Workforce management in periodic delivery operations

Service quality and driver efficiency in the delivery industry may be enhanced by increasing the regularity with which a driver visits the same set of customers. However, effectively managing a workforce of drivers may increase travel distance, a traditional metric of the vehicle routing problem (VRP). This paper evaluates the effect that workforce management has on routing costs, providing insight for managerial decision making. The analysis is presented in the context of the period vehicle routing problem (PVRP), an extension of the VRP with vehicle routes constructed to service customers according to preset visit frequencies over an established period of time. We develop models to apply workforce management principles. We show that multi-objective PVRP models can achieve a balance between workforce management and travel distance goals, through a computational study with standard PVRP test cases and real-world delivery data. With the proper parameters in place, workforce management principles may be successfully applied without sacrificing other operational objectives

The association between body posture and malocclusion - a literature review

Effective body posture entails the correct alignment of body parts in relation to each other and is crucial for preserving balance, stability, and the efficient operation of muscles and joints. The major types of posture abnormalities such as lordosis, kyphosis and scoliosis can lead to alterations in various areas of the body, such as stomatognatic system. The potential correlation between malocclusion and body posture remains a subject of controversy. The aim of this review is to investigate and evaluate the association between posture defects and malocclusion on the basis of literature. This literature review has analyzed 18 studies. Inclusion criteria: clinical researches published after 2010, regarding children and adults. PubMed and Google Scholar has been searched to identify the papers. In 18 analyzed  studies, 2133 patients were enrolled (including 979 children aged 4-18). A positive correlation between scoliosis and different types of malocclusion has been proven by six papers. There are also other noteworthy dependencies,  such as overjet and pelvic torsion, kyphosis and sagittal position of mandible, skeletal Class III and torticollis, cross bite and scapula plane.  Adolescent Idiopathic Scoliosis significantly affects the stomatognathic system, leading to issues like crossbite, crowding, increased overjet, overbite, partial open bite, and midline deviation. Orthopedists should collaborate with orthodontists for comprehensive treatment, particularly during developmental stages

Beyond conventional therapies: exploring the role of Pilates in neurological physical therapy – a review of the latest research

Pilates exercise method, characterized by its holistic approach, underscores core stability, strength, and flexibility, coupled with meticulous muscle control, optimal posture, and focused attention on breathing. Widely embraced in both general and clinical fitness realms, this study aims to evaluate the integration of Pilates into physical therapy practices for patients with neurological disorders. Existing studies indicate the potential efficacy of Pilates in diverse rehabilitation contexts. However, neurological disorders, specifically multiple sclerosis (MS) and Parkinson's disease (PD), have been the primary focus. While systematic reviews and meta-analyses suggest Pilates as a plausible option in physiotherapy for PD and MS patients, a paucity of research on this subject necessitates a comprehensive review of recent original studies. Analysis of gathered data suggests that Pilates, when incorporated, may yield benefits for patients with various neurological disorders. Consideration of Pilates as a supplementary element to physical activity for those with PD and MS emerges as a reasonable proposition. The study also encourages contemplation of Pilates in rehabilitation research across a broader spectrum of neurological disorders. Subsequent investigations, incorporating relevant considerations, will contribute to a nuanced understanding of Pilates' potential benefits and its comparative advantages over traditional interventions for neurological disorders

The Impact of E-Cigarettes on Oral Injuries and Bone Fractures

Introduction The rising prevalence of electronic cigarette (e-cigarette) use has prompted concerns regarding its potential health implications. While much attention has focused on respiratory and cardiovascular effects, injuries, oral trauma, and bone fractures linked to e-cigarette use have received less scrutiny. This paper aims to comprehensively review the landscape of injuries, oral trauma, and bone fractures induced by e-cigarettes, shedding light on this underexplored facet of e-cigarette-related harm. Material and Methods This literature review has analyzed 16 papers. Inclusion criteria: researches and case reports published after 2015. PubMed and Google Scholar has been searched to identify the papers.  Analysis of the Literature Existing literature suggests a growing incidence of injuries, oral trauma, and bone fractures associated with e-cigarette use, albeit with limited systematic investigation. Mechanisms underlying these injuries range from device malfunctions to inadvertent impacts during use. Case reports highlight a spectrum of injuries, including oral burns, dental trauma, and skeletal fractures, often involving the face and mouth regions. Conclusions Despite the lack of comprehensive epidemiological data emerging evidence underscores the need for heightened awareness and preventive measures to mitigate e-cigarette-related injuries. Enhanced education, regulation of e-cigarette devices, and promotion of safer usage practices are crucial steps towards reducing the burden of e-cigarette-related harm on oral and skeletal health

Association between deficient levels of vitamin D and the occurrence of selected retinal diseases

Introduction and Purpose: Vision originates in the eye's retina, a complex structure essential for processing visual information. The connection between nutritional inadequacy, particularly vitamin deficiencies, and overall health, including ocular health, has long been acknowledged. Recent studies highlight the potential impact of vitamin D, a crucial nutrient, on retinal health. The aim is to investigate the association between low levels of vitamin D and retinal diseases like age-related macular degeneration (AMD) and diabetic retinopathy (DR), and to evaluate the potential benefits of vitamin D supplementation or lifestyle changes for at-risk patients. Description of the State of Knowledge: AMD, a significant cause of blindness in the elderly, involves factors like oxidative stress and inflammation. Various stages of AMD require different treatments, with limited options for advanced stages. DR, a complication of diabetes, leads to conditions such as retinal ischemia and neovascularization. Both conditions are potentially influenced by vitamin D levels. Studies show mixed results regarding the impact of vitamin D on these diseases. Some suggest lower levels may increase risk, while others report no significant effect or even contradictory findings. Conclusions: While some studies indicate a potential association between low vitamin D levels and the occurrence of retinal diseases, discrepancies exist in the findings. Lower vitamin D concentrations may be linked to a higher frequency of AMD and DR, but the evidence is not consistent across all studies. Therefore, a more in-depth exploration of this subject is warranted to draw conclusive insights. It is crucial to consider supplementation or dietary changes in cases of vitamin D deficiency, given its potential impact on systemic health

