Dynamic Robot Routing and Destination Assignment Policies for Robotic Sorting Systems

Robotic sorting systems (RSSs) use mobile robots to sort items by destination. An RSS pairs high accuracy and flexible capacity sorting with the advantages of a flexible layout. This is why several express parcel and e-commerce retail companies, who face heavy demand fluctuations, have implemented these systems. To cope with fluctuating demand, temporal robot congestion, and high sorting speed requirement, workload balancing strategies such as dynamic robot routing and destination reassignment may be of benefit. We investigate the effect of a dynamic robot routing policy using a Markov decision process (MDP) model and dynamic destination assignment using a Mixed Integer Programming (MIP) model. To obtain the MDP model parameters, we first model the system as a semi-open queuing network (SOQN) that accounts for robot movement dynamics and network congestion. Then we construct the MIP model to find a destination reassignment scheme that minimizes the workload imbalance. With inputs from the SOQN and MIP models, the Markov decision process minimizes parcel waiting and postponement costs and helps to find a good heuristic robot routing policy to reduce congestion. We show that the heuristic dynamic routing policy is near optimal in small-scale systems and outperforms benchmark policies in large-scale realistic scenarios. Dynamic destination reassignment also has positive effects on the throughput capacity in highly loaded systems. Together, in our case company, they improve the throughput capacity by 35%. Simultaneously, the effect of dynamic routing exceeds that of dynamic destination reassignment, suggesting that managers should focus more on dynamic robot routing than dynamic destination reassignment to mitigate temporal congestion

AI-toepassingen binnen de strafrechtketen:private actoren in rechtsstatelijk perspectief

AI wordt in de strafrechtketen gebruikt om grootschalig data te verzamelen en te analyseren, waarbij soms private actoren een centrale rol vervullen. Deze verschuiving van macht van de publieke naar de private sector roept vragen op over de wenselijkheid ervan. Wenselijkheid kan echter benaderd worden vanuit verschillende invalshoeken. In deze opinie benaderen wij deze wenselijkheid vanuit een theoretisch-rechtsstatelijk perspectief

Prejudiciële procedures voor Gerecht: a brave new world?

Het Gerecht is met ingang van 1 oktober 2024 bevoegd om kennis te nemen van prejudiciële verzoeken op een aantal specifieke gebieden van het EU-recht. Het gaat daarbij om btw, accijnzen, douane- en tariefindeling, compensatie- en bijstand aan reizigers en de handel in broeikasgasemissierechten. In dit artikel bespreekt en evalueert de auteur deze hervorming van de prejudiciële procedure. Daarbij wordt onder andere ingegaan op de vraag in hoeverre de hervorming bijdraagt aan vermindering van de werklast van het HvJ. Verder wordt betoogd dat de hervorming mogelijk verder kan gaan dan een louter praktische, technische herverdeling van prejudiciële bevoegdheden. Bij eventuele toekomstige uitbreiding van de prejudiciële bevoegdheid van het Gerecht naar andere rechtsgebieden zal de gerechtelijke structuur van de EU mogelijk fundamenteel veranderen en het HvJ meer op het spoor zetten van een constitutioneel hof

Increase in prevalence and costs of cirrhosis in the Netherlands:A nationwide hospital diagnosis data analysis

Introduction: Due to the rising incidence of patients with cirrhosis and its accompanied extensive management, there is an increasing burden of cirrhosis patients on healthcare resources and costs. However, exact data on Dutch cirrhosis epidemiology and associated costs are lacking. Aims and methods: We aimed to determine the year-prevalence of adults (aged ≥18 years) with cirrhosis registered as active patients in Dutch hospitals (2017-2021) using the Dutch hospital claims database. Next, we assessed average reimbursed annual healthcare costs. Results: The prevalence of patients with cirrhosis registered as an active patient in Dutch hospitals increased by 54% from 48.7 patients per 100 000 in 2017 to 75.2 per 100 000 in 2021. There were regional differences and prevalence for cirrhosis was at highest of 105.6 patients per 100 000. The yearly incidence of patients for which hospitals requested claims was n = 3725 in 2018, n = 3840 in 2019 (+3%), n = 3749 in 2020 (-2%), and n = 3695 in 2021 (-1%). Total number of hospital admissions increased by 19% from 2443 in 2017 to 2899 in 2021. The annual reported costs for patients with cirrhosis increased by 120% from €35 million in 2017 to €78 million in 2021. Adjusted for inflation this increase was 143% to €85 million. Conclusion: The prevalence of patients with cirrhosis registered as a patient in Dutch hospitals increased by more than 50 percent from 2017 to 2021, with regional differences. Consequently, total healthcare costs for Dutch patients with cirrhosis more than doubled in less than 5 years.</p

Bridging the gap:a practical step-by-step approach to warrant safe implementation of large language models in healthcare

