10–50 customers. For large-scale problems (50–90 customers), GA reaches feasible solutions of problems within time limits. In conclusion, for the real-world applications, GA is preferable rather than MIP to reach feasible solutions in short time periods.
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Fracasso, Hélio Augusto Alves, Joaquim Olinto Branco, and Edison Barbieri. "A comparison of foraging between the South American and Cabot's Tern in southern Brazil." Biota Neotropica 11, no. 3 (September 2011): 189–96. http://dx.doi.org/10.1590/s1676-06032011000300016.
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Despite being widely distributed in South America and having relatively large populations, little is known about the trophic ecology of the South American Tern (Sterna hirundinacea) and Cabot's Tern (Thalasseus acuflavidus). In Brazil, South American and Terns Cabot's breed in mixed colonies from the state of Espírito Santo to Santa Catarina. Here, we describe results of a study of the feeding ecology of these two species during the reproductive seasons of April to October of 2003, 2005 and 2006 from Cardos Island, Santa Catarina, Brazil. A total of 6248, 5140, and 4006 fishes were delivered to chicks or females by South American Terns; and 1157, 628 and 98 fish and or other prey items by Cabot's Terns during the breeding seasons of 2003, 2005, and 2006, respectively. Prey items identified included eight, seven and nine fish families for South American Terns; and, five, three and two families for Cabot's terns, in the three respective years. The number of food deliveries per chick for South American Terns was between 09:00 and 10:00 am in 2006, and between 11:00 and 12:00 am in 2005. Cabot's Terns chicks were fed in the early hours of the morning until late afternoon.
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Waniala, Isaac, Sandra Nakiseka, Winnie Nambi, Isaac Naminya, Margret Osuban Ajeni, Jacob Iramiot, Rebecca Nekaka, and Julius Nteziyaremye. "Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study." Obstetrics and Gynecology International 2020 (July 20, 2020): 1–11. http://dx.doi.org/10.1155/2020/5036260.
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Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
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Konlan, Kennedy Diema, Milipaak Japiong, Amos Nawunimali Suuk, Abdul-Razak Doat, Agani Afaya, and Solomon Mohammed Salia. "Community factors accountable for home births in a low income rural setting in Ghana." International Journal Of Community Medicine And Public Health 4, no. 6 (May 22, 2017): 1834. http://dx.doi.org/10.18203/2394-6040.ijcmph20172141.
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Background: Many maternal deaths occur as a result of delivery that takes place in the home or late referral of women in labour to the health facility. This situation is further worsened in remote poor communities of the northern region of Ghana; where health care services are inequitably distributed. This study determined the factors in low income rural communities that are responsible for the high numbers of homebirths using the Bunkpurugu Yunyoo district as a case study. Methods: The study employed mixed method study that used both qualitative and quantitative methods. Three hundred women who delivered within the last one year were made to respond to a research questionnaire while four health care workers (three midwives and a general registered nurse) were engaged in an in-depth interview. Results: The study identified poor road network, inequitable distribution of health facilities, inadequate family support during labour, cultural factors like taboos and the stigma associated with FGM to be responsible for the high numbers of home deliveries. Even though women intended to give birth in the health facility during pregnancy, they are unable to do so as labour occurs when they were not expecting it. Conclusions: The study recommended the use of equipment like the ultrasound during the first trimester of pregnancy to measure accurately the expected date of delivery of each pregnant woman so as to enable them plan for birth.
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Wuryaningrum, Pratiwi, Tri Achmadi, Achmad Mustakim, Hasan Iqbal Nur, Siti Dwi Lazuardi, and Marita Kusumadewi. "Optimization of Product Oil Shipment System for Archipelegic Region." Rekayasa 12, no. 2 (October 31, 2019): 120–25. http://dx.doi.org/10.21107/rekayasa.v12i2.5929.
