Vehicle Dynamics in Pickup-And-Delivery Problems Using Electric Vehicles

Electric Vehicles (EVs) are set to replace vehicles based on internal combustion engines. Path planning and vehicle routing for EVs need to take their specific characteristics into account, such as reduced range, long charging times, and energy recuperation. This paper investigates the importance of vehicle dynamics parameters in energy models for EV routing, particularly in the Pickup-and-Delivery Problem (PDP). We use Constraint Programming (CP) technology to develop a complete PDP model with different charger technologies. We adapt realistic instances that consider vehicle dynamics parameters such as vehicle mass, road gradient and driving speed to varying degrees. The results of our experiments show that neglecting such fundamental vehicle dynamics parameters can affect the feasibility of planned routes for EVs, and fewer/shorter charging visits will be planned if we use energy-efficient paths instead of conventional shortest paths in the underlying system model

Bi-Objective Search with Bi-Directional A*

Bi-objective search is a well-known algorithmic problem, concerned with finding a set of optimal solutions in a two-dimensional domain. This problem has a wide variety of applications such as planning in transport systems or optimal control in energy systems. Recently, bi-objective A*-based search (BOA*) has shown state-of-the-art performance in large networks. This paper develops a bi-directional and parallel variant of BOA*, enriched with several speed-up heuristics. Our experimental results on 1,000 benchmark cases show that our bi-directional A* algorithm for bi-objective search (BOBA*) can optimally solve all of the benchmark cases within the time limit, outperforming the state of the art BOA*, bi-objective Dijkstra and bi-directional bi-objective Dijkstra by an average runtime improvement of a factor of five over all of the benchmark instances

Use of Fentanyl Patch and Intravenous Morphine for Treatment of Leg Bone Fracture: Treatment Profile, and Clinical Effectiveness

BACKGROUND: Severe pain is one of the major problems in patients with leg bone fracture. Various methods have been proposed to relieve pain. Opioids are one of the most important available medications to control these types of pain. Among the opioids available, fentanyl can be applied for its unique properties as transdermal patches. AIM: Therefore, the current study aimed to investigate the effect of intravenous morphine and fentanyl skin patch in patients with a lower leg fracture. METHODS: We entered 60 patients in this randomised, one-blind randomised clinical trial among patients referring to the emergency department of Vali-e-Asr Hospital in Arak with a fracture of the leg. Demographic and clinical data were recorded for patients. The case group (n = 30) received the fentanyl patch in the same area. Patients in the control group (30) received 0.1mcg/kg of morphine intravenously. In both groups, the severity of pain was measured every 20 minutes within two hours after onset of treatment based on VAS criteria and subsequently recorded in the checklist. Data were analysed by SPSS v.22 software package. RESULTS: The results of the present study demonstrated that the mean visual analogue scale (VAS) pain score at minutes 20, 40, 60 and 80 were statistically lower in intervention group when compared with the control group (p = 0.000). CONCLUSION: Our results indicated a considerable risk-benefit profile for the treatment of pain in patients suffering from dysphagia, nausea and vomiting, or resistance to other opioids. The use of fentanyl patch is also suitable for patients who are not able to take their medication at their scheduled time

Traumatic injuries in pregnant women: a case of motor vehicle accident for “Ground Round” discussion

The main objective for introducing this case study is to create a platform from which the importance of road traffic related injuries and traumas can be emphasized and discussed within and across various fields of investigation. The long term goal is to entice public campaign around unmet needs for higher road safety measures to reduce primary, secondary, and tertiary risks of injuries and traumas

Association between Myometrial Thickness and Assisted Reproductive Technologies Outcomes: A Prospective Cohort Study

Background: Myometrial thickness has been expected to be a prognosticator for lower uterine segment function. Anabnormal function of the uterine muscle layer can cause common and important reproductive problems. This studyaimed to evaluate the relationship between the baseline myometrial thickness and assisted reproductive technologies(ART) outcomes.Materials and Methods: In this prospective cohort study, 453 infertile women undergoing ART cycles without anyobvious uterine pathology, participated in this prospective cohort study from February 2013 to May 2015. In order tomeasure the myometrial thickness in the anterior and posterior of the uterine, trans-vaginal ultrasounds were conducted ondays 2-4 of the cycle (menstrual phase) preceding ovarian stimulation and the day of human chorionic gonadotropin(hCG) injection. We defined three groups based on the baseline myometrial thickness in the anterior and posterior, including(A) <25 mm, (B) 25-29.9 mm and (C) ≥30 mm. Ovarian stimulation, oocyte retrieval and luteal phase support wereperformed in accordance with the standard long protocol. Two weeks after embryo transfer, the patients underwent apregnancy test by checking their serum β-hCG levels. The primary outcome measure was the clinical pregnancy rate. Secondaryoutcome measures were implantation rate, abortion rate and live birth rate.Results: The clinical pregnancy (P=0.013) and implantation (P=0.003) rates were significantly lower in group A thanin two other groups. Although the live birth rate was lower in group A than two other groups, this decrease was not statisticallysignificant (P=0.058).Conclusion: The findings may be a way for clinicians to draw focus on providing therapeutic strategies and a specificsupportive care for women with a baseline myometrial thickness <25 mm in order to improve the reproductive outcomeof in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI)

Unusual Presentations of Cutaneous Leishmaniasis in an Endemic Area, Kerman Province, Iran

Leishmaniasis is a infectious disease with broad spectrum of clinical features from typical noduloulcerative lesion to atypical lesions. In this article, we presented 4 cases with atypical presentation of cutaneous leishmaniasis lesions (including eczematous, sporotrichoid and lichenoid) in an endemic area in Iran, Kerman. The first case was a 28- year- old man presented with a pruritic purplish -red plaque with lichenoid appearance around proximal nail fold of right third finger since a few months ago. The second case was a young woman with an indurated yellowish-brown plaque with peripheral depigmentation firstly diagnosed as keloid with subsequent intralesional triamcinolone injection. The third case was a middle-aged woman with multiple ulcerated reddish-brown nodules and plaques in a linear array on both legs and one forearm (sporotrichoid pattern). The forth case was a man with a painful indurated reddish-brown plaque with yellowish crust and swelling resembling infected contact dermatitis

Unusual Presentations of Cutaneous Leishmaniasis in an Endemic Area, Kerman Province, Iran

Leishmaniasis is a infectious disease with broad spectrum of clinical features from typical noduloulcerative lesion to atypical lesions. In this article, we presented 4 cases with atypical presentation of cutaneous leishmaniasis lesions (including eczematous, sporotrichoid and lichenoid) in an endemic area in Iran, Kerman. The first case was a 28- year- old man presented with a pruritic purplish -red plaque with lichenoid appearance around proximal nail fold of right third finger since a few months ago. The second case was a young woman with an indurated yellowish-brown plaque with peripheral depigmentation firstly diagnosed as keloid with subsequent intralesional triamcinolone injection. The third case was a middle-aged woman with multiple ulcerated reddish-brown nodules and plaques in a linear array on both legs and one forearm (sporotrichoid pattern). The forth case was a man with a painful indurated reddish-brown plaque with yellowish crust and swelling resembling infected contact dermatitis

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world’s highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.Peer ReviewedPostprint (published version

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe