A flexible integrated forward/reverse logistics model with random path

This dissertation focuses on the structure of a particular logistics network design problem, one that is a major strategic issue for supply chain design and management. Nowadays, the design of the supply chain network must allow for operation at the lowest cost, while providing the best customer service and accounting for environmental protection. Due to business and environmental issues, industrial players are under pressure to take back used products. Moreover, the significance of transportation costs and customer satisfaction spurs an interest in developing a flexible network design model. To this end, in this study, we attempt to include this reverse flow through an integrated design of a forward/reverse supply chain network design, that avoids the sub-optimal solutions derived from separated designs. We formulate a cyclic, seven-stage, logistics network problem as an NP-hard mixed integer linear programming (MILP) model. This integrated, multi-stage model is enriched by using a complete delivery graph in forward flow, which makes the problem more complex. As these kinds of problems belong to the category of NP-hard problems, traditional approaches fail to find an optimal solution in sufficiently short time. Furthermore, considering an integrated design and flexibility at the same time makes the logistics network problem even more complex, and makes it even less likely, if not impossible, for a traditional approach to provide solution within an acceptable time frame. Hence, researchers develop efficient non-traditional techniques for the large-term operation of the whole supply chain. These techniques provide near optimal solutions particularly for large scale test problems. In our case within this thesis, to find a near optimal solution, we apply a Memetic Algorithm with a neighborhood search mechanism and a novel chromosome representation called extended random path direct encoding method which includes two segments. Chromosome representation is one of the main issues that can affect the performance of a Memetic Algorithm. To illustrate the performance of the proposed Memetic Algorithm, LINGO optimization software as commercial package serves as a comparison for small size problems. We show that the proposed algorithm is able to efficiently find a good solution for the flexible, integrated, logistics network. Each algorithm has some parameters that need to be investigated to provide the best performance. In this regard, the effect of different parameters on the behavior of the proposed meta-heuristic algorithm is surveyed first. Then, the Taguchi method is adapted to identify the most important parameters and rank the latter. Additionally, Taguchi method is applied to identify the optimum operating condition of the proposed Memetic Algorithm to improve the results. In this study, four factors that are defined inputs of the proposed Memetic Algorithm, namely: population size, cross over rate, local search iteration, and number of iterations are considered. The analysis of the parameters and the improvement in results are both illustrated by a numerical case studies. Finally, to show the performance of the Memetic Algorithm, a Genetic Algorithm - as a second meta-heuristic algorithm option - is considered as regards large size cases

A New Approach to the Diagnostic and Therapeutic Dysmenorrhea Protocols, a Combination of Persian Medicine and Contemporary Medicine