Large Language Models (LLMs) offer considerable potential to enhance various aspects of healthcare, from aiding with administrative tasks to clinical decision support. However, despite the growing use of LLMs in healthcare, a critical gap persists in clear, actionable guidelines available to healthcare organizations and providers to ensure their responsible and safe implementation. In this paper, we propose a practical step-by-step approach to bridge this gap and support healthcare organizations and providers in warranting the responsible and safe implementation of LLMs into healthcare. The recommendations in this manuscript include protecting patient privacy, adapting models to healthcare-specific needs, adjusting hyperparameters appropriately, ensuring proper medical prompt engineering, distinguishing between clinical decision support (CDS) and non-CDS applications, systematically evaluating LLM outputs using a structured approach, and implementing a solid model governance structure. We furthermore propose the ACUTE mnemonic; a structured approach for assessing LLM responses based on Accuracy, Consistency, semantically Unaltered outputs, Traceability, and Ethical considerations. Together, these recommendations aim to provide healthcare organizations and providers with a clear pathway for the responsible and safe implementation of LLMs into clinical practice.</p

Normative values for lung, bronchial sizes, and bronchus-artery ratios in chest CT scans:from infancy into young adulthood

Objective: To estimate the developmental trends of quantitative parameters obtained from chest computed tomography (CT) and to provide normative values on dimensions of bronchi and arteries, as well as bronchus-artery (BA) ratios from preschool age to young adulthood. Materials and methods: Two independent radiologists screened a dataset of 1160 chest CT scans, initially reported as normal, from participants aged 0 to 24 years. Using an automated deep learning-based algorithm, we computed the following bronchus and artery parameters: bronchial outer diameter (Bout), bronchial inner diameter (Bin), adjacent pulmonary artery diameter (A), bronchial wall thickness (Bwt), bronchial wall area (BWA), and bronchial outer area (BOA). From these parameters, we computed the following ratios: Bout/A, Bin/A, Bwt/A, Bwt/Bout, and BWA/BOA. Furthermore, mean lung density, total lung volume, and the square root of wall area of bronchi with a 10-mm lumen perimeter (Pi10) were obtained. The effects on CT parameters of age, sex, and iodine contrast were investigated using mixed-effects or regression model analyses. Results: 375 normal inspiratory chest CT scans (females / males = 156 / 219; mean age [SD] 12.7 [5.0] years) met the inclusion criteria. Bout and Bin progressively increased with age (all p &lt; 0.05), but Bwt, Bout/A, Bin/A, Bwt/A, Bwt/Bout, or BWA/BOA did not. Total lung volume and mean lung density continuously increased with age (both p &lt; 0.001), while Pi10 did not exhibit such a trend. Bout, total lung volume, and mean lung density were the only parameters that differed between males and females, all higher in males than females (all p &lt; 0.03). The presence of iodinated contrast led to greater values for Bwt, Bwt/Bout, and BWA/BOA, but lower values for Bin, Bout/A, Bin/A, and Bwt/A (all p &lt; 0.01). Conclusion: Quantitative CT parameters of both lung parenchyma and bronchi exhibit growth-related changes, but from 6 to 24 years ratios between bronchus and artery dimensions remain constant. Contrast-enhanced CT scans affect the assessment of lung parenchyma and bronchial size. We propose age and technique-dependent normative values for bronchial dimensions and wall thickness. Key Points: Question What are the developmental trends of quantitative lung CT parameters in patients from childhood into young adulthood? Findings The ratio between bronchus and pulmonary artery dimensions demonstrates consistent values across age groups, indicating synchronized growth between bronchi and paired pulmonary arteries. Clinical relevance Our findings highlight the importance of standardized CT protocol and volume acquisition, and emphasize the need for ongoing collection of normal chest CT scans to refine the proposed reference values.</p

