A bi-objective home care scheduling problem: Analyzing the trade-off between costs and client inconvenience

Organizations providing home care services are inclined to optimize their activities in order to meet the constantly increasing demand for home care. In this context, home care providers are confronted with multiple, often conflicting, objectives such as minimizing their operating costs while maximizing the service level offered to their clients by taking into account their preferences. This paper is the first to shed some light on the trade-off relationship between these two objectives by modeling the home care routing and scheduling problem as a bi-objective problem. The proposed model accounts for qualifications, working regulations and overtime costs of the nurses, travel costs depending on the mode of transportation, hard time windows, and client preferences on visit times and nurses. A distinguishing characteristic of the problem is that the scheduling problem for a single route is a biobjective problem in itself, thereby complicating the problem considerably. A metaheuristic algorithm, embedding a large neighborhood search heuristic in a multi-directional local search framework, is proposed to solve the problem. Computational experiments on a set of benchmark instances based on reallife data are presented. A comparison with exact solutions on small instances shows that the algorithm performs well. An analysis of the results reveals that service providers face a considerable trade-off between costs and client convenience. However, starting from a minimum cost solution, the average service level offered to the clients may already be improved drastically with limited additional costs. (authors' abstract

Extended Lower Limb Venous Ultrasound for the Diagnosis of Proximal and Distal Vein Thrombosis in Asymptomatic Patients after Total Hip Replacement

AbstractObjective. To assess the performance of extended lower limb venous ultrasound (US) for the diagnosis of asymptomatic deep vein thrombosis (DVT) and to estimate a 3-month DVT incidence on repeated US after total hip replacement.Design. Diagnostic performance study and prospective cohort study.Materials and methods. US was compared to phlebography in 70 consecutive patients and interobserver agreement was assessed in the last 48 patients at day 8. US was repeated in these 48 patients at day 13 and day 90.Results. Phlebography demonstrated a DVT in 18/70 (26%) patients, with five proximal and 13 distal and US in 23/70 (33%) patients, with eight proximal and 15 distal. Sensitivity and specificity of US with 95% CI were 94% (73–100) and 89% (76–96), respectively. Sensitivity in isolated distal vein thrombosis was 92% (67–99). The Kappa coefficient for agreement between observers was 0.84 (0.66–1.00). Follow-up showed a DVT in 15/48 (31%) patients on day 8, in 20/48 patients (42%) on day 13. DVT recurred in two patients during follow-up.Conclusions. The incidence of asymptomatic DVT is still significant despite prophylaxis but most DVTs remain distal and occur in the first 2 weeks. Extended US could replace phlebography for systematic screening in clinical trials using surrogate endpoints in view of its high accuracy and reliability

New insights into the classification and nomenclature of cortical GABAergic interneurons.

A systematic classification and accepted nomenclature of neuron types is much needed but is currently lacking. This article describes a possible taxonomical solution for classifying GABAergic interneurons of the cerebral cortex based on a novel, web-based interactive system that allows experts to classify neurons with pre-determined criteria. Using Bayesian analysis and clustering algorithms on the resulting data, we investigated the suitability of several anatomical terms and neuron names for cortical GABAergic interneurons. Moreover, we show that supervised classification models could automatically categorize interneurons in agreement with experts' assignments. These results demonstrate a practical and objective approach to the naming, characterization and classification of neurons based on community consensus

Personalized Tourist Route Generation

When tourists are at a destination, they typically search for information in the Local Tourist Organizations. There, the staff determines the profile of the tourists and their restrictions. Combining this information with their up-to-date knowledge about the local attractions and public transportation, they suggest a personalized route for the tourist agenda. Finally, they fine tune up this route to better fit tourists' needs. We present an intelligent routing system to fulfil the same task. We divide this process in three steps: recommendation, route generation and route customization. We focus on the last two steps and analyze them. We model the tourist planning problem, integrating public transportation, as the Time Dependent Team Orienteering Problem with Time Windows (TDTOPTW) and we present an heuristic able to solve it on real-time. Finally, we show the prototype which generates and customizes routes in real-time