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Demand of products oil continues to increase by increasing the mobilization in various areas in Indonesia. The government should rethink considering the uneven spread of demand and supply of products oil that can not be mixed in the cargo hold. Currently product oil deliveries to Nusa Tenggara Barat carried by tanker vessels. The issue is whether the vessel’s size not yet optimum. The purpose of this study is to optimize the distribution of product oil from Transit Terminal Product Oil to Unloading Ports. The most influenced variable are the size of the main vessel and the effect on the primary measure is the amount of goods transported. The main dimensions of tanker are LPP= 105 m; B= 18,01 m; H= 8.23 m T= 6.78 m ;DWT= 7,992 DWT ;Payload = 8,933 KL and Tankers’s unit cost is Rp. 203,587.70 per Kiloliter
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Grossman, Leah, Gali Pariente, Yael Baumfeld, David Yohay, Reut Rotem, and Adi Y. Weintraub. "Trends of changes in the specific contribution of selected risk factors for shoulder dystocia over a period of more than two decades." Journal of Perinatal Medicine 48, no. 6 (July 28, 2020): 567–73. http://dx.doi.org/10.1515/jpm-2019-0463.
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AbstractObjectivesShoulder dystocia (SD) is an obstetrical emergency with well-recognized risk factors. We aimed to identify trends of changes in the specific contribution of risk factors for SD over time.MethodsA nested case control study comparing all singleton deliveries with and without SD was undertaken. A multivariable logistic regression model was used in order to identify independent risk factors for SD and a comparison of the prevalence and the specific contribution (odds ratio (OR)) of the chosen risk factors in three consecutive eight-year intervals from 1988 to 2014 was performed.ResultsDuring the study period, there were 295,946 deliveries. Of them 514 (0.174%) were complicated with SD. Between 1988 and 2014 the incidence of SD has decreased from 0.3% in 1988 to 0.1% in 2014. Using a logistic regression model grandmultiparity, diabetes mellitus (DM), fetal weight, and large for gestational age (LGA) were found to be independent risk factors for SD (OR 1.25 95% CI 1.04–1.51, p=0.02; OR 1.53 95% CI 1.19–1.97, p=0.001; OR 1.002 95% CI 1.001–1.002, p < 0.001; OR 3.88 95% CI 3.09–4.87, p < 0.001; respectively). While the OR for grandmultiparity, fetal weight, and LGA has significantly changed during the study period with a mixed trend, the OR of DM has demonstrated a significant linear increase over time.ConclusionsThe individual contribution of selected risk factors for the occurrence of SD has significantly changed throughout the years. The contribution of DM has demonstrated a linear increase over time, emphasizing the great impact of DM on SD.
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Roberti, Roberto, and Mario Ruthmair. "Exact Methods for the Traveling Salesman Problem with Drone." Transportation Science 55, no. 2 (March 2021): 315–35. http://dx.doi.org/10.1287/trsc.2020.1017.
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Efficiently handling last-mile deliveries becomes more and more important nowadays. Using drones to support classical vehicles allows improving delivery schedules as long as efficient solution methods to plan last-mile deliveries with drones are available. We study exact solution approaches for some variants of the traveling salesman problem with drone (TSP-D) in which a truck and a drone are teamed up to serve a set of customers. This combination of truck and drone can exploit the benefits of both vehicle types: the truck has a large capacity but usually low travel speed in urban areas; the drone is faster and not restricted to street networks, but its range and carrying capacity are limited. We propose a compact mixed-integer linear program (MILP) for several TSP-D variants that is based on timely synchronizing truck and drone flows; such an MILP is easy to implement but nevertheless leads to competitive results compared with the state-of-the-art MILPs. Furthermore, we introduce dynamic programming recursions to model several TSP-D variants. We show how these dynamic programming recursions can be exploited in an exact branch-and-price approach based on a set partitioning formulation using ng-route relaxation and a three-level hierarchical branching. The proposed branch-and-price can solve instances with up to 39 customers to optimality outperforming the state-of-the-art by more than doubling the manageable instance size. Finally, we analyze different scenarios and show that even a single drone can significantly reduce a route’s completion time when the drone is sufficiently fast.
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Marchenko, S. S., L. E. Mamedova, and M. E. Gogolyukhina. "Economic Aspects of Modernization of Vessels Operating on the Northern Sea Route." Economics and Management 27, no. 6 (July 23, 2021): 471–78. http://dx.doi.org/10.35854/1998-1627-2021-6-471-478.
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Aim. The presented study aims to develop methodological tools for assessing the economic aspects of the modernization of vessels operating on the Northern Sea Route.Tasks. The authors address the problem of economic justification for the modernization and improvement of efficiency of mixed river-sea cargo transport vessels operating on the Northern Sea Route; develop an algorithm and methodology for assessing the economic aspects of the modernization of vessels operating on the Northern Sea Route; determine the economic effect of upgrading the register class of modernized river vessels. Methods. This study proposes an algorithm for the economic assessment of the modernization of river and sea vessels, which includes the constructed mathematical models for upgrading the class of the vessel and forecasting net income.Results. The authors assess the economic viability of upgrading the register class of modernized vessels of the Omskiy and Sibirskiy type, which could become more competitive in the future and continue to operate on the Northern Sea Route with high economic efficiency, ensuring the supply of goods to northern Russian territories; form the financial profile of investment projects for the modernization of the considered types of vessels.Conclusions. Modernizing and upgrading the register class of river vessels and mixed river-sea vessels is a promising direction for adding modern cargo ships to the Russian fleet operating on the Northern Sea Route, particularly in the context of deliveries of goods to northern Russian territories. The performed economic assessment of the modernization of a Sibirskiy-type vessel according to the developed algorithm confirms the economic viability of modernizing mixed river-sea vessels.
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Sharma, Shiv K., Elaine J. Sidawi, Susan M. Ramin, Michael J. Lucas, Kenneth J. Leveno, and Gary F. Cunningham. "Cesarean Delivery." Anesthesiology 87, no. 3 (September 1, 1997): 487–94. http://dx.doi.org/10.1097/00000542-199709000-00006.
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Background Reports indicate that the administration of epidural analgesia for pain relief during labor interferes with labor and increases cesarean deliveries. However, only a few controlled trials have assessed the effect of epidural analgesia on the incidence of cesarean delivery. The authors' primary purpose in this randomized study was to evaluate the effects of epidural analgesia on the rate of cesarean deliveries by providing a suitable alternative: patient-controlled intravenous analgesia. Methods Seven hundred fifteen women of mixed parity in spontaneous labor at full term were randomly assigned to receive either epidural analgesia or patient-controlled intravenous meperidine analgesia. Epidural analgesia was maintained with a continuous epidural infusion of 0.125% bupivacaine with 2 microg/ml fentanyl. Patient-controlled analgesia was maintained with 10-15 mg meperidine given every 10 min as needed using a patient-controlled pump. Procedures recorded in a manual that prescribed the intrapartum management were followed for each woman randomized in the study. Results A total of 358 women were randomized to receive epidural analgesia, and 243 (68%) of these women complied with the epidural analgesia protocol. Similarly, 357 women were randomized to receive patient-controlled intravenous meperidine analgesia, and 259 (73%) of these women complied with the patient-controlled intravenous analgesia protocol. Only five women who were randomized and received patient-controlled intravenous meperidine analgesia according to the protocol crossed over to epidural analgesia due to inadequate pain relief. There was no difference in the rate of cesarean deliveries between the two analgesia groups using intention-to-treat analysis based on the original randomization (epidural analgesia, 4% [95% CI: 1.9-6.2%] compared with patient-controlled intravenous analgesia, 5% [95% CI: 2.6-7.2%]). Similar results were observed for the analysis of the protocol-compliant groups (epidural analgesia, 5% [95% CI: 2.6-8.5%] compared with patient-controlled intravenous analgesia, 6% [95% CI: 3-8.9%]). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received patient-controlled intravenous analgesia. Conclusions Epidural analgesia was not associated with increased numbers of cesarean delivery when compared with a suitable alternative method of analgesia.
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McLaughlin, DWJ, RE Bell, DJ Graham, and R. McKeivor. "Quantification of Selected Vapour-Phase Compounds using Thermal Desorption-Gas Chromatography." Beiträge zur Tabakforschung International/Contributions to Tobacco Research 21, no. 4 (December 1, 2004): 211–15. http://dx.doi.org/10.2478/cttr-2013-0782.