Instability of the AUROC of Clinical Prediction Models

Background: External validations are essential to assess the performance of a clinical prediction model (CPM) before deployment. Apart from model misspecification, also differences in patient population, the standard of care, predictor definitions, and other factors influence a model's discriminative ability, as commonly quantified by the AUC (or c-statistic). We aimed to quantify the variation in AUCs across sets of external validation studies and propose ways to adjust expectations of a model's performance in a new setting.Methods: The Tufts-PACE CPM Registry holds a collection of CPMs for prognosis in cardiovascular disease. We analyzed the AUC estimates of 469 CPMs with at least one external validation. Combined, these CPMs had a total of 1603 external validations reported in the literature. For each CPM and its associated set of validation studies, we performed a random-effects meta-analysis to estimate the between-study standard deviation (Formula presented.) among the AUCs. Since the majority of these meta-analyses have only a handful of validations, this leads to very poor estimates of (Formula presented.). So, instead of focusing on a single CPM, we estimated a log-normal distribution of (Formula presented.) across all 469 CPMs. We then used this distribution as an empirical prior. We used cross-validation to compare this empirical Bayesian approach with frequentist fixed and random-effects meta-analyses. Results: The 469 CPMs included in our study had a median of 2 external validations with an IQR of [1–3]. The estimated distribution of (Formula presented.) had a mean of 0.055 and a standard deviation of 0.015. If (Formula presented.) = 0.05, then the 95% prediction interval for the AUC in a new setting has a width of at least (Formula presented.) 0.1, no matter how many validations have been done. When there are fewer than 5 validations, which is typically the case, the usual frequentist methods grossly underestimate the uncertainty about the AUC in a new setting. Accounting for (Formula presented.) in a Bayesian approach achieved near nominal coverage. Conclusion: Due to large heterogeneity among the validated AUC values of a CPM, there is great irreducible uncertainty in predicting the AUC in a new setting. This uncertainty is underestimated by existing methods. The proposed empirical Bayes approach addresses this problem which merits wide application in judging the validity of prediction models.</p

Perioperative Airway Management for Midface Surgery in Children With Syndromic Craniosynostosis; a Single Center Experience With Immediate Extubation

Background: Midface advancements in children with syndromic craniosynostosis present challenges for anesthesiologists and intensive care teams. Aims: This study reviewed the perioperative airway management protocol for immediate tracheal extubation after midface surgery at our tertiary center over the past 10 years. Methods: A retrospective cohort study was performed to obtain information on respiratory disorders, surgical and anesthetic management, airway support, and respiratory complications following le Fort III (LF3) and monobloc (MB) with distraction. Patients with a tracheostomy were excluded. Results: Thirty-two patients (12 LF3, 20 MB) were included. All were immediately extubated with a median of 25 min after surgery. Immediate extubation was performed in young patients (n = 8/32, &lt; 5 years old), in patients with severe OSA (n = 6/32, median oAHI 23/h), with difficult airways (n = 5/32, Cormack-Lehane airway grade ≥ 3), with significant intraoperative blood loss (n = 32, median 46 mL/kg), and with long operative times (n = 32, median 223 min). The majority of patients received no or only oxygen support in the first hours after extubation (n = 29/32) and could be discharged from the pediatric intensive care unit to the surgical ward after 1 day (n = 30/32). A 5-month-old patient with MB required intermittent oxygen and Guedel airway throughout his hospitalization due to airway obstruction at the tongue base combined with supine positioning to allow external traction. Conclusions: Despite the pre-existing airway disorder, the extent of the procedure and the effect of anesthesia on airway tone, all patients were extubated immediately after midface advancement, with only one young patient needing prolonged postoperative support. Immediate extubation is feasible following midface advancement in patients with syndromic craniosynostosis. Further prospective randomized trials are needed to demonstrate superiority to delayed extubation.</p

Results From a Phase 1 Study Evaluating the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Efficacy of ANX005, a C1q Inhibitor, in Patients With Guillain–Barré Syndrome

Background and Aims: Guillain–Barré syndrome (GBS) is an acute autoimmune peripheral neuropathy driven by autoantibodies and classical complement pathway activation. Despite treatments with intravenous immunoglobulin or plasma exchange, GBS remains characterized by variability in recovery and high incidence of residual disabilities. This randomized, double-blind, placebo-controlled Phase 1 trial evaluated the safety, tolerability, and pharmacokinetics of ANX005, a novel therapeutic targeting the classical complement cascade. Methods: Patients with recent-onset GBS, who had no access to intravenous immunoglobulin or plasma exchange, received escalating doses of ANX005 or placebo as a single IV infusion. Primary objectives included assessments of safety. Secondary objectives included determination of pharmacokinetic and pharmacodynamic profiles and clinical outcomes through Week 8. Exploratory objectives included an evaluation of serum and cerebrospinal fluid (CSF) complement and tissue damage biomarkers. Results: Fifty patients were randomized to receive either ANX005 (n = 38) or placebo (n = 12). ANX005 was well-tolerated across all doses with no dose-limiting toxicities, suggesting an acceptable safety profile. Pharmacodynamic data showed effective C1q inhibition and a reduction in neurofilament light chain levels, suggesting nerve damage mitigation. Exploratory endpoints evaluating clinical outcomes included improvements in Medical Research Council sum scores, GBS-Disability Score, and Overall Neuropathy Limitations Scale with ANX005 compared to placebo, particularly in patients receiving doses that inhibited serum C1q for ≥ 1 week and provided C1q blockade in the CSF. Interpretation: These results support ANX005 as a targeted therapy for GBS that modulates the classical complement pathway. Further investigation in a larger Phase 3 trial is warranted to confirm these results and assess the long-term benefits of complement inhibition in patients with GBS.</p