زمینه و هدف: با وجود پیشرفت‌های پزشکی تشخیص و درمان دیسمنوره یکی از معضلات مراقبت‌های بهداشتی محسوب می‌گردد و تاکنون پروتکل تلفیقی دانش طب سنتی ایران و طب رایج برای تشخیص و درمان دیسمنوره ارائه نشده است، لذا در این مطالعه به بررسی این پروتکل‌ها پرداخته می‌شود. مواد و روش‌ها:‌ برای تدوین این دو پروتکل از سه روش مرور نقلی، کیفی و اجماع صاحب‌نظران استفاده شد. در این راستا، جستجو در 19 منبع طب سنتی ایران و همچنین دو کتاب مرجع ژنیکولوژی و 4 پایگاه‌ اطلاعاتی انجام شد. یافته‌ها: یافته‌ها در سه بخش مروری بر تبیین دیسمنوره از دیدگاه طب سنتی ایران و طب رایج، پروتکل تشخیص دیسمنوره و پروتکل درمان گام ‌به‌ گام دیسمنوره اولیه بیان ‌شد. پروتکل تشخیص دیسمنوره از هر دو دیدگاه طب سنتی ایران و طب رایج می‌تواند راه‌گشای تشخیص علت موارد ناشناخته دیسمنوره اولیه باشد. از سوی دیگر درمان‌های دیسمنوره اولیه در طب رایج تنها اثر تسکینی داشته و با عدم پاسخ به درمان همراه هستند، در حالی‌ که مکتب طب سنتی ایران دارای روش‌های متعدد، متنوع و گام به گام در درمان دیسمنوره اولیه می‌باشد که این درمان‌ها علاوه بر اثر تسکینی دارای اثر درمانی نیز هستند. نتیجه‌گیری: توصیه می‌شود در بررسی علل و درمان دیسمنوره اولیه دیدگاه طب سنتی ایران در کنار دیدگاه طب رایج در نظر گرفته شود.Background and Aim: Despite medical advances, diagnosis and treatment of dysmenorrhea is one of the health care problems. The protocol for the diagnosis and treatment of dysmenorrhea has not yet been presented in a combination of Persian Medicine and contemporary medicine. Therefore, the aim of the present study is to examine these protocols. Materials and Methods: Three methods including narrative review, qualitative method and scientific consensus were used to write these two protocols. In this regard, 19 ITM references, 2 gynecology references and 4 databases were searched. Findings: The findings were presented in three parts including the review on the explanation of dysmenorrhea from the perspective of ITM and contemporary medicine, the diagnosis protocol for dysmenorrhea and the stepwise treatment protocol for primary dysmenorrhea. The diagnosis protocol for dysmenorrhea from both ITM and contemporary medicine perspectives, could identify the unknown causes of primary dysmenorrhea. On the other hand, treatment of primary dysmenorrhea in contemporary medicine has only palliative effects and are associated with lack of response to treatment, while ITM School has explained several, varied, and step-by-step methods for the treatment of primary dysmenorrhea, which have therapeutic effects in addition to palliative effects. Conclusion: It is recommended that ITM perspective be considered along with the view of contemporary medicine in the study of the causes and treatment of primary dysmenorrhea.   Please cite this article as: Shirooye P, Nabi Meybodi R, Tansaz M, Behmanesh E, Mokaberinejad R. A New Approach to the Diagnostic and Therapeutic Dysmenorrhea Protocols, a Combination of Persian Medicine and Contemporary Medicine. Med Hist J 2018; 9(33): 63-75

Ein flexibles integriertes Vorwärts-/Rückwärts logistikmodell mit zufälligem Weg

This dissertation focuses on the structure of a particular logistics network design problem, one that is a major strategic issue for supply chain design and management. Nowadays, the design of the supply chain network must allow for operation at the lowest cost, while providing the best customer service and accounting for environmental protection. Due to business and environmental issues, industrial players are under pressure to take back used products. Moreover, the significance of transportation costs and customer satisfaction spurs an interest in developing a flexible network design model. To this end, in this study, we attempt to include this reverse flow through an integrated design of a forward/reverse supply chain network design, that avoids the sub-optimal solutions derived from separated designs. We formulate a cyclic, seven-stage, logistics network problem as an NP-hard mixed integer linear programming (MILP) model. This integrated, multi-stage model is enriched by using a complete delivery graph in forward flow, which makes the problem more complex. As these kinds of problems belong to the category of NP-hard problems, traditional approaches fail to find an optimal solution in sufficiently short time. Furthermore, considering an integrated design and flexibility at the same time makes the logistics network problem even more complex, and makes it even less likely, if not impossible, for a traditional approach to provide solution within an acceptable time frame. Hence, researchers develop efficient non-traditional techniques for the large-term operation of the whole supply chain. These techniques provide near optimal solutions particularly for large scale test problems. In our case within this thesis, to find a near optimal solution, we apply a Memetic Algorithm with a neighborhood search mechanism and a novel chromosome representation called "extended random path direct encoding method" which includes two segments. Chromosome representation is one of the main issues that can affect the performance of a Memetic Algorithm. To illustrate the performance of the proposed Memetic Algorithm, LINGO optimization software as commercial package serves as a comparison for small size problems. We show that the proposed algorithm is able to efficiently find a good solution for the flexible, integrated, logistics network. Each algorithm has some parameters that need to be investigated to provide the best performance. In this regard, the effect of different parameters on the behavior of the proposed meta-heuristic algorithm is surveyed first. Then, the Taguchi method is adapted to identify the most important parameters and rank the latter. Additionally, Taguchi method is applied to identify the optimum operating condition of the proposed Memetic Algorithm to improve the results. In this study, four factors that are defined inputs of the proposed Memetic Algorithm, namely: population size, cross over rate, local search iteration, and number of iterations are considered. The analysis of the parameters and the improvement in results are both illustrated by a numerical case studies. Finally, to show the performance of the Memetic Algorithm, a Genetic Algorithm - as a second meta-heuristic algorithm option - is considered as regards large size cases