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AbstractA robust method for the analysis of selected vapour phase (VP) compounds in mainstream smoke (MSS) is described. Cigarettes are smoked on a rotary smoking machine and the VP that passes through the Cambridge filter pad collected in a TedlarA¯ bag. On completion of smoking, the bag contents are sampled onto an adsorption tube containing a mixed carbon bed. The tube is subsequently analysed on an automated thermal desorption (TD) system coupled to a gas chromatography-flame ionization detector (GC-FID) using a PoraPLOT-Q column. Quantification of 14 volatile compounds including the major carbonyls is achieved. Details of the method validation data are included in this paper. This method has been used to analyse the VP of cigarette MSS over a wide range of ‘tar’ deliveries and configurations with excellent repeatability. Results for the University of Kentucky reference cigarette 1R4F are in good agreement with reported values.
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MAHDIRAJI, Hannan AMOOZAD, Moein BEHESHTI, Seyed Hossein RAZAVI HAJIAGHA, and Edmundas Kazimieras ZAVADSKAS. "A FUZZY BINARY BI OBJECTIVE TRANSPORTATION MODEL: IRANIAN STEEL SUPPLY NETWORK." Transport 33, no. 3 (October 2, 2018): 810–20. http://dx.doi.org/10.3846/transport.2018.5800.
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Prominent influence of transportation costs on supply chain overall profit indicates the importance and emer-gence of transportation optimization models. Regarding this issue and in view of realistic situation consisting of non-de-terministic information, in this research optimizing inbound and outbound transportation costs of a multi echelon supply chain has been considered. To deal with uncertain time deliveries and pricing strategies adopted by different members of supply chain, in conjunction with unpredictable demand rate, fuzzy logic and specifically Trapezoidal Fuzzy Numbers (TrFNs) are included. After designing a fuzzy binary multi objective model based upon structural assumptions, the solving approach is proposed and the model is employed on Iranian steel supply network to illustrate the potential and advantages of our scheduled model. The bi-objective mixed integer fuzzy programming model presents and encompasses many realis-tic circumstances making the model applicable in network transportation cases.
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Hammond, Jonathan, Thomas Mason, Matt Sutton, Alex Hall, Nicholas Mays, Anna Coleman, Pauline Allen, Lynsey Warwick-Giles, and Kath Checkland. "Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening." BMJ Open 9, no. 4 (April 2019): e024156. http://dx.doi.org/10.1136/bmjopen-2018-024156.
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ObjectivesExplore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms.MethodsQualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (among women, 25–64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome—unassisted birth rates—largely unaffected by HSCA changes.ResultsInterviewees identified that cervical screening commissioning and provision was more complex and ‘fragmented’, with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4%) than those dealing with one local authority (1.0%). Over the same period, unassisted deliveries decreased by 1.6% and 2.0%, respectively, in the two groups.ConclusionsArrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively strengthens this finding. The study suggests large-scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.
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Li, Jinghua, Hui Guo, Qinghua Zhou, and Boxin Yang. "Vehicle Routing and Scheduling Optimization of Ship Steel Distribution Center under Green Shipbuilding Mode." Sustainability 11, no. 15 (August 6, 2019): 4248. http://dx.doi.org/10.3390/su11154248.
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Timeliness of steel distribution centers can effectively ensure the smooth progress of ship construction, but the carbon emissions of vehicles in the distribution process are also a major source of pollution. Therefore, when considering the common cost of vehicle distribution, taking the carbon emissions of vehicles into account, this paper establishes a Mixed Integer Linear Programming (MILP) model called green vehicle routing and scheduling problem with simultaneous pickups and deliveries and time windows (GVRSP-SPDTW). An intelligent water drop algorithm is designed and improved, and compared with the genetic algorithm and traditional intelligent water drop algorithm. The applicability of the improved intelligent water drop algorithm is proven. Finally, it is applied to a specific example to prove that the improved intelligent water drop algorithm can effectively reduce the cost of such problems, thereby reducing the carbon emissions of vehicles in the distribution process, achieving the goals of reducing environmental pollution and green shipbuilding.
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Borges, João Bosco Ramos, Telma Guarisi, Ana Carolina Marchesini de Camargo, Thomaz Rafael Gollop, Rogério Bonassi Machado, and Pítia Cárita de Godoy Borges. "Urinary incontinence after vaginal delivery or cesarean section." Einstein (São Paulo) 8, no. 2 (June 2010): 192–96. http://dx.doi.org/10.1590/s1679-45082010ao1543.
