Volume Delivery Research Articles

An adaptive agent-based approach for instant delivery order dispatching: Incorporating task buffering and dynamic batching strategies

The volume of instant delivery has witnessed a significant growth in recent years. Given the involvement of numerous heterogeneous stakeholders, instant delivery operations are inherently characterized by dynamics and uncertainties. This study introduces two order dispatching strategies, namely task buffering and dynamic batching, as potential solutions to address these challenges. The task buffering strategy aims to optimize the assignment timing of orders to couriers, thereby mitigating demand uncertainties. On the other hand, the dynamic batching strategy focuses on alleviating delivery pressure by assigning orders to couriers based on their residual capacity and extra delivery distances. To model the instant delivery problem and evaluate the performances of order dispatching strategies, Adaptive Agent-Based Order Dispatching (ABOD) approach is developed, which combines agent-based modelling, deep reinforcement learning, and the Kuhn-Munkres algorithm. The ABOD effectively captures the system's uncertainties and heterogeneity, facilitating stakeholders learning in novel scenarios and enabling adaptive task buffering and dynamic batching decision-makings. The efficacy of the ABOD approach is verified through both synthetic and real-world case studies. Experimental results demonstrate that implementing the ABOD approach can lead to a significant increase in customer satisfaction, up to 275.42%, while simultaneously reducing the delivery distance by 11.38% compared to baseline policies. Additionally, the ABOD approach exhibits the ability to adaptively adjust buffering times to maintain high levels of customer satisfaction across various demand scenarios. As a result, this approach offers valuable support to logistics providers in making informed decisions regarding order dispatching in instant delivery operations.

A Review of Literature on Vehicle Routing Problems of Last-Mile Delivery in Urban Areas

Logistics has long been important in an industrial society. Compared with the traditional structure of distribution, which requires freight to be delivered mostly to warehouses or retail stores, customers now often prefer packages to be delivered to their residences, especially after the delivery challenges during the COVID-19 pandemic. The delivery of parcels to urban residential areas increases the challenge due to the amount of delivery volume, tight delivery schedules, and continuously changing delivery conditions. Last-mile delivery tries to address the challenges, taking advantage of the available automation, sensor and communication technologies, and people’s attitudes toward parcel delivery for the benefit of all stakeholders. Various approaches to last-mile delivery have been proposed and analyzed in the literature. This paper reviews the recent literature on vehicle routing for last-mile delivery. The review identified four major categories: crowdshipping, parcel lockers, delivery by sidekicks, and delivery to optional points. The nature of the problems is discussed in five aspects: fleet capacity, time window, fleet option, dynamism of input, and stochastic parameters. The