The Effect of Various Parameters of Solution Methodology on a Flexible Integrated Supply Chain Model

A successful supply chain must be able to operate at the lowest cost while providing the best customer service as well as environmental protection. As industrial players are under pressure but mostly unprepared to take back products after their usage, logistics network design becomes an even more important issue. To allow for a maximum of flexibility and efficiency, we consider an integrated design of the forward/reverse logistics network using full delivery graph. We apply a Memetic Algorithm with a novel population generation to find a near optimal solution for large size problems. The effect of different parameters on the behavior of the proposed Metaheuristic Algorithm is investigated. Using the experimental work to find the best parameters for this problem is the outlook of these researches

Al-Zahrawi, The First Physician who Described Dysmenorrhea

Menstrual period is one of the girl’s puberty stages, in which any change can expose a woman’s sex life to natural fertility or infertility. Dysmenorrhea is a kind of pelvic pain that 50-90% of reproductive women experience during their lives. It is the greatest cause of lost working and school days among young women that decreases the quality of life. There is a great trend to use Traditional Medicine recommendations and prescriptions in the world. As a result, searching the literature and finding common points in Traditional Medicine and Gynecology is necessary. This way, opening up new avenues in the treatment and control of dysmenorrhea, possibly avoids wasting time and community’s investment and enhances the quality of life of women. While searching ancient PM texts during 9th -19th A.D., there are many overlapping conditions, which may mimic this disorder. There are not any particular terms and definitions for dysmenorrhea, while, it is mentioned in Persian Medicine literature under different names such as Oja-e Rahem (Uterus pain), Osr-o Tams (dysmenorrhea) and Oja-e Zahr (back pain). There are many management lines for women in the TPM literature which have been of great interest to physicians throughout the history, but among menstrual changes, dysmenorrhea is not the earliest concern. First explanation of dysmenorrhea was found in the Al-Zahrawi‘s masterpiece of Al-tasrif in detail. It can be helpful to test these suggestions as ideas for clinical researches

Effect of eryngo (Eryngium caucasicum Trautv) on primary dysmenorrhea: A randomized, double-blind, placebo-controlled study

Objective: This study strove to investigate the safety and effectiveness of Eryngo in the treatment of primary dysmenorrhea. Materials and methods: The researchers conducted a blinded, randomized, trial design on 169 women, 15–30 years of age, who had been diagnosed with primary dysmenorrhea at Babol University of Medical Sciences. Subjects were randomly assigned to receive 5 ml syrup of Eryngo, placebo, or Ibuprofen (200 mg) three times a day (15 ml/day), from one day prior to the onset of bleeding for five days. The degree of dysmenorrhea was reported by two measures; Visual analogue scale (VAS), as a primary outcome, and the assessment of dysmenorrhea severity (VMS), as a secondary outcome at 4 menstrual cycles: at pretreatment phase, at the first menstrual cycle, at the second menstrual cycle, and the third menstrual cycle without drug. Results: The reduced peak-pain differed by the treatment length in women treated for two menstrual cycles: 4.2 (1.0) cm in the Eryngo group, 4.3 (0.0) cm in the Ibuprofen group, and 0.9 (0.1) cm in the placebo group (P < 0.0001). No serious side effects were reported in all groups under study. According to the results, minor side effects did not increase in the Eryngo group when compared with the placebo group. Conclusion: Eryngo relieved dysmenorrhea as effectively as Ibuprofen did. Thus, Eryngo could be regarded as a new herbal remedy for the treatment of dysmenorrhea. However, in order to prescribe Eryngo as herbal remedy, rigorous research studies are required to establish its efficacy by investigating its chemical, pharmacologic, and therapeutic properties. Keywords: Dysmenorrhea, Herbal medicine, Wome