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ABSTRACT Objective: To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. Methods: A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). Results: Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. Conclusions: One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.
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Hung, Yuen W., Michael R. Law, Lucy Cheng, Sharon Abramowitz, Lys Alcayna-Stevens, Grégoire Lurton, Serge Manitu Mayaka, et al. "Impact of a free care policy on the utilisation of health services during an Ebola outbreak in the Democratic Republic of Congo: an interrupted time-series analysis." BMJ Global Health 5, no. 7 (July 2020): e002119. http://dx.doi.org/10.1136/bmjgh-2019-002119.
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BackgroundDuring past outbreaks of Ebola virus disease (EVD) and other infectious diseases, health service utilisation declined among the general public, delaying health seeking behaviour and affecting population health. From May to July 2018, the Democratic Republic of Congo experienced an outbreak of EVD in Equateur province. The Ministry of Public Health introduced a free care policy (FCP) in both affected and neighbouring health zones. We evaluated the impact of this policy on health service utilisation.MethodsUsing monthly data from the national Health Management Information System from January 2017 to January 2019, we examined rates of the use of nine health services at primary health facilities: total visits; first and fourth antenatal care visits; institutional deliveries; postnatal care visits; diphtheria, pertussis and tetanus (DTP) vaccinations and visits for uncomplicated malaria, pneumonia and diarrhoea. We used controlled interrupted time series analysis with a mixed effects model to estimate changes in the rates of services use during the policy (June–September 2018) and afterwards.FindingsOverall, use of most services increased compared to control health zones, including EVD affected areas. Total visits and visits for pneumonia and diarrhoea initially increased more than two-fold relative to the control areas (p<0.001), while institutional deliveries and first antenatal care increased between 20% and 50% (p<0.01). Visits for DTP, fourth antenatal care visits and postnatal care visits were not significantly affected. During the FCP period, visit rates followed a downward trend. Most increases did not persist after the policy ended.InterpretationThe FCP was effective at rapidly increasing the use of some health services both EVD affected and not affected health zones, but this effect was not sustained post FCP. Such policies may mitigate the adverse impact of infectious disease outbreaks on population health.
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Gautham, Meenakshi, Katia Bruxvoort, Richard Iles, Manish Subharwal, Sanjay Gupta, Manish Jain, and Catherine Goodman. "Investigating the nature of competition facing private healthcare facilities: the case of maternity care in Uttar Pradesh, India." Health Policy and Planning 34, no. 6 (July 1, 2019): 450–60. http://dx.doi.org/10.1093/heapol/czz056.
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Abstract The private healthcare sector in low- and middle-income countries is increasingly seen as of public health importance, with widespread interest in improving private provider engagement. However, there is relatively little literature providing an in-depth understanding of the operation of private providers. We conducted a mixed methods analysis of the nature of competition faced by private delivery providers in Uttar Pradesh, India, where maternal mortality remains very high. We mapped health facilities in five contrasting districts, surveyed private facilities providing deliveries and conducted in-depth interviews with facility staff, allied providers (e.g. ambulance drivers, pathology laboratories) and other key informants. Over 3800 private facilities were mapped, of which 8% reported providing deliveries, mostly clustered in cities and larger towns. 89% of delivery facilities provided C-sections, but over half were not registered. Facilities were generally small, and the majority were independently owned, mostly by medical doctors and, to a lesser extent, AYUSH (non-biomedical) providers and others without formal qualifications. Recent growth in facility numbers had led to intense competition, particularly among mid-level facilities where customers were more price sensitive. In all facilities, nearly all payment was out-of-pocket, with very low-insurance coverage. Non-price competition was a key feature of the market and included location (preferably on highways or close to government facilities), medical infrastructure, hotel features, staff qualifications and reputation, and marketing. There was heavy reliance on visiting consultants such as obstetricians, surgeons and anaesthetists, and payment of hefty commission payments to agents who brought clients to the facility, for both new patients and those transferring from public facilities. Building on these insights, strategies for private sector engagement could include a foundation of universal facility registration, adaptation of accreditation schemes to lower-level facilities, improved third-party payment mechanisms and strategic purchasing, and enhanced patient information on facility availability, costs and quality.
