An Application of the Multi-Level Heuristic for the Heterogeneous Fleet Vehicle Routing Problem

The Multi-Level heuristic is used to investigate the heterogeneous fleet vehicle routing problem (HFVRP). The initial solution for the Multi-Level heuristic is obtained by Dijkstra\u27s algorithm based on a cost network constructed by the sweep algorithm and the 2-opt procedure. The proposed algorithm uses a number of local search operators such as swap, 1-0 insertion, 2-opt, and Dijkstra\u27s Algorithm. In addition, in order to improve the search process, a diversification procedure is applied. The proposed algorithm is thentested on the data sets from the literature

Clinical determinants of vaginal dryness in patients with primary Sjögren's syndrome

Objective. The majority of women with primary Sjogren's syndrome (pSS) suffer from vaginal dryness, which negatively impacts daily and sexual activities. As little is known about the aetiology and clinical context of this complaint, this study investigated the relationship between vaginal dryness and other clinical parameters associated with pSS. Methods. Female participants of the REgistry of Sjogren syndrome at UMCG - LongiTudinal (RESULT) cohort who fulfilled ACR-EULAR and/or AECG classification criteria for pSS were included, using baseline data for analyses. Patient-reported vaginal dryness (range 0-10) was correlated with demographic characteristics, systemic disease activity (i.e. ESSDAI), Sjogren's Syndrome Disease Damage Index, salivary and lacrimal gland function, patient-reported outcomes (ESSPRI, MFI), serology and quality of life (SF-36, EQ-5D). Significantly associated parameters (p Results. This cross-sectional study included 199 women with pSS; mean age was 52 +/- 14 years, 53% were postmenopausal, and median vaginal dryness score was 5 (IQR 2-7). Vaginal dryness was significantly associated with older age, postmenopausal status, peripheral neuropathy, oral and ocular dryness, ESSPRI and SF-36 mental and general health. After correction for age, menopausal status and medication use, peripheral neuropathy (B=1.632), oral dryness (B=0.302), and ocular dryness (B=0.230) were independently associated with vaginal dryness. Conclusion. The independent association of vaginal dryness with oral and ocular dryness might imply that the aetiology of these symptoms is partly shared. Of all extraglandular features, only peripheral neuropathy was independently associated with vaginal dryness, suggesting that peripheral neuropathy plays a significant role in the pathology of vaginal dryness in pSS