A survey of anaphylaxis etiology and treatment

Identifying the causes of anaphylaxis which is an acute, potentially fatal systemic reaction is very important in every community. Treatment strategies and pitfalls should also be determined. We sought to determine the most common triggers of anaphylaxis, clinical manifestations and treatment strategies in Mashhad, northeast of Iran. An observational cross-sectional study was conducted to evaluate all patients with a history of anaphylactic reaction who were referred to University Allergy Clinics between 2006 and 2016 in Mashhad Iran. We used a combination of patient's clinical history and allergy diagnostic testing including radioallergosorbant test and skin prick test in order to determine the etiology of anaphylaxis. We identified 172 anaphylactic reactions in 70 patients. Median age was 15 years with a range from 6 months to 48 years. The triggers included: foods, 61.4%; drugs, 15.7%; hymenoptera venom, 8.6%; idiopathic, 5.7%; immunotherapy, 4.3% and other etiologies: 5.7%. Nuts and seeds were the most important triggers of food induced anaphylaxis, especially in school children, adolescents and young adults, followed by fruits. However, Cow's milk and hen's egg were the main triggers of anaphylaxis in children aged under 2 years. The most common symptoms were cutaneous and cardiovascular. Corticosteroids (94.3%) and/or antihistamines (85.7%) were used most frequently for treatment followed by intravenous fluids (54.3%), whereas epinephrine was only used in 17.1% of the cases. Food related anaphylaxis and other typical triggers of anaphylaxis are age dependent and the risks and triggers change with age. Epinephrine injection should be increased by improving the awareness of physician and medical teams. The study was approved by the Ethics Committee of the Faculty of Medicine of Mashhad University of Medical Sciences (approved number: IR.MUMS.REC.1393.960)

Evaluation of Clinical and Laboratory Data in Patients with Recurrent Infections and Suspected Immunodeficiency

Background: Frequent infections is among the most frequent clinical dilemmas for primary care physicians. Immunodeficiency disorders are a heterogeneous group of illnesses that predispose patients to the recurrent infections, autoimmunity and malignancies. The aim of this study was to evaluate the clinical and laboratory data collected for the final diagnosis of patients referred with recurrent infections and suspected immunodeficiency to a local immunodeficiency clinic.   Methods: This epidemiological study was carried out between April 2010 and September 2012 at the Immunodeficiency Clinic of Mashhad. All patients with clinical manifestations of immunodeficiency who were referred to our clinic during this period of time were included in this study. 41 patients aged from 10 months to 51 years, were evaluated. Results: Forty one patients, aged between 10 months and 51 years were evaluated. Eleven patients had a primary immunodeficiency, four cases had a secondary immunodeficiency, in three patients an underlying structural disease were found, eight patients were predisposed to recurrent infections as a result of allergies and finally, fifteen cases were found to be normal individuals.   Discussion: Most patients with recurrent infection have a normal immune system. Allergic disorders are the most common predisposing factor to recurrent infection. However, as immunodeficiency disorders are potentially serious, early diagnosis can improve the quality of life and outcome and prevent severe sequels in future