Search Results (302)

The rapid growth of e-commerce and advances in information and communication technologies have placed increasing pressure on last-mile delivery companies to enhance operational productivity. As investments in logistics infrastructure require long-term planning, maximizing the efficiency of existing terminal operations has become a critical priority. This study proposes a mathematical model for inbound truck scheduling that simultaneously minimizes truck waiting times and balances workload across temporary inventory storage located at outbound chutes in cross-docking terminals. The model incorporates a dynamic rescheduling strategy that updates the assignment of inbound trucks in real time, based on the latest terminal conditions. Numerical experiments, based on real operational data, demonstrate that the proposed approach significantly outperforms conventional strategies such as First-In First-Out (FIFO) and Random assignment in terms of both load balancing and truck turnaround efficiency. In particular, the proposed model improves workload balance by approximately 10% and 12% compared to the FIFO and Random strategies, respectively, and it reduces average truck waiting time by 17% and 18%, thereby contributing to more efficient workflow and alleviating bottlenecks. The findings highlight the practical potential of the proposed strategy for improving the responsiveness and efficiency of parcel distribution centers operating under fixed infrastructure constraints. Future research may extend the proposed approach by incorporating realistic operational factors, such as cargo heterogeneity, uncertain arrivals, and terminal shutdowns due to limited chute storage. Full article

Mixed-flow assembly lines are widely employed in industrial manufacturing to handle diverse production tasks. For mixed flow assembly lines that involve mold changes and greater processing difficulties, there are currently two approaches: batch production and production according to order sequence. The first approach struggles to meet the processing constraints of workpieces with higher production difficulty, while the second approach requires the development of suitable scheduling schemes to balance mold changes and continuous processing. Therefore, under the second approach, developing an excellent scheduling scheme is a challenging problem. This study addresses the mixed-flow assembly shop scheduling problem, considering continuous processing and mold-changing constraints, by developing a multi-objective optimization model to minimize additional production time and customer waiting time. As this NP-hard problem poses significant challenges in solution space exploration, the conventional NSGA-II algorithm suffers from limited local search capability. To address this, we propose an enhanced NSGA-II algorithm (RLVNS-NSGA-II) integrating deep reinforcement learning. Our approach combines multiple neighborhood search operators with deep reinforcement learning, which dynamically utilizes population diversity and objective function data to guide and strengthen local search. Simulation experiments confirm that the proposed algorithm surpasses existing methods in local search performance. Compared to VNS-NSGA-II and SVNS-NSGA-II, the RLVNS-NSGA-II algorithm achieved hypervolume improvements ranging from 19.72% to 42.88% and 12.63% to 31.19%, respectively. Full article

Background: Delays in breast cancer treatment negatively affect prognosis and have increased over time. Data on waiting times in Switzerland are limited. Patients and Methods: This study analyzed cancer registry data from 2003 to 2005 (2628 patients) and 2015 to 2017 (421 patients) to evaluate waiting times for diagnosis, surgery, and radiotherapy; temporal trends; and survival in women with stage I–III invasive breast cancer treated with surgery without chemotherapy. Associations with demographic/clinical factors and overall survival (OS) were assessed using ANOVA, uni-/multivariable regression, Kaplan–Meier, and Cox regression. Results: From 2003 to 2005, mean intervals were biopsy-to-diagnosis 4.3 days, diagnosis-to-surgery 18.8 days, biopsy-to-surgery 26.8 days, and surgery-to-radiotherapy 56.7 days. Longer diagnosis-to-surgery times were associated with metropolitan areas, public hospitals, basic insurance, mastectomy, and older age (all p < 0.001). Radiotherapy delays were also longer in metropolitan areas and after mastectomy (p < 0.001). Between 2003–2005 and 2015–2017, diagnosis-to-surgery times rose in Eastern Switzerland (from 21.3 to 31.2 days), while radiotherapy timing remained stable. Five-year overall survival improved (from 76.7% to 88.4%), but was not significantly impacted by diagnosis-to-surgery intervals. Conclusions: Despite timely surgery in Switzerland (2003–2005), disparities existed, and time to surgery increased by 2015–2017. Reducing waiting times remains important despite no significant short-term OS impact. Full article

