47 research outputs found
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 MUNICĂPIO DE MORRO DA FUMAĂA: UMA ABORDAGEM RECENTE Ă LUZ DA EVOLUĂĂO DO VALOR ADICIONADO E DO EMPREGO
Desde o lançamento do Plano Real em 1994, ou seja, nos Ășltimos quinze anos, a economia brasileira passou por vĂĄrias modificaçÔes com consequĂȘncias nos municĂpios, independentemente de seu tamanho. Estudos em relação Ă s capitais e Ă s cidades de grande porte sĂŁo frequentes na literatura econĂŽmica. Todavia, para os pequenos municĂpios hĂĄ uma carĂȘncia de pesquisas que permitam uma idĂ©ia mesmo que genĂ©rica sobre sua realidade econĂŽmica. Faz parte das preocupaçÔes que levaram Ă criação do Curso de Economia da Unesc estudar as economias locais prĂłximas ao seu campus, num esforço para suprimir tal lacuna. Este resumo tem como objetivo principal lançar alguma luz sobre o desempenho econĂŽmico 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 nĂșmeros sobre emprego, foi pesquisĂĄ-los no banco de dados do MinistĂ©rio do Trabalho e Emprego. De posse dessa informação, em seguida buscou-se na Secretaria de Estado da Fazenda de Santa Catarina os nĂșmeros do valor adicionado, que foram corrigidos para preços de 2009 pelo INPC/IBGE. Eliminado o problema inflacionĂĄrio e de posse dos dados, percebeu-se que ao longo do perĂodo estudado houve um aumento real no valor adicionado anual do municĂpio da ordem de 195,13%, passando de R 212,5 milhĂ”es 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 Ă variação do emprego formal. Isto Ă©, enquanto o valor adicionado real cresceu quase trĂȘs vezes (195,13%), o emprego no municĂpio 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 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 trĂȘs variĂĄveis pesquisadas: valor adicionado real, emprego e valor adicionado real por empregado. Ressalta-se assim, a capacidade que o municĂpio teve de manter-se em crescimento a despeito das vĂĄrias situaçÔes externas, que em algumas vezes foi bastante hostil ĂĄ economia local. Por fim recomenda-se que outras pesquisas sejam realizadas, pois uma visĂŁo mais ampla e precisa da economia nĂŁo pode ficar presa Ă s trĂȘs 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 â©Ÿ 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] 0.389â1.819; 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 0.180â1.544; 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 (0â4 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] â0·33, 95% CI â0·52 to â0·14) that was maintained at follow-up (â0·21, â0·42 to â0·01). We also identified benefits at the endpoint for functional impairment (â0·29, â0·43 to â0·15) and for strengths: coping (â0·22, â0·43 to â0·02), hope (â0·29, â0·48 to â0·09), and social support (â0·27, â0·52 to â0·02). 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 15â18 years (â0·43, â0·63 to â0·23), in non-displaced children (â0·40, â0·52 to â0·27), and in children living in smaller households (<6 members; â0·27, â0·42 to â0·11).
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 drugâdrug 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 âknownâ 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 âknownâ risk drugs + 0.93 ms (â8.88;10.75)]. Estimates for
the âconditionalâ risk class increased upon refinement with relative drug exposure and coadministration of a âknownâ 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
Offâlabel long acting injectable antipsychotics in realâworld clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study
Introduction: Information on the offâlabel use of LongâActing 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 onâ vs offâlabel LAIs and predictors of offâlabel Firstâ or SecondâGeneration 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 offâ or onâlabel 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 offâlabel group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their onâ and offâlabel use. Approximately 1 in 4 patients received an offâlabel prescription. In the offâlabel 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 = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 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 offâlabel LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use coâmorbidities 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 âDepot Studyâ 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] 34.4â44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3â43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4â84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6â40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6â27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742â0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003â4.634; p = 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
Locomozione sui piani inclinati a galleggiante propulsore; Nuovo sistema idraulico degli ingegneri
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