Monitoring neural activity with bioluminescence during natural behavior

Existing techniques for monitoring neural activity in awake, freely behaving vertebrates are invasive and difficult to target to genetically identified neurons. We used bioluminescence to non-invasively monitor the activity of genetically specified neurons in freely behaving zebrafish. Transgenic fish with the Ca^(2+)-sensitive photoprotein green fluorescent protein (GFP)-Aequorin in most neurons generated large and fast bioluminescent signals that were related to neural activity, neuroluminescence, which could be recorded continuously for many days. To test the limits of this technique, we specifically targeted GFP-Aequorin to the hypocretin-positive neurons of the hypothalamus. We found that neuroluminescence generated by this group of ~20 neurons was associated with periods of increased locomotor activity and identified two classes of neural activity corresponding to distinct swim latencies. Our neuroluminescence assay can report, with high temporal resolution and sensitivity, the activity of small subsets of neurons during unrestrained behavior

Accessory gland as a site for prothoracicotropic hormone controlled ecdysone synthesis in adult male insects

Insect steroid hormones (ecdysteroids) are important for female reproduction in many insect species and are required for the initiation and coordination of vital developmental processes. Ecdysteroids are also important for adult male physiology and behavior, but their exact function and site of synthesis remains unclear, although previous studies suggest that the reproductive system may be their source. We have examined expression profiles of the ecdysteroidogenic Halloween genes, during development and in adults of the flour beetle Tribolium castaneum. Genes required for the biosynthesis of ecdysone (E), the precursor of the molting hormone 20-hydroxyecdysone (20E), are expressed in the tubular accessory glands (TAGs) of adult males. In contrast, expression of the gene encoding the enzyme mediating 20E synthesis was detected in the ovaries of females. Further, Spookiest (Spot), an enzyme presumably required for endowing tissues with competence to produce ecdysteroids, is male specific and predominantly expressed in the TAGs. We also show that prothoracicotropic hormone (PTTH), a regulator of E synthesis during larval development, regulates ecdysteroid levels in the adult stage in Drosophila melanogaster and the gene for its receptor Torso seems to be expressed specifically in the accessory glands of males. The composite results suggest strongly that the accessory glands of adult male insects are the main source of E, but not 20E. The finding of a possible male-specific source of E raises the possibility that E and 20E have sex-specific roles analogous to the vertebrate sex steroids, where males produce primarily testosterone, the precursor of estradiol. Furthermore this study provides the first evidence that PTTH regulates ecdysteroid synthesis in the adult stage and could explain the original finding that some adult insects are a rich source of PTTH

Seasonal dynamics of active SAR11 ecotypes in the oligotrophic Northwest Mediterranean Sea

A seven-year oceanographic time series in NW Mediterranean surface waters was combined with pyrosequencing of ribosomal RNA (16S rRNA) and ribosomal RNA gene copies (16S rDNA) to examine the environmental controls on SAR11 ecotype dynamics and potential activity. SAR11 diversity exhibited pronounced seasonal cycles remarkably similar to total bacterial diversity. The timing of diversity maxima was similar across narrow and broad phylogenetic clades and strongly associated with deep winter mixing. Diversity minima were associated with periods of stratification that were low in nutrients and phytoplankton biomass and characterised by intense phosphate limitation (turnover time80%) by SAR11 Ia. A partial least squares (PLS) regression model was developed that could reliably predict sequence abundances of SAR11 ecotypes (Q2=0.70) from measured environmental variables, of which mixed layer depth was quantitatively the most important. Comparison of clade-level SAR11 rRNA:rDNA signals with leucine incorporation enabled us to partially validate the use of these ratios as an in-situ activity measure. However, temporal trends in the activity of SAR11 ecotypes and their relationship to environmental variables were unclear. The strong and predictable temporal patterns observed in SAR11 sequence abundance was not linked to metabolic activity of different ecotypes at the phylogenetic and temporal resolution of our study