A two-echelon multi-trip vehicle routing problem with synchronization for an integrated water- and land-based transportation system

This study focuses on two-echelon synchronized logistics problems in the context of integrated water- and land-based transportation (IWLT) systems. The aim is to meet the increasing demand in city logistics as a result of the growth in transport activities, including parcel delivery, food delivery, and waste collection. We propose two models, a novel mixed integer linear joint model, and a logic-based Benders’ decomposition (LBBD) model, for a two-echelon problem under realistic settings such as multi-trips, time windows, and synchronization at the satellites with no storage and limited resource capacities. The objective is to optimize transfers and satellite assignments, thereby reducing overall logistics costs for street vehicles and vessels. Computational experiments demonstrate that the LBBD model is more robust in terms of solution quality and solution time on average while the added value of the LBBD is more evident when solving large-scale instances with 100 customers, reducing the overall costs by 10.6% on average and significantly reducing the fleet costs on both networks. Furthermore, we assess the effect of changing cost parameters and satellite locations in the proposed IWLT system–analyzing system behavior and suggesting potential improvements–and evaluate several system alternatives in city logistics–consisting of different transportation network designs (single- and two-echelon), vehicle types, and operational constraints. On average, the proposed two-echelon IWLT system reduces the number of kilometers traveled by vehicles at street level by ranging from 20% to 30% compared to a typical single-echelon service design that relies solely on trucks.</p

Does the Adoption of EMR Systems Inflate Medicare Reimbursements?

The adoption of EMR systems has been argued to lead to physicians “upcoding” their patients to inflate insurance reimbursements. In this paper, we examine if the adoption of the Clinical Physician Order Entry (CPOE) system is associated with an increase in the complexity of the patients\u27 case mix that hospitals report (termed upcoding ). We make use of a staggered roll-out of the Recovery Audit Program to combat upcoding as a natural experiment to assess the impact of the adoption of the CPOE systems on the case mix that a hospital reports. We find that on average the adoption of CPOE systems is associated with an increase in the reported case mix of hospitals, and that the Audit program has had an effect on reducing the case mix that hospitals report to Medicare for reimbursement. Implications for preventing inflated reimbursements due to upcoding are discussed

A proposal for a coordinated effort for the determination of brainwide neuroanatomical connectivity in model organisms at a mesoscopic scale

In this era of complete genomes, our knowledge of neuroanatomical circuitry remains surprisingly sparse. Such knowledge is however critical both for basic and clinical research into brain function. Here we advocate for a concerted effort to fill this gap, through systematic, experimental mapping of neural circuits at a mesoscopic scale of resolution suitable for comprehensive, brain-wide coverage, using injections of tracers or viral vectors. We detail the scientific and medical rationale and briefly review existing knowledge and experimental techniques. We define a set of desiderata, including brain-wide coverage; validated and extensible experimental techniques suitable for standardization and automation; centralized, open access data repository; compatibility with existing resources, and tractability with current informatics technology. We discuss a hypothetical but tractable plan for mouse, additional efforts for the macaque, and technique development for human. We estimate that the mouse connectivity project could be completed within five years with a comparatively modest budget.Comment: 41 page

A two-neuron system for adaptive goal-directed decision-making in Lymnaea

During goal-directed decision-making, animals must integrate information from the external environment and their internal state to maximize resource localization while minimizing energy expenditure. How this complex problem is solved by the nervous system remains poorly understood. Here, using a combined behavioural and neurophysiological approach, we demonstrate that the mollusc Lymnaea performs a sophisticated form of decision-making during food-searching behaviour, using a core system consisting of just two neuron types. The first reports the presence of food and the second encodes motivational state acting as a gain controller for adaptive behaviour in the absence of food. Using an in vitro analogue of the decision-making process, we show that the system employs an energy management strategy, switching between a low- and high-use mode depending on the outcome of the decision. Our study reveals a parsimonious mechanism that drives a complex decision-making process via regulation of levels of tonic inhibition and phasic excitation

Mental turmoil, suicide risk, illness perception, and temperament, and their impact on quality of life in chronic daily headache

To evaluate the relationship among quality of life, temperament, illness perception, and mental turmoil in patients affected by chronic daily headache with concomitant medication overuse headache. Participants were 116 consecutive adult outpatients admitted to the Department of General Medicine of the Sant’Andrea Hospital in Rome, between January 2007 and December 2007 with a diagnosis of chronic daily headache (illness duration >5 years). Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), the Beck Hopelessness Scale (BHS), the Hamilton Rating Scale for Depression (HAM-D), the Mini-International Neuropsychiatric Interview (MINI), the Revised Illness Perception Questionnaire (IPQ), the Suicide Score Scale (SSS), and the Quality of Life Index (QL-Index). Twenty-eight percent of the patients evidenced moderate to severe depression, and 35% evidenced severe hopelessness. Analyses also indicated that quality of life, temperament, illness perception, and psychological turmoil are associated. However, a hierarchical multivariate regression analysis with quality of life as dependent variable indicated that only a model with mental turmoil variables may fit data; further, only the MINI suicidal intent resulted associated with quality of life (standardized regression coefficient = −0.55; t = −3.06; P < 0.01). Suicide risk may play a central role in affecting the quality of life of patients with chronic headache. The investigation of the interplay of factors that precipitate suicide risk should include assessment of chronic headache and its effects on wellbeing

Changes in tourist traffic from Poland to Turkey on the background of other major directions of travel

The development of outbound tourism from Poland to Turkey after 2010 can be divided into three periods. The first one is connected with a stable increase in the number of departures. The second period includes the growth in the number of trips which served as a replacement for vacations in Greece, Egypt or Tunisia. The last period started in 2014, when the number of visitors rapidly declined as the result of terrorist attacks and the military coup in Turkey. Due to concerns about the security after numerous terrorist attacks, the traditional destinations of Polish tourism such as France and Morocco lost their popularity. There was the inexorable decline in trust toward countries such as Egypt and in particular Turkey, where the numbers of tourists fell by 63% after the terrorist attacks and military coup. In first half of 2015 we have about 209.2 thous. Polish tourists in Turkey, and in 2016, the same time, only 82.7 thous. what gives decrease of nearly 60.5%. Undoubtedly, the tightening of internal policies after the unsuccessful military coup will deepen the decline in interest in Turkey by Polish visitors

Genetic dissection of an amygdala microcircuit that gates conditioned fear

The role of different amygdala nuclei (neuroanatomical subdivisions) in processing Pavlovian conditioned fear has been studied extensively, but the function of the heterogeneous neuronal subtypes within these nuclei remains poorly understood. Here we use molecular genetic approaches to map the functional connectivity of a subpopulation of GABA-containing neurons, located in the lateral subdivision of the central amygdala (CEl), which express protein kinase C-δ (PKC-δ). Channelrhodopsin-2-assisted circuit mapping in amygdala slices and cell-specific viral tracing indicate that PKC-δ^+ neurons inhibit output neurons in the medial central amygdala (CEm), and also make reciprocal inhibitory synapses with PKC-δ^− neurons in CEl. Electrical silencing of PKC-δ^+ neurons in vivo suggests that they correspond to physiologically identified units that are inhibited by the conditioned stimulus, called Cel_(off) units. This correspondence, together with behavioural data, defines an inhibitory microcircuit in CEl that gates CEm output to control the level of conditioned freezing

Improvement in Field CBR Values of Subgrade Soil Using Construction-Demolition Materials

Many countries suffer from the stacks of construction and demolition (CD) materials as they cause environmental and health problems in society. The city of Mosul in Iraq suffers from a huge amount of demolition materials resulting from destruction of most of the infrastructure. In the present study, attempts have been made to assess the influence of three types of CD materials (dragged asphalt, DA; crushed brick, CB; and crushed concrete, CC) on the response of a low-plasticity clay (CL) for use as a road subgrade layer. An intensive series of both experimental and numerical studies on the CL with 10% CD materials was carried out using field California bearing ratio (CBR) tests performed in a large-scale model box. The results showed significant improvement in the CBR values upon the addition of CD materials to the CL soil. The CBR values increased by 12.4, 13.7, and 49.7% with the addition of DA, CB, and CC, respectively. The CBR values improved between 1.1 and 1.7 times, corresponding to an increase in the layer thickness from 50 to 100 cm. Further increases in CBR values range from 1.5 to 1.8 times attendant with increasing the thickness of layer from 50 cm to 150 cm. The addition of CC is more active and gives higher CBR values. A good match was observed between the CBR values obtained from the experimental results and the numerical analysis using the PLAXIS 2D package

Plasma Levels of Tumor Necrosis Factor-Alpha and Interleukin-6 in Obsessive Compulsive Disorder

Aim. Recent research implicated place of an immune mechanism in the pathophysiology of obsessive-compulsive disorder (OCD). Despite increasing evidence involvement of cytokine release in OCD, results of the studies are inconsistent. The aim of this study was to evaluate the plasma levels of the cytokines; tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in OCD patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 31 drug-free outpatients with OCD, and 31-year age and sex-matched healthy controls. TNF-α and IL-6 concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA). Results. Both TNF-α and IL-6 levels showed statistically significant increases in OCD patients compared to controls (P < .000, P < .001, resp.). In addition, the age of onset was negatively correlated with TNF-α level (r = −.402, P = .025) and duration of illness was weakly correlated with IL-6 levels (r : .357; P : .048) in patients group. Conclusion. OCD patients showed increases in TNF-α and IL-6 levels compared to the healthy controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of OCD