A hybrid local search algorithm for heterogeneous fleet vehicle routing problem with simultaneous pickup and delivery

The Vehicle Routing Problem with Simultaneous Pickup and Delivery (VRPSPD) has gained importance due to its applicability in numerous reverse logistic systems involving bi-directional flow of goods. The VRPSPD can be encountered in a distribution/collection system involving a set of customers requiring delivery and pickup services simultaneously. Originally, the VRPSPD assumes a homogeneous fleet of vehicles to serve the customers. However, in many transportation systems there are different types of vehicles available to perform the pickup and delivery operations. In this study, we extend the original version of the VRPSPD by assuming the fleet of vehicles to be heterogeneous. The Heterogeneous Fleet Vehicle Routing Problem with Simultaneous Pickup and Delivery (HFVRPSPD) is considered to be an NP-hard problem because it generalizes the classical VRP. For this reason, we propose a local search metaheuristic algorithm in which an adaptive threshold adjusting strategy is integrated with tabu search. The proposed algorithm is applied to a set of randomly generated problem instances. The results indicate that the developed approach can produce efficient and effective solutions

Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit

Objective: This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM). Methods: Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed. Results: At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ2 = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01). Conclusions: One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients' outcomes

Analysis of the patients who applied to emergency medicine with dizziness

WOS: 000480626400038Purpose: In this study, it was aimed to evaluate the demographic characteristics of the patients presenting to the emergency room with dizziness, the etiologic causes leading to the complaints and the laboratory findings as well as the prognosis. Material and Methods: The file data of a total of 5,056 patients admitted to the Adana Numune Training and Research Hospital Emergency Medicine Clinic between January 2013 and January 2015 were reviewed retrospectively. Mean, standard deviation, median, lowest, highest, frequency and ratio values were used in the descriptive statistics of the data. SPSS 22.0 program was used in the analyses. Results: Two thousand nine hundered four of the patients were female (57.4%), 2,152 were male (42.6%) and the average age was 53.6 (+/- 18.2) years. It was determined that the complaints were common in the population between the ages of 51-70, and peripheric peripheral vertigo (n: 4.130, 81.6%), systemic causes (n: 664, 13.1%), and central vertigo (n: 249, 4.9%) were the most prevalent etiologies, respectively. 83% of the patients were discharged following necessary procedures in the emergency room. Conclusion: Dizziness is one of the most important symptoms that brings patients to the emergency services. While many etiologies play a part in it, it is determined that neurological and cardiological evaluations must be done, annd patients can mainly be managed in emergency services by simple maneuvering or medical treatment options

Examination of humor styles and mental health status of health services students in vocational schools

Objectives: The aim of the study is to determine the humor styles and general mental health of health services students in a vocational school in Turkey. Methods: This descriptive study was conducted in Turkey in 2013. A total of 354 of health services students from vocational schools agreed to participate in the study. Data were collected from students using a descriptive form, a humor styles questionnaire and a General Health Questionnaire (GHQ 12). Data were analyzed using SPSS 17.0. Descriptive and Pearson tests were used to analyze the study data. Results: Students' mean ages was 21.01 +/- 2.26, most participants were women (64.5%), of a moderate socio-economic status (61.9%) and non-smokers (63.8%). The students mean scores for the humor sub-scales are as follows: Affiliative humor 39.63 +/- 8.18, self-enhancing humor 33.64 +/- 9,44, aggressive humor 23.29 +/- 7.67 and self-defecting humor 26.51 +/- 7.87. Most of the students' GHQ scores suggested that participants were at risk of having a mental health disorder (20.6%), while 27.1%were found to be at high risk of having a mental health disorder. A low negative significant correlation between the students self-enhancing humor and general health risk was found. Conclusion: The study found that students have positive humor styles. Nearly half of the student partisans were found to be at a low risk regarding the development of psychiatric disorders

Ovarian Stiffness Is Significantly Increased in Polycystic Ovary Syndrome and Related With Anti-Mullerian Hormone A Point Shear Wave Elastography Study

Objectives Parenchymal stiffness obtained by point shear-wave elastography (pSWE) in solid organs is used as a sign of damage in these organs. However, its clinical use and whether patients with polycystic ovary syndrome (PCOS) have increased ovarian tissue stiffness are still unclear. The aim of this study is to determine the parameters related to ovarian stiffness and whether there is an increase in ovarian stiffness in patients with PCOS compared with healthy controls. Methods Forty-five women who were followed up regularly with the diagnosis of PCOS and 30 healthy controls similar to age and sex were included in this study. In addition to the routine follow-up parameters for PCOS, serum homeostatic model assessment of insulin resistance and anti-Mullerian hormone (AMH) levels were examined in all patients, and pSWE examination was performed with pelvic ultrasound (US) and ElastPQ technique. Results Serum dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment of insulin resistance, and AMH were higher in PCOS compared with healthy controls (P < 0.001). Right, left, and mean ovary stiffness and volumes were significantly higher in PCOS group than healthy controls (P < 0.001). Correlation analysis was performed between mean ovary stiffness and dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment, and AMH and ovary volumes (P < 0.01 for each one). In linear regression analysis, only AMH was found to be related to mean ovary stiffness (P < 0.001 and beta = 0.734). Conclusions Ovarian stiffness value obtained by ElastPQ technique and pSWE method increases in PCOS patients compared with healthy controls and is closely related to serum AMH levels. In patients with PCOS, in addition to the conventional US, ovarian stiffness measured by pSWE may be an auxiliary examination in the follow-up of the disease. However, it was concluded that the ovarian stiffness measurement obtained in our current study should be supported by studies involving more patients and the transvaginal US method

A View from Young Oncologists on Clinical Trials in Turkey: Obstacles and Solution Proposals

There is a new improvement in oncology nearly in every day as a result of preclinical or clinical. As the number of publication per capita, Turkey is far behind the other developed European countries. For example, the number of publications in oncology field is 2.134.964 in the world, it is 15.576 in our country. The most important obstacles for clinical trials in Turkey may be listed as financial problems, difficulties of working conditions, time limitation due to work intensity, inadequate experienced/trained man-power, absence of assistance team at all steps of a scientific trial, difficulties faced during project planning and ethics committee submissions, and lack of motivation. In this article, we, as young oncologists, aimed to discuss the place of Turkey in areas of scientific and clinical trials in the world; underlying causes for inadequate number, type and quality of national studies and possible solution proposals in our country