Axle Weights in Combined Vehicle Routing and Container Loading Problems

Overloaded axles not only lead to increased erosion on the road surface, but also to an increased braking distance and more serious accidents due to higher impact energy. Therefore, the load on axles should be already considered during the planning phase and thus before loading the truck in order to prevent overloading. Hereby, a detailed 2D or 3D planning of the vehicle loading space is required. We model the Axle Weight Constraint for trucks with and without trailers based on the Science of Statics. We include the Axle Weight Constraint into the combined Vehicle Routing and Container Loading Problem ("2L-CVRP" and "3L-CVRP"). A hybrid approach is used where an outer Adaptive Large Neighbourhood Search tackles the routing problem and an inner Deepest-Bottom-Left-Fill algorithm solves the packing problem. Moreover, to ensure feasibility, we show that the Axle Weight Constraint must be checked after each placement of an item. The impact of the Axle Weight Constraint is also evaluated.Overloaded axles not only lead to increased erosion on the road surface, but also to an increased braking distance and more serious accidents due to higher impact energy. Therefore, the load on axles should be already considered during the planning phase and thus before loading the truck in order to prevent overloading. Hereby, a detailed 2D or 3D planning of the vehicle loading space is required. We model the Axle Weight Constraint for trucks with and without trailers based on the Science of Statics. We include the Axle Weight Constraint into the combined Vehicle Routing and Container Loading Problem ("2L-CVRP" and "3L-CVRP"). A hybrid approach is used where an outer Adaptive Large Neighbourhood Search tackles the routing problem and an inner Deepest-Bottom-Left-Fill algorithm solves the packing problem. Moreover, to ensure feasibility, we show that the Axle Weight Constraint must be checked after each placement of an item. The impact of the Axle Weight Constraint is also evaluated

Distribution of oral nutritional supplements with medication: Is there a benefit? A systematic review

Introduction: Disease related Malnutrition remains a major burden for patients and healthcare systems. The Medication Pass Nutritional Supplement Program (MEDPass) involves providing patients with oral nutritional supplements (ONS) in unusually small amounts three to four times a day during medication rounds. This systematic review aims to evaluate the impact of MEDPass ONS administration on compliance, total energy and protein intake, food intake, body weight (BW), and handgrip strength (HGS) in hospitalized adults and nursing home residents. Methods: We conducted a systematic literature search in the databases MEDLINE, Embase, Sciencedirect and the Cochrane Library. Included study types were randomized controlled trials (RCT), non-randomized controlled trials (non-RCT) and before-after studies. Validated tools specific to the study design were used to assess included studies. Results: Ten studies were identified with two being RCTs, three non-RCTs and five before-after trials. Compliance increased by 23.4-66% with MEDPass administration, resulting in compliance rates of 72.7-96%. With MEDPass administration, BW increased by 1-6.8% or remained stable. The assessed evidence on total energy intake is ambiguous for protein, with a trend towards an increased intake. Trials on energy intake from food show mixed results as well. One study suggests a slight increase in HGS. The included studies predominantly raise concerns for bias. Conclusion: We conclude that MEDPass ONS administration increases compliance in hospitalized adults and nursing home residents. For all other outcomes, robust and well-powered trials are necessary

Distribution of oral nutritional supplements with medication: Is there a benefit? A systematic review.

OBJECTIVES Disease-related malnutrition remains a major burden for patients and health care systems. The Medication Pass Nutritional Supplement Program (MEDPass) involves providing patients with oral nutritional supplements (ONS) in unusually small amounts three to four times per day during medication rounds. This systematic review aims to evaluate the impact of MEDPass ONS administration on compliance, total energy and protein intake, food intake, body weight and handgrip strength in hospitalized adults and nursing-home residents. METHODS We conducted a systematic literature search in the databases MEDLINE, Embase, ScienceDirect, and the Cochrane Library and included randomized controlled trials (RCTs), non-RCTs, and before-after studies. Validated tools specific to the study design were used to assess the included studies. RESULTS Ten studies were identified, including two RCTs, three non-RCTs, and five before-after trials. Compliance increased by 23.4% to 66% with MEDPass administration, resulting in compliance rates of 72.7% to 96%. With MEDPass administration, body weight increased by 1% to 6.8% or remained stable. The assessed evidence on total energy intake is ambiguous for protein, with a trend toward an increased intake. Trials on energy intake from food show mixed results as well. One study suggested a slight increase in handgrip strength. The included studies predominantly raise concerns for bias. CONCLUSIONS We conclude that MEDPass ONS administration increases compliance in hospitalized adults and nursing-home residents. For all other outcomes, robust and well-powered trials are necessary

Iron in Micronutrient Powder Promotes an Unfavorable Gut Microbiota in Kenyan Infants

Iron supplementation may have adverse health effects in infants, probably through manipulation of the gut microbiome. Previous research in low-resource settings have focused primarily on anemic infants. This was a double blind, randomized, controlled trial of home fortification comparing multiple micronutrient powder (MNP) with and without iron. Six-month-old, non- or mildly anemic, predominantly-breastfed Kenyan infants in a rural malaria-endemic area were randomized to consume: (1) MNP containing 12.5 mg iron (MNP+Fe, n = 13); (2) MNP containing no iron (MNP−Fe, n = 13); or (3) Placebo (CONTROL, n = 7), from 6–9 months of age. Fecal microbiota were profiled by high-throughput bacterial 16S rRNA gene sequencing. Markers of inflammation in serum and stool samples were also measured. At baseline, the most abundant phylum was Proteobacteria (37.6% of rRNA sequences). The proteobacterial genus Escherichia was the most abundant genus across all phyla (30.1% of sequences). At the end of the intervention, the relative abundance of Escherichia significantly decreased in MNP−Fe (−16.05 ± 6.9%, p = 0.05) and CONTROL (−19.75 ± 4.5%, p = 0.01), but not in the MNP+Fe group (−6.23 ± 9%, p = 0.41). The second most abundant genus at baseline was Bifidobacterium (17.3%), the relative abundance of which significantly decreased in MNP+Fe (−6.38 ± 2.5%, p = 0.02) and CONTROL (−8.05 ± 1.46%, p = 0.01), but not in MNP-Fe (−4.27 ± 5%, p = 0.4445). Clostridium increased in MNP-Fe only (1.9 ± 0.5%, p = 0.02). No significant differences were observed in inflammation markers, except for IL-8, which decreased in CONTROL. MNP fortification over three months in non- or mildly anemic Kenyan infants can potentially alter the gut microbiome. Consistent with previous research, addition of iron to the MNP may adversely affect the colonization of potential beneficial microbes and attenuate the decrease of potential pathogens

Pennsylvania Folklife Vol. 22, No. 2

• The Easton Bible Artist Identified • Christmas Customs in the Lehigh Valley • The Inn Crowd: The American Inn, 1730-1830 • Pennsylvania German Astronomy and Astrology IV: Tombstones • Emigrants of the 18th Century from the Northern Palatinate • Butchering on the Pennsylvania Farm: Folk-Cultural Questionnaire No. 27https://digitalcommons.ursinus.edu/pafolklifemag/1051/thumbnail.jp

Witness: The Modern Writer as Witness

Editor\u27s Note [Excerpt] The United States, as a society, is on the brink of profound and positive change. Demographically and culturally, things are improving, and the reason is obvious to people who study history: Conflict pushes us to be better, to strive for principled goals. Consider the inspired eco-advocacy of Greta Thunberg. Or the swearing in of most diverse class of lawmakers in history into the 116th Congress. Or billionaire Robert F. Smith’s pledge to pay off every Morehouse College (in Atlanta, Georgia) student’s debt. Indeed, there are many good people helping and great moments happening in spite of a bleak 24-hour news cycle designed to ruin happiness and to limit our understanding of our human potential. We at Witness see this yearning for transformation in the works we selected. The doorway must be crossed, and the voices and characters we featured in our Winter 2019 issue stand at the vestibule, ready for the light to warm them, primed to fight for that necessary illumination.https://digitalscholarship.unlv.edu/witness/1000/thumbnail.jp

Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings

BACKGROUND: To describe quantitative data quality monitoring and performance metrics adopted by the Global Network´s (GN) Maternal Newborn Health Registry (MNHR), a maternal and perinatal population-based registry (MPPBR) based in low and middle income countries (LMICs). METHODS: Ongoing prospective, population-based data on all pregnancy outcomes within defined geographical locations participating in the GN have been collected since 2008. Data quality metrics were defined and are implemented at the cluster, site and the central level to ensure data quality. Quantitative performance metrics are described for data collected between 2010 and 2013. RESULTS: Delivery outcome rates over 95% illustrate that all sites are successful in following patients from pregnancy through delivery. Examples of specific performance metric reports illustrate how both the metrics and reporting process are used to identify cluster-level and site-level quality issues and illustrate how those metrics track over time. Other summary reports (e.g. the increasing proportion of measured birth weight compared to estimated and missing birth weight) illustrate how a site has improved quality over time. CONCLUSION: High quality MPPBRs such as the MNHR provide key information on pregnancy outcomes to local and international health officials where civil registration systems are lacking. The MNHR has measures in place to monitor data collection procedures and improve the quality of data collected. Sites have increasingly achieved acceptable values of performance metrics over time, indicating improvements in data quality, but the quality control program must continue to evolve to optimize the use of the MNHR to assess the impact of community interventions in research protocols in pregnancy and perinatal health.Fil: Goudar, Shivaprasad S.. KLE University. Jawaharlal Nehru Medical College; IndiaFil: Stolka, Kristen B.. Research Triangle Institute International; Estados UnidosFil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados UnidosFil: Honnungar, Narayan V.. KLE University. Jawaharlal Nehru Medical College; IndiaFil: Mastiholi, Shivanand C.. KLE University. Jawaharlal Nehru Medical College; IndiaFil: Ramadurg, Umesh Y.. S. Nijalingappa Medical College; IndiaFil: Dhaded, Sangappa M.. KLE University. Jawaharlal Nehru Medical College; IndiaFil: Pasha, Omrana. Aga Khan University; PakistánFil: Patel, Archana. Indira Gandhi Government Medical College and Lata Medical Research Foundation; IndiaFil: Esamai, Fabian. University School of Medicine; KeniaFil: Chomba, Elwyn. University of Zambia; ZambiaFil: Garces, Ana. Universidad de San Carlos; GuatemalaFil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Carlo, Waldemar A.. University of Alabama at Birmingahm; Estados UnidosFil: Goldenberg, Robert L.. Columbia University; Estados UnidosFil: Hibberd, Patricia L.. Massachusetts General Hospital for Children; Estados UnidosFil: Liechty, Edward A.. Indiana University; Estados UnidosFil: Krebs, Nancy F.. University of Colorado School of Medicine; Estados UnidosFil: Hambidge, Michael K.. University of Colorado School of Medicine; Estados UnidosFil: Moore, Janet L.. Research Triangle Institute International; Estados UnidosFil: Wallace, Dennis D.. Research Triangle Institute International; Estados UnidosFil: Derman, Richard J. Christiana Care Health Services; Estados UnidosFil: Bhalachandra, Kodkany S.. KLE University. Jawaharlal Nehru Medical College; IndiaFil: Bose, Carl L.. University of North Carolina; Estados Unido

Trends and determinants of stillbirth in developing countries: results from the Global Network\u27s Population-Based Birth Registry.

BACKGROUND: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations\u27 Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries. METHODS: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths. RESULTS: The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age \u3c 20 years and age \u3e 35 years. Compared to parity 1-2, zero parity and parity \u3e 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites. CONCLUSIONS: At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction. TRIAL REGISTRATION: NCT01073475

Slowest relaxation mode of the partially asymmetric exclusion process with open boundaries

We analyze the Bethe ansatz equations describing the complete spectrum of the transition matrix of the partially asymmetric exclusion process on a finite lattice and with the most general open boundary conditions. We extend results obtained recently for totally asymmetric diffusion [J. de Gier and F.H.L. Essler, J. Stat. Mech. P12011 (2006)] to the case of partial symmetry. We determine the finite-size scaling of the spectral gap, which characterizes the approach to stationarity at large times, in the low and high density regimes and on the coexistence line. We observe boundary induced crossovers and discuss possible interpretations of our results in terms of effective domain wall theories.Comment: 30 pages, 9 figures, typeset for pdflatex; revised versio