Optimizing integrated service for a transit route with heterogeneous demand

The methodology developed in this dissertation attempts to optimize integrated service that minimizes the total cost, including user and supplier costs, of a transit route with heterogeneous demand. While minimizing total cost, a set of practical constraints, such as capacity, operable fleet size and frequency conservation, are considered. The research problem is presented in three scenarios, consisting of various service patterns (e.g., all-stop, short-turn and express) under heterogeneous demand. A logit-based model was used to estimate passenger transfer demand. An exhaustive search method was developed to find the optimal solutions for a simplified transit route with six stops, and a Genetic Algorithm (GA) was developed to find the optimal solution for a real-world, large scale transit route. The optimized variables include the combination of service patterns, the associated service frequencies, and stops skipped by the express service. A six-stop transit route was designed and analyzed via a proof-of-concept demonstration to ensure that the developed models are capable of finding the optimal solutions. A sensitivity analysis was conducted, which enables transit planners to quantify the impact of various model parameters (e.g., user value of time, vehicle capacity, operating cost, etc.) to the decision variables and the objective function. Finally, the developed models and solution algorithm were applied to optimize integrated service for a real world bus route in New Jersey

Comparison of Cognitive Readiness Levels of the 4th Grade Students of Primary Education by Learning Domains

Previous acquisitions of students have a huge impact on student

Aortocaval Fistula in a Behcet's Disease Patient

Behcet's disease (BD) is a chronic, recurrent, systemic disease that is characterized by oral and genital ulcers and oculocutaneous inflammatory lesions. Cardiovascular involvement especially large artery involvement is a serious and vital complication of BD. Pseudoaneurysms in the major arteries may be the cause of sudden death in BD. In our case a pulsatile abdominal mass was determined to be an aortic pseudoaneurysm associated with BD and an aortocaval fistula. Here we report this case and a short review of literature because this is the first reported aortocaval fistula in a BD patient in English literature

Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease

SummaryPurposeIn this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease.MethodsNinety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH (n = 48) or SH (n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6–36) months.ResultsThe patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group.ConclusionHSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method

Coronary arteriovenous fistulas in the adults: natural history and management strategies

<p>Abstract</p> <p>Objective</p> <p>To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies.</p> <p>Methods</p> <p>Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 ± 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography</p> <p>Results</p> <p>All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients.</p> <p>Conclusion</p> <p>Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.</p

Teachers

The study examines the views of classroom teachers on the preparedness of primary school first year pupils with preschool education on learning mathematics subjects. The sample of the study consists of 15 classroom teachers teaching first year of primary school

An Evaluation of the Apical Seal in Oval-shaped Root Canals Prepared with Either Self-adjusting Files or ProTaper Files

Objective: This study aimed to evaluate the apical seal obtained with lateral compaction of gutta-percha in oval-shaped root canals prepared with either self-adjusting files or ProTaper rotary files. Materials and Methods: Twelve pairs of extracted mandibular premolars with oval-shaped root canals were randomly divided into two groups. The first group was biomechanically prepared with ProTaper files, while the self-adjusting file system was used in the second group. The roots were obturated using cold lateral compaction of gutta-percha. Apical microleakage was measured with the computerized fluid filtration method. The results were analyzed statistically using the Mann-Whitney U test. Results: All of the roots in both groups showed leakage. Group 1 demonstrated significantly less microleakage (p &lt; 0.05). Conclusions: Instrumentation of oval-shaped canals using a self-adjusting file system with cold lateral compaction of gutta-percha demonstrated significantly greater apical microleakage when compared to ProTaper. The apical leakage with different obturation techniques, combined with self-adjusting files, should be evaluated in further studies

Clinical Study Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications