A rolling horizon approach for the integrated multi-quays berth allocation and crane assignment problem for bulk ports

In this paper, an efficient rolling horizon-based heuristic is presented to solve the integrated berth allocation and crane assignment problem in bulk ports. We were guided by a real case study of a multi-terminal port, owned by our Moroccan industrial partner, under several restrictions as high tides and installation’s availability. First, we proposed a mixed integer programming model for the problem. Then, we investigated a strategy to dissipate the congestion within the presented rolling horizon. A variety of experiments were conducted, and the obtained results show that the proposed methods were efficient from a practical point of view

Optimisation de laboratoires médicaux

This thesis focuses on the optimization of clinical laboratory design and operating decisions. A clinicallaboratory is an organization gathering human and machinery resources to analyze blood samples. Inthis thesis, a decision support tool including mathematical models, a heuristic algorithm and acustomized simulation model is developed to aid decision makers for the main strategic, tactical andoperational problems in clinical laboratory design and operations management. This decision supporttool follows a top-down stepwise framework starting from strategic problems and ending withoperational ones, including a recursive loop for modification and improvement. In this thesis, machineselection and facility layout are studied as the main strategic problems, analyzer configuration problemas the tactical problem, and assignment, aliquoting, and scheduling as the principal operationalproblems. In order to deal with machine selection problem for clinical laboratory, a mathematical modelis proposed which aids to select the most appropriate machines to equip the system. To tackle physicalarrangement of instruments within the laboratory area, a heuristic approach is developed. The proposedheuristic comprises the key constraints of laboratory layout design. To address the analyzerconfiguration problem which mainly deals with the assignment of chemical materials to the analyzersin clinical laboratory, a bi-objective mathematical model is developed. In addition, to determine anefficient assignment of sample tubes to the analyzers, a mathematical model with three objectives isproposed. A customized, flexible, and fine-grained simulation model is developed in FlexSim to studythe clinical laboratory designed through the outputs of developed mathematical models and layoutalgorithm. Simulation model plays a key role in the proposed framework as it is used for many purposes.The simulation model helps the designer to construct and analyze a complete clinical laboratory takinginto account all major features of the system. This simulation attribute provides the ability to scrutinizethe system behaviour and to find out whether the designed system is efficient. System performanceanalysis through simulation and resulting key performance indicators give helpful feedbacks for systemimprovement. Furthermore, simulation model can be fruitful to decide on scheduling, aliquoting andstaffing problems through the evaluation of various scenarios proposed by decision maker for each ofthese problems. To verify the validity of the proposed framework, data extracted from a real case isused. The output results seal on the applicability and the efficiency of the proposed framework as wellas competency of proposed techniques to deal with each optimization problem. To the best of ourknowledge, this thesis is one of the leading studies on the optimization of clinical laboratories.Cette thèse porte sur l'optimisation de la conception et des décisions opérationnelles des laboratoires d'analyses médicales. Dans cette thèse, un outil d'aide à la décision comprenant des modèles mathématiques, un algorithme heuristique et un modèle de simulation personnalisé est développé pour aider les décideurs à résoudre les principaux problèmes stratégiques, tactiques et opérationnels en conception et gestion des opérations des laboratoires d'analyses médicales. Dans cette thèse, la sélection des machines et la disposition des instruments sont étudiées en tant que principaux problèmes stratégiques, le problème de configuration des analyseurs en tant que problème tactique et l’affectation, l’aliquotage et l'ordonnancement en tant que principaux problèmes opérationnels. Un modèle de simulation personnalisé et flexible est développé dans FlexSim pour étudier le laboratoire d'analyse médicale conçu à l'aide des résultats de modèles mathématiques et d'un algorithme de layout développés. Le modèle de simulation aide le concepteur à construire et à analyser un laboratoire complet en tenant compte de toutes les principales caractéristiques du système. Cet attribut de simulation permet d'analyser le comportement du système et de déterminer si le système conçu est efficace. Pour vérifier la validité du cadre proposé, les données extraites d’un cas réel sont utilisées. Les résultats de sortie scellent l'applicabilité et l'efficacité du cadre proposé ainsi que la compétence des techniques proposées pour traiter chaque problème d'optimisation. À notre connaissance, cette thèse est l’une des principales études sur l’optimisation des laboratoires d'analyses médicales

Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

International audienceOBJECTIVE: Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers. DESIGN AND SETTING: French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012. PARTICIPANTS: Patients were HIV-infected smokers at least 40 years, at least 20 pack-years, with a CD4 T-lymphocyte nadir count below 350 cells/μl. INTERVENTION: Single chest CT with a proposed standardized workup algorithm of positive images. MAIN OUTCOME MEASURE: The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up. RESULTS: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years. CONCLUSION: Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general populatio

PLoS One

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6-11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06-1.14, p<0.0001 and 1.06, 95% CI 1.01-1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.

BACKGROUND: Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. METHODS: A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. RESULTS: During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71% consensus), Social and Cultural Context (59% consensus), Built and Natural Environment (65% consensus), Psychology and Behaviour (80% consensus), Politics and Economics (78% consensus), and Institutional and Home Settings (78% consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89% of the participants. CONCLUSION: Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time

Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans

BACKGROUND: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors. METHODOLOGY/PRINCIPAL FINDINGS: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)]. CONCLUSIONS/SIGNIFICANCE: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI

Managing sedentary behavior to reduce the risk of diabetes and cardiovascular disease

Modern human environments are vastly different from those of our forebears. Rapidly advancing technology in transportation, communications, workplaces, and home entertainment confer a wealth of benefits, but increasingly come with costs to human health. Sedentary behavior—too much sitting as distinct from too little physical activity—contributes adversely to cardiometabolic health outcomes and premature mortality. Findings from observational epidemiology have been synthesized in meta-analyses, and evidence is now shifting into the realm of experimental trials with the aim of identifying novel mechanisms and potential causal relationships. We discuss recent observational and experimental evidence that makes a compelling case for reducing and breaking up prolonged sitting time in both the primary prevention and disease management contexts. We also highlight future research needs, the opportunities for developing targeted interventions, and the potential of population-wide initiatives designed to address too much sitting as a health risk

Combinatorial hydrogel library enables identification of materials that mitigate the foreign body response in primates

The foreign body response is an immune-mediated reaction that can lead to the failure of implanted medical devices and discomfort for the recipient. There is a critical need for biomaterials that overcome this key challenge in the development of medical devices. Here we use a combinatorial approach for covalent chemical modification to generate a large library of variants of one of the most widely used hydrogel biomaterials, alginate. We evaluated the materials in vivo and identified three triazole-containing analogs that substantially reduce foreign body reactions in both rodents and, for at least 6 months, in non-human primates. The distribution of the triazole modification creates a unique hydrogel surface that inhibits recognition by macrophages and fibrous deposition. In addition to the utility of the compounds reported here, our approach may enable the discovery of other materials that mitigate the foreign body response.Leona M. and Harry B. Helmsley Charitable Trust (3-SRA-2014-285-M-R)United States. National Institutes of Health (EB000244)United States. National Institutes of Health (EB000351)United States. National Institutes of Health (DE013023)United States. National Institutes of Health (CA151884)United States. National Institutes of Health (P41EB015871-27)National Cancer Institute (U.S.) (P30-CA14051