A two-level local search heuristic for pickup and delivery problems in express freight trucking

We consider a multiattribute vehicle routing problem inspired by a freight transportation company operating a fleet of heterogeneous trucks. The company offers an express service for requests including multiple pickup and multiple delivery positions spread in a regional area, with associated soft or hard time windows often falling in the same working day. Routes are planned on a daily basis and reoptimized on-the-fly to fit new requests, taking into account constraints and preferences on capacities, hours of service, route termination points. The objective is to maximize the difference between the revenue from satisfied orders and the operational costs. The problem mixes attributes from both intercity less-than-truckload and express couriers operations, and we propose a two-level local search heuristic. The first level assigns orders to vehicles through a variable neighborhood stochastic tabu search; the second level optimizes the route service sequences. The algorithm, enhanced by neighborhood filtering and parallel exploration, is embedded in a decision support tool currently in use in a small trucking company. Results have been compared to bounds obtained from a mathematical programming model solved by column generation. Experience on the field and test on literature instances attest to the quality of results and the efficiency of the proposed approach

A ECONOMIA DO MUNICÍPIO DE MORRO DA FUMAÇA: UMA ABORDAGEM RECENTE À LUZ DA EVOLUÇÃO DO VALOR ADICIONADO E DO EMPREGO

Desde o lançamento do Plano Real em 1994, ou seja, nos últimos quinze anos, a economia brasileira passou por várias modificações com consequências nos municípios, independentemente de seu tamanho. Estudos em relação às capitais e às cidades de grande porte são frequentes na literatura econômica. Todavia, para os pequenos municípios há uma carência de pesquisas que permitam uma idéia mesmo que genérica sobre sua realidade econômica. Faz parte das preocupações que levaram à criação do Curso de Economia da Unesc estudar as economias locais próximas ao seu campus, num esforço para suprimir tal lacuna. Este resumo tem como objetivo principal lançar alguma luz sobre o desempenho econômico de Morro da Fumaça a partir do valor adicionado real, emprego e valor adicionado real por empregado no cotejamento de 1994 com 2009. A metodologia utilizada para a obtenção dos números sobre emprego, foi pesquisá-los no banco de dados do Ministério do Trabalho e Emprego. De posse dessa informação, em seguida buscou-se na Secretaria de Estado da Fazenda de Santa Catarina os números do valor adicionado, que foram corrigidos para preços de 2009 pelo INPC/IBGE. Eliminado o problema inflacionário e de posse dos dados, percebeu-se que ao longo do período estudado houve um aumento real no valor adicionado anual do município da ordem de 195,13%, passando de R$72 milhões em 1994 para R$ 212,5 milhões em 2009. No mesmo espaço de tempo a quantidade de trabalhadores formalmente empregada saiu de 2.386 para 5.382. Um aumento de 125,57%. A comparação dessas duas categorias aponta, que o valor adicionado real registrou um ritmo de crescimento superior à variação do emprego formal. Isto é, enquanto o valor adicionado real cresceu quase três vezes (195,13%), o emprego no município variou pouco acima de duas vezes (125,57%). Consequentemente, o valor adicionado ao ano por empregado na economia de Morro da Fumaça, que em 1994 era de R$30.176 passou para R$ R$ 39.483 quinze anos depois, implicando num aumento real de 30,84% no comparativo de 2009 com 1994. Como resultado fica evidente a evolução da economia de Morro da Fumaça para as três variáveis pesquisadas: valor adicionado real, emprego e valor adicionado real por empregado. Ressalta-se assim, a capacidade que o município teve de manter-se em crescimento a despeito das várias situações externas, que em algumas vezes foi bastante hostil á economia local. Por fim recomenda-se que outras pesquisas sejam realizadas, pois uma visão mais ampla e precisa da economia não pode ficar presa às três categorias pesquisadas para o presente resumo

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial

AimsAs refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe.MethodsRefugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes.ResultsOf 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001).ConclusionsThe present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.</p

Focused psychosocial interventions for children in low-resource humanitarian settings : a systematic review and individual participant data meta-analysis

Background: Results from studies evaluating the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in humanitarian settings in low-income and middle-income countries have been inconsistent, showing varying results by setting and subgroup (eg, age or gender). We aimed to assess the effectiveness of these interventions, and to explore which children are likely to benefit most. Methods: We did a systematic review and meta-analysis of individual participant data (IPD) from 3143 children recruited to 11 randomised controlled trials of focused psychosocial support interventions versus waiting list. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycArticles, Web of Science, and the main local low-income and middle-income countries (LMICs) databases according to the list of databases relevant to LMIC developed collaboratively by Cochrane and WHO Library, up to November, 2016. We included randomised controlled trials that assessed the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in LMICs, compared with waiting lists (eg, inactive controls). We excluded quasirandomised trials, studies that did not focus on psychosocial support interventions, and studies that compared two active interventions without control conditions. We requested anonymised data from each trial for each of the prespecified variables for each child who was randomly assigned. The main outcomes considered were continuous scores in post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and anxiety symptoms assessed with rating scales administered immediately (0–4 weeks) after the intervention. We harmonised all individual items from rating scales using item response theory methods. This study is registered with PROSPERO, number CRD42013006960. Findings: We identified a beneficial effect of focused psychosocial support interventions on PTSD symptoms (standardised mean difference [SMD] –0·33, 95% CI –0·52 to –0·14) that was maintained at follow-up (–0·21, –0·42 to –0·01). We also identified benefits at the endpoint for functional impairment (–0·29, –0·43 to –0·15) and for strengths: coping (–0·22, –0·43 to –0·02), hope (–0·29, –0·48 to –0·09), and social support (–0·27, –0·52 to –0·02). In IPD meta-analyses focused on age, gender, displacement status, region, and household size we found a stronger improvement in PTSD symptoms in children aged 15–18 years (–0·43, –0·63 to –0·23), in non-displaced children (–0·40, –0·52 to –0·27), and in children living in smaller households (<6 members; –0·27, –0·42 to –0·11). Interpretation: Overall, focused psychosocial interventions are effective in reducing PTSD and functional impairment, and in increasing hope, coping, and social support. Future studies should focus on strengthening interventions for younger children, displaced children, and children living in larger households

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p&nbsp;= 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p&nbsp;= 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p&nbsp;=&nbsp;0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p&nbsp;=&nbsp;0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

The proteins of the grape (Vitis vinifera L.) seed endosperm: Fractionation and identification of the major components

Grape (Vitis vinifera L.) seed endosperm proteins were characterized after sequential fractionation, according to a modified Osborne procedure. The salt-soluble fraction (albumins and globulins) comprised the majority (58.4%) of the total extracted protein. The protein fractions analysed by SDS-PAGE showed similar bands, indicating different solubility of the same protein components. SDS-PAGE in non-reducing and reducing conditions revealed the polypeptide composition of the protein bands. The main polypeptides, which were similar in all the grape varieties analysed, were identified by LC-MS/MS as homologous to the 11S globulin-like seed storage proteins of other plant species, while a monomeric 43 kDa protein presented high homology with the 7S globulins of legume seeds. The results provide new insights about the identity, structure and polypeptide composition of the grape seed storage proteins