Adolescents' views of food and eating: Identifying barriers to healthy eating

This is a postprint version of the article. The official published version can be accessed from the link below - © 2006 The Association for Professionals in Services for Adolescents Published by Elsevier Ltd.Contemporary Western society has encouraged an obesogenic culture of eating amongst youth. Multiple factors may influence an adolescent's susceptibility to this eating culture, and thus act as a barrier to healthy eating. Given the increasing prevalence of obesity amongst adolescents, the need to reduce these barriers has become a necessity. Twelve focus group discussions of single-sex groups of boys or girls ranging from early to-mid adolescence (N = 73) were employed to identify key perceptions of, and influences upon, healthy eating behaviour. Thematic analysis identified four key factors as barriers to healthy eating. These factors were: physical and psychological reinforcement of eating behaviour; perceptions of food and eating behaviour; perceptions of contradictory food-related social pressures; Q perceptions of the concept of healthy eating itself. Overall, healthy eating as a goal in its own right is notably absent from the data and would appear to be elided by competing pressures to eat unhealthily and to lose weight. This insight should inform the development of future food-related communications to adolescents. (c) 2006 The Association for Professionals in Services for Adolescents.Funding from Safefood: the food safety promotion board is acknowledged

Vitamin D status of pregnant women with obesity in the United Kingdom and its association with pregnancy outcomes: a secondary analysis of the UPBEAT study

Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI≥30kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17±1 weeks' gestation were assessed using multivariable linear regression and reported as percent differences in serum hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67% had 25(OH)D &lt;50nmol/L and 26% had concentrations &lt;25nmol/L. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = -33; 95%CI: -39 to -27), Asian (% difference= -43; 95%CI: -51 to -35) and other non-White (% difference= -26; 95%CI: -35 to -14) ethnicity compared to women of White ethnicity (n=1086; P&lt;0.001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D &lt;25nmol/L compared to ≥50nmol/L (OR=1.58; 95%CI: 1.09 to 2.31), but the magnitude of effect estimates was attenuated in the multivariable model (OR=1.33; 95%CI: 0.88 to 2.00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth, or SGA or LGA delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.</p

Racial disparities in modifiable risk factors and statin usage in Black patients with familial hypercholesterolemia

Background Black men and women are at higher risk for, and suffer greater morbidity and mortality from, atherosclerotic cardiovascular disease (ASCVD) compared with adults of European Ancestry (EA). Black patients with familial hypercholesterolemia are at particularly high risk for ASCVD complications because of lifelong exposure to elevated levels of low-density-lipoprotein cholesterol. Methods and Results This retrospective study analyzed ASCVD prevalence and risk factors in 808 adults with heterozygous familial hypercholesterolemia from 5 US-based lipid clinics, and compared findings in Black versus EA patients. Multivariate logistic regression models were used to determine the strongest predictors of ASCVD as a function of race. No significant difference was noted in the prevalence of ASCVD in Black versus EA patients with familial hypercholesterolemia (39% versus 32%, respectively

Combined population genomic screening for three high-risk conditions in Australia: a modelling study

BACKGROUND: No previous health-economic evaluation has assessed the impact and cost-effectiveness of offering combined adult population genomic screening for mutliple high-risk conditions in a national public healthcare system. METHODS: This modeling study assessed the impact of offering combined genomic screening for hereditary breast and ovarian cancer, Lynch syndrome and familial hypercholesterolaemia to all young adults in Australia, compared with the current practice of clinical criteria-based testing for each condition separately. The intervention of genomic screening, assumed as an up-front single cost in the first annual model cycle, would detect pathogenic variants in seven high-risk genes. The simulated population was 18–40 year-olds (8,324,242 individuals), modelling per-sample test costs ranging AU$100–$1200 (base-case AU$200) from the year 2023 onwards with testing uptake of 50 FINDINGS: Over the population lifetime (to age 80 years), the model estimated that genomic screening per-100,000 individuals would lead to 747 QALYs gained by preventing 63 cancers, 31 CHD cases and 97 deaths. In the total model population, this would translate to 31,094 QALYs gained by preventing 2612 cancers, 542 non-fatal CHD events and 4047 total deaths. At AU$200 per-test, genomic screening would require an investment of AU$832 million for screening of 50$23,926 (∼£12,050/€14,110/US$15,345) per QALY gained over the status quo. In scenario analysis with 3$4758/QALY was obtained. Sensitivity analysis for the base case indicated that combined genomic screening would be cost-effective under 70% of simulations, cost-saving under 25% and not cost-effective under 5%. Threshold analysis showed that genomic screening would be cost-effective under the AU$50,000/QALY willingness-to-pay threshold at per-test costs up to AU$325 (∼£164/€192/US$208). INTERPRETATION: Our findings suggest that offering combined genomic screening for high-risk conditions to young adults would be cost-effective in the Australian public healthcare system, at currently realistic testing costs. Other matters, including psychosocial impacts, ethical and societal issues, and implementation challenges, also need consideration. FUNDING: Australian Government, Department of Health, Medical Research Future Fund, Genomics Health Futures Mission (APP2009024). National Heart Foundation Future Leader Fellowship (102604)