This study investigates the factors influencing school trip mode choice among senior high school students in the Chiang Rai urban area, Chiang Rai, Thailand, under normal and adverse weather conditions. Utilizing data from 472 students across six extra-large urban schools, a Multinomial Logit (MNL) regression model was applied to examine the effects of socio-demographic attributes, household vehicle ownership, travel distance, and spatial variables on mode selection. The results revealed notable modal shifts during adverse weather, with motorcycle usage decreasing and private vehicle reliance increasing, while school bus usage remained stable, highlighting its role as a resilient transport option. Car ownership emerged as a strong enabler of modal flexibility, whereas students with limited access to private transport demonstrated reduced adaptability. Additionally, increased waiting and travel times during adverse conditions underscored infrastructure and service vulnerabilities, particularly for mid-distance travelers. The findings suggest an urgent need for transport policies that promote inclusive and climate-resilient mobility systems, particularly in the context of Chiang Rai, including expanded school bus services, improved first-mile connectivity, and enhanced pedestrian infrastructure. This study contributes to the literature by addressing environmental variability in school travel behavior and offers actionable insights for sustainable transport planning in secondary cities and border regions. Full article

Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article

Objective: Gut dysbiosis has been implicated in the pathology of inflammatory bowel disease (IBD). There is some evidence to suggest that the use of antibiotic treatment can incite an early clinical response or remission when used in conjunction with standard-of-care (SOC) therapy to treat IBD-related flares. Furthermore, antibiotics have been historically investigated for use as a bridge when initiating biologic therapy while waiting for peak biologic treatment effect to occur. This study investigated and compared the time to clinical response when treated with combination antibiotics, metronidazole monotherapy, or SOC therapy in pediatric patients with an active IBD flare. Methods: This study was a retrospective, Institution Review Board-approved, single-centered cohort study which included patients who were less than 18 years of age with a confirmed diagnosis of IBD who received conventional treatment alone or with either combination antibiotic therapy or metronidazole monotherapy to treat an active IBD flare between March 2013 and January 2024. Patients were excluded if they received antibiotic therapy to treat an active infection, had positive stool cultures or enteric pathogen polymerase chain reaction panel, or had colonic disease limited to the rectum. Results: Fifty-nine patients were included and divided into metronidazole monotherapy (n = 18), SOC therapy (n = 20), and combination antibiotics (n = 21). The primary outcome of days to clinical response was not significantly different across all groups; however, patients who received combination antibiotics achieved the fastest time to clinical response (median (IRQ))—4 days (1, 65), compared to 7.5 days (1, 119) for the SOC group and 9 days (2, 217) for the metronidazole group. Secondary outcomes of achievement of clinical response, remission, or failure were determined to be non-significant between all groups. Conclusions: There is no significant difference in time to clinical response, attaining clinical response or remission, or treatment failure rate for patients treated with combination antibiotics, metronidazole monotherapy, or SOC. However, results of this study suggest that the use of combination antibiotics plus SOC may lead to a faster time to clinical response and remission compared to SOC therapy alone. Further studies are warranted to elucidate the role of antimicrobial therapy in management of pediatric IBD. Full article

Background/Objectives: Timing of fixation of stable slipped capital femoral epiphysis (SCFE) is controversial. As pressure mounts to limit inpatient admissions and procedures, our aim was to investigate whether treatment of SCFE in a delayed manner is a safe alternative to immediate fixation. Our hypothesis was that there would be no difference in complications for stable slips treated immediately (<24 h) versus semi-electively (>24 h) with screw fixation. Methods: A retrospective review was performed at two academic institutions during a 10-year-period yielding 91 SCFEs. Data collected included patient demographics, time to treatment, radiographic measurements (Southwick angle), and complications. Between-group analysis was performed using Welch’s t-test and Fisher’s exact test. Results: 91 stable SCFEs were identified with a median age of 12.3 years (IQR: 11.4–13.3). A total of 62 (68%) slips were treated immediately while 29 (32%) were treated in a semi-elective manner with a median time from diagnosis to surgery of 4 days (range: 2–11 days). There were no instances of >18° increase in Southwick angle in either group or conversion from stable to unstable slips during the semi-elective period. Overall, 12 (13%) patients experienced complications, but no difference in complication rate was observed between groups (15% vs. 10%, p = 0.75). However, the complication profile varied between groups. Of note, two patients (2%, 2/91) experienced AVN, both of which were treated in a semi-elective manner and underwent in situ pinning. Conclusions: There was no difference in complication rate between stable SCFEs treated immediately or semi-electively; however, the complication profile differed by group. No SCFEs in either group had >18° worsening of the Southwick angle between the time of diagnosis and the time of fixation and there were no conversions of stables slips to unstable slips while waiting for semi-elective surgery. These findings suggest that performing semi-elective surgical fixation within 11 days of diagnosing stable, mild SCFEs appears to be a safe alternative to inpatient admission at the time of diagnosis. Full article

This study presents a discrete event simulation model to minimize operating costs in quarry mining processes by determining the optimal allocation of backhoes and dump trucks, which are the primary mining equipment. The modeling focuses on four principal vehicle types (24-ton dump truck, 2.0 m³ backhoe, 41-ton dump truck, 4.64 m³ backhoe) commonly deployed in quarry mining. The simulation replicates the sequential mining stages involving soil removal, rock ripping (weathered rock or weathered soil), and blasting operations. This methodology is applied to a case study of mining process planning under resource constraints, incorporating real-world quarry conditions in South Korea. Results demonstrate that optimizing the number of equipment units reduces construction costs and shortens the construction period by decreasing dump truck waiting times. When the number of backhoes is limited to 10 during operations, findings indicate an increase in costs and a gradual decline in net profit. Additionally, the interaction between the 24-ton and 41-ton dump trucks is shown to influence the optimal allocation strategy. The simulation-based optimization executes iterative experiments for each scenario, yielding statistically robust results within a 95% confidence interval, thereby supporting informed decision-making for managers. Full article

Background: Children with food allergies can present with paediatric feeding disorder (PFD). However, access to coordinated multidisciplinary services to support these children in Australia is inconsistent. To date, the availability of services or the perceived care needs of Australian health professionals working with this population have not been formally explored. Methods: A web-based survey was distributed to health professionals in Australia. Quantitative demographic data were summarised using descriptive statistics, and open-ended responses were analysed using content analysis. Results: The final sample comprised 98 responses, with speech pathologists representing the largest professional group (n = 39; 40%). A majority (59%) worked in hospital-based services. Open-ended responses were coded utilising content analysis. Three categories were developed including (1) service delivery, (2) intervention, and (3) resources. Services were commonly impacted by long wait times, limited staff training, and inconsistencies between hospital and community care. Additionally, mental health support was frequently reported as insufficient. Conclusions: The findings from this study underscore the need for integrated services for children with food allergies and paediatric feeding disorder. Recommended areas for future research include exploring caregiver perspectives and the impact of food allergies and paediatric feeding disorder, and consideration of co-designed studies to inform service improvement initiatives. Full article

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited environments. Methods: We evaluated the economic and health impacts of Egypt’s recent initiative aimed at decreasing surgical waiting lists. The study conducts a CE analysis of the initiative by estimating incremental costs (expressed in Egyptian Pounds—EGP) and outcomes (expressed in quality-adjusted life years—QALYs) before and after its implementation, performs a benefit–cost analysis to quantify the initiative’s return on investment, and employs a budget share method to evaluate catastrophic health expenditure (CHE). The analysis included five elective surgical interventions: open-heart surgery, cardiac catheterization, cochlear implantation, ophthalmic surgery, and orthopedic (joint replacement) surgery. Results: The main research outcomes of the study are as follows. The initiative resulted in incremental cost-effectiveness ratios of EGP 46,795 (societal perspective) and EGP 56,094 (payer perspective) per QALY, both within acceptable CE thresholds. Most of the evaluated interventions demonstrated substantial returns on the investment. Without public funding, more than 90% of patients faced CHE, indicating considerable financial barriers to elective surgeries. Conclusions: Egypt’s initiative to reduce waiting times was deemed cost-effective. Our adaptable modeling framework could be practical for similar evaluations in low/middle-income countries, especially where data is limited. Scaling up the initiative to include additional curative and preventive services and integrating it with broader health system reforms in Egypt is strongly recommended. Full article

Background: The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. Methods: An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May–July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). Results: The mean age was 61.9 (min 30–max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. Conclusions: This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes. Full article

Background: The integration of artificial intelligence (AI) into healthcare research has the potential to enhance research capacity, streamline protocol development, and reduce barriers to engagement. Medway NHS Foundation Trust identified a plateau in homegrown research participation, particularly among clinicians with limited research experience. A generative AI-driven chatbot was introduced to assist researchers in protocol development by providing step-by-step guidance, prompting ethical and scientific considerations, and offering immediate feedback. Methods: The chatbot was developed using OpenAI’s GPT-3.5 architecture, customised with domain-specific training based on Trust guidelines, Health Research Authority (HRA) requirements, and Integrated Research Application System (IRAS) submission protocols. It was deployed to guide researchers through protocol planning, ensuring compliance with ethical and scientific standards. A mixed-methods evaluation was conducted using a qualitative-dominant sequential explanatory design. Seven early adopters completed a 10-item questionnaire (5-point Likert scales), followed by eight free-flowing interviews to achieve thematic saturation. Results: Since its launch, the chatbot has received an overall performance rating of 8.86/10 from the seven survey respondents. Users reported increased confidence in protocol development, reduced waiting times for expert review, and improved inclusivity in research participation across professional groups. However, limitations in usage due to free-tier platform constraints were identified as a key challenge. Conclusions: AI-driven chatbot tools show promise in supporting research engagement in busy clinical environments. Future improvements should focus on expanding access, optimising integration, and fostering collaboration among NHS institutions to enhance research efficiency and inclusivity. Full article

Purpose: Organ preservation (OP) is an increasingly recognized treatment for locally advanced rectal cancer. However, variability in patient selection, treatment regimens, and surveillance can hinder widespread adoption. We conducted a national, cross-sectional survey evaluating how OP is implemented across Canada. Methods: Between June and July 2023, surgeons, radiation oncologists, and medical oncologists with expertise in OP from all 44 Canadian radiation centers completed an electronic survey about the implementation of OP at their centers. Primary OP was defined as administering neoadjuvant therapy with the explicit goal of avoiding surgery. Secondary OP was defined as deferring planned surgery only when there was an unexpected yet sufficient clinical response. Results: Responses from 40 radiation centers (response rate 90.9%) identified that 20 (50.0%) offered primary and secondary OP, 11 (27.8%) offered only secondary, and 8 (20.0%) offered neither. The most common treatment in primary OP was chemoradiation with consolidation chemotherapy (17/20, 89.5%). When assessing the response in primary OP, endoscopic biopsies were more commonly performed with a near-complete response (10/20, 50.0%) than a complete response (4/20, 20.0%). Watch-and-wait surveillance was more frequently offered for a complete response (17/31, 54.8%) than a near-complete response (4/31, 12.9%). Challenges included limited MRI (21/40, 52.5%), clinic time (18/40, 45.0%), timely surgery if required (16/40, 40.0%), and limited familiarity with the protocols and evidence (15/40, 37.5%). Conclusion: OP is recognized nationwide but is inconsistently implemented. Challenges raise concerns about the current feasibility of OP in Canada and highlight the need for less resource-intensive, complex OP protocols. Full article

Telemedicine has emerged as a vital tool for expanding healthcare access, particularly in underserved areas, yet its effectiveness is often hindered by inefficient queuing systems, fluctuating patient demand, and limited resources. This study addresses these challenges by developing a hybrid Artificial Neural Network–Particle Swarm Optimization (ANN-PSO) model aimed at improving the performance of telemedicine queuing systems. A simulation-based dataset was generated to represent patient arrivals, service rates, and queuing behaviors. An ANN was trained to predict key performance metrics, including queue intensity, system utilization, and delays. To further enhance the model’s predictive capabilities, PSO was applied to optimize critical ANN parameters, such as neuron count, swarm size, and acceleration factors. The optimized ANN-PSO model achieved high predictive accuracy, with correlation coefficients (R²) consistently exceeding 0.90 and low mean squared errors across most outputs. The findings show that optimal parameter configurations vary depending on the specific performance metric, reinforcing the value of adaptive optimization. The results confirm the ANN-PSO model’s ability to accurately predict queuing behavior and optimize system performance, providing a practical decision-support tool for telemedicine administrators to dynamically manage patient flow, reduce waiting times, and enhance resource utilization under variable demand conditions. Full article

Background: Rural communities in the United States experience significant barriers in accessing healthcare, including inadequate numbers of providers and local healthcare facilities. These barriers are exacerbated during seasons with high rates of respiratory diseases when rural clinics and providers may be overwhelmed. When mild, many of these respiratory diseases may be managed effectively in alternate settings, including community pharmacies. Investigators interviewed pharmacists in Washington State to explore the capacity of pharmacists and pharmacies to provide test-to-treat services for COVID-19, influenza, and strep throat. Methods: A qualitative study design was used to conduct key informant interviews with pharmacists who precepted student pharmacists from a local university. Twenty interviews were conducted, transcribed, and qualitatively evaluated to identify themes. The 5 A’s of Access were utilized as a theoretical framework. This framework describes five domains of access, including affordability, availability, accessibility, accommodation, and acceptability. Results: Qualitative analysis identified several themes that described the benefits of offering test-to-treat services in rural communities, such as reducing geographical barriers to accessing care, reducing wait times for patients, and reducing the number of patients seeking higher levels of care for basic treatments. Barriers to offering test-to-treat services identified by pharmacist participants included difficulties with receiving payment for services, challenges with adequate staffing, and the lack of awareness among many people in rural communities that pharmacies offer test-to-treat services. Conclusions: Rural communities experience challenges with the limited capacity of healthcare providers to meet the needs of patients in their communities. The results of this qualitative analysis may be useful to pharmacists in U.S. states where collaborative drug therapy agreements or collaborative practice agreements allow the provision of test-to-treat services. By providing test-to-treat services, pharmacists can increase access to care for rural patients and alleviate the burden of offering these services from other healthcare providers. Full article