Hybridising heuristics within an estimation distribution algorithm for examination timetabling

This paper presents a hybrid hyper-heuristic approach based on estimation distribution algorithms. The main motivation is to raise the level of generality for search methodologies. The objective of the hyper-heuristic is to produce solutions of acceptable quality for a number of optimisation problems. In this work, we demonstrate the generality through experimental results for different variants of exam timetabling problems. The hyper-heuristic represents an automated constructive method that searches for heuristic choices from a given set of low-level heuristics based only on non-domain-specific knowledge. The high-level search methodology is based on a simple estimation distribution algorithm. It is capable of guiding the search to select appropriate heuristics in different problem solving situations. The probability distribution of low-level heuristics at different stages of solution construction can be used to measure their effectiveness and possibly help to facilitate more intelligent hyper-heuristic search methods

Use of fractional exhaled nitric oxide to guide the treatment of asthma an official american thoracic society clinical practice guideline

Background: The fractional exhaled nitric oxide (FENO) test is a point-of-care test that is used in the assessment of asthma.Objective: To provide evidence-based clinical guidance on whether FENO testing is indicated to optimize asthma treatment in patients with asthma in whom treatment is being considered.Methods: An international, multidisciplinary panel of experts was convened to form a consensus document regarding a single question relevant to the use of FENO. The question was selected from three potential questions based on the greatest perceived impact on clinical practice and the unmet need for evidencebased answers related to this question. The panel performed systematic reviews of published randomized controlled trials between 2004 and 2019 and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework to develop recommendations. All panel members evaluated and approved the recommendations.Main Results: After considering the overall low quality of the evidence, the panel made a conditional recommendation for FENO-based care. In patients with asthma in whom treatment is being considered, we suggest that FENO is beneficial and should be used in addition to usual care. This judgment is based on a balance of effects that probably favors the intervention; the moderate costs and availability of resources, which probably favors the intervention; and the perceived acceptability and feasibility of the intervention in daily practice.Conclusions: Clinicians should consider this recommendation to measure FENO in patients with asthma in whom treatment is being considered based on current best available evidence. </p

Effect of Niacin Supplementation on

Thirty-two high lactating Holstein cattle were used in this study to determine the effect of niacin supplementation, as a means of improving thermoregulatory responses, on dairy cattle performance during summer conditions. The experiment was conducted in Alkharj area, central region of Saudi Arabia. Half of these animals were used during summer and the other half during winter. In each season, eight animals were served as control and fed the basal diet, and the rest of the animals fed the niacin (8g/cow/day). Cows were housed in covered free stall cooled with Korral Kool system during summer months and milked three times a day. Exposure to summer heat stress resulted in a significant decrease in milk production (24.3%). Niacin supplementation positively affected animal performance, milk production increased significantly (7.1 and 10.1 % during summer and winter, respectively). Supplementation with niacin did not significantly affect rectal tempereture, and skin temperature while respiratory rate increased significantly. These results show that niacin supplementation to heat-stressed dairy cattle was beneficial

Simulation for Neonatal Endotracheal Intubation Training: How Different Is It From Clinical Practice?

INTRODUCTION: Neonatal endotracheal intubation is a critical skill that is difficult for learners to acquire even with simulation-based training (SBT). Trainees prefer clinical experiences over SBT. The objective of the study was to explore the differences between SBT and clinical practice in acquiring neonatal intubation skills to inform mannequin design and to improve fidelity. METHODS: A basic qualitative study using semistructured interviews was conducted to determine the experience of newly competent trainees (second- and third-year neonatal-perinatal medicine fellows) and their instructors in developing intubation skills. Participants were asked to compare learning through SBT with clinical practice in terms of context, equipment, and environment. Their responses were analyzed using an inductive approach. RESULTS: Thirty-two participants (20 fellows and 12 faculty) indicated that SBT does not equal the real experience. Specifically, the look, feel, and function of the simulators differ enough from the real patient and the clinical environmental that they do not elicit the desired learning responses. The clinical environment prompted heightened emotions and had a chaotic atmosphere that was not fully captured by SBT. Participants suggested that programs use SBT in the initial phases of training only to gain basic skills and they provided several solutions for mannequin and SBT session design. CONCLUSIONS: Simulation-based training does not fully prepare neonatal-perinatal medicine fellows for neonatal intubation. Mannequins with unique active features, such as multiple airway configurations, slipperiness, secretions, and softer textures should be developed. Realistic environments that replicate the interprofessional nature and stressors of the clinical environment might better prepare learners for the complexity of clinical practice