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McAllister, R. M., R. W. Ogilvie, and R. L. Terjung. "Impact of reduced cytochrome oxidase activity on peak oxygen consumption of muscle." Journal of Applied Physiology 69, no. 1 (July 1, 1990): 384–89. http://dx.doi.org/10.1152/jappl.1990.69.1.384.
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The impact of reduced muscle oxidative capacity on peak oxygen consumption and isometric performance was evaluated using an isolated rat hindlimb preparation perfused with a high oxygen delivery. Capacity for electron transport was reduced with chloramphenicol (CAP), an inhibitor of mitochondrial gene-coded protein synthesis. The activity of cytochrome oxidase, a mitochondrial cristae component, was reduced approximately 45% (P less than 0.005) in the mixed-fiber-type plantaris muscle. Several facets of muscle remodeling were also evident with the 10- to 14-day CAP treatment, including decreased citrate synthase activity, increased capillarity, and increased numbers of type IIc fibers. Perfusion of CAP (n = 6) and control (n = 7) rat hindlimbs of similar size with similar total flows (10-11 ml/min) and oxygen contents (20-21 vol%) resulted in similarly high oxygen deliveries to contracting muscles of the hindlimbs (CAP, 9.66 +/- 0.83 mumols.min-1.g-1; control, 8.74 +/- 0.75). Performance of the gastrocnemius-plantaris-soleus group declined in a similar fashion for both groups during increasingly intense near-steady-state tetanic contraction (100 ms at 100 Hz) conditions of 4, 8, 15, 30, 45, and 60 per minute. Oxygen consumption was similar for both groups at rest and increased similarly at each contraction condition. Peak oxygen consumption was not different between CAP (5.34 +/- 0.55 mumols.min-1.g-1) and control (5.74 +/- 0.43) groups and required only 56-68% of the oxygen delivered. This implies that rat skeletal muscle can suffer a significant reduction in its electron transport capacity without impairing peak oxygen consumption and muscle performance.(ABSTRACT TRUNCATED AT 250 WORDS)
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Rahimi, Ali, Mikael Rönnqvist, Luc LeBel, and Jean-François Audy. "An optimization model for selecting wood supply contracts." Canadian Journal of Forest Research 50, no. 4 (April 2020): 399–412. http://dx.doi.org/10.1139/cjfr-2019-0281.
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Procurement for forest companies with pulp and paper mills aims to ensure that a sufficient volume of wood supply enters the production process. Numerous suppliers and contract types are available; however, their selection is a complex decision for procurement managers. In addition, managers typically dedicate a portion of their wood fiber demand to each group of suppliers, which is referred to as a portfolio strategy. Despite the available literature in contract selection, the consideration of contract types and their characteristics have not been addressed for the complex procurement process. In this study, a mixed-integer optimization model is proposed to best select contracts for pulp and paper procurement. The challenge was to plan deliveries in each time period to satisfy the demand of raw material at the mills. The potential of this model is demonstrated with a case study based on characteristics from a forest company in Quebec, Canada. A comparison between traditional fixed and flexible contracts is presented. Different portfolio strategies are also evaluated for groups of suppliers to investigate potential improvements.
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Li, Yuyu, Wei Yang, and Bo Huang. "Impact of UAV Delivery on Sustainability and Costs under Traffic Restrictions." Mathematical Problems in Engineering 2020 (August 8, 2020): 1–15. http://dx.doi.org/10.1155/2020/9437605.
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Compared with traditional vehicles delivery, unmanned aerial vehicle (UAV) delivery can reduce energy consumption and greenhouse gas emissions, which benefits environmental sustainability. Besides, UAVs can overcome traffic restrictions, which are the big obstacle in parcel delivery. In reality, there are two kinds of most popular traffic restrictions, vehicle-type restriction, and half-side traffic. We propose a mixed-integer (0-1 linear) green routing model with these two kinds of traffic restrictions for UAVs to exploit the environmental aspects of the use of UAVs in logistics. A genetic algorithm is proposed to efficiently solve the complex routing problem, and an experimental analysis is made to illustrate and validate our model and the algorithm. We found that, under both these two traffic restrictions, UAV delivery can accomplish deliveries that cannot be carried out or are carried out at much higher costs by vehicles only and can always effectively save costs and cut CO2 emissions, which is environmentally friendly. Furthermore, UAV delivery saves more cost and cuts more CO2 emission under the first kind of traffic restriction than that under the second.
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Moufad, Imane, and Fouad Jawab. "Mixed applied survey methodology for planning/enforcement of urban logistics delivery bays– An application to the Moroccan context." Archives of Transport 55, no. 3 (September 30, 2020): 95–110. http://dx.doi.org/10.5604/01.3001.0014.4237.
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Roads and parking areas represent a place of conflict between freight vehicles and other urban activities, especially on mixed residential and commercial streets. This conflict results in traffic congestion, illegal parking, pollution and road safety problems. The challenge is to allocate public space between the right operating activities, parking activities, public transport and so on. To address that, urban logistics delivery bays, also known as loading/unloading (L/U) zones, have become a real solution to facilitate the delivery and pick-up operations of urban freight vehicles, ensure accessibility for delivery drivers, reduce congestion and improve road safety. Therefore, this paper reports on planning and enforcement of urban delivery bays needs. It is part of the urban freight transport (UFT) surveys. This involves consolidating with new contribution the development, implementation and statistical analysis of a survey in order to quantify the need of delivery areas. Compared to the existing literature, this paper presents a mixed applied methodology which is divided into two parts : “Exploratory survey” and “Establishment-vehicle observation” survey. These two surveys techniques were conducted to offer an overview of the freight vehicle delivery and pick-up frequency according to the daytime and weekdays and the operations related to the loading/unloading activities. This makes it possible to estimate the delivery bays requirement in the study area. The findings from a methodological and practical angle are illustrated through a real case study in a commercial street in Morocco. The findings suggest that 60% of deliveries are made between 8:00 A.M and 12 A.M, and the movements generated by each establishment are 257 movements. For this, the study zone requires the development of three loading/unloading (L/U) bays. The main contribution is to propose an approach that urban authorities can use to estimate urban delivery areas efficiently and thus allow simple replication of the proposed framework in other cities.
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Ridde, Valéry, Seni Kouanda, Maurice Yameogo, Kadidiatou Kadio, and Aristide Bado. "Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso." Evaluation and Program Planning 36, no. 1 (February 2013): 145–52. http://dx.doi.org/10.1016/j.evalprogplan.2012.09.005.
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Short, Tracee. "508 Cancel Burn Camp: No Way! Our Institutions Creation of a Virtual Burn Camp and What it Taught Us About Our Patients." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S101. http://dx.doi.org/10.1093/jbcr/irab032.159.
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Abstract Introduction Last year we planned and created our own burn camp. We saw a need not being served and jumped in a created a camp experience that was archived in a documentary and received stellar reviews by all who attended. The kids’ camp expectations was exceeded and everyone was looking forward to 2020. We planned for a great 2020 camp experience and then COVID struck. We debated about the safety to proceed with residential camp as we knew it. Other camps cancelled but our inner need to serve wouldn’t let us do this. Methods Our planning committee quickly shifted and began planning for how we can bring that experience to a virtual platform. We engaged our Facebook group and called every kid on our list to inform the parents of the change. We then created a daily schedule and purchased the items needed for all activities. We then sent or delivered these with a gift card to kids that couldn’t make the pickups. Pickups were scheduled in the cities where most of our kids reside. We conducted daily yoga and meditation, cooking classes, painting and campfire stories. We mixed daily online sessions with 3 tailgating meet ups. We invited guest lectures and left the virtual space open for the kids to hang out. Results At the final tailgate/virtual pizza party, we had an awards ceremony and received testimonials from kids and parents about how for the first-time siblings were able to participate. We delivered to 15 kids and had 20 attend the tailgate pickups. On average, we had 16 kids attend daily. Conclusions Parents could see how their child benefitted from this community and the intent of camp. This event revealed exactly where our patients reside from a socioeconomic standpoint. Deliveries to some homes left our volunteers in tears. This helped explain the discrepancy between interest expressed and the numbers that showed daily for events. It also made us recognize that camp means even more as it is an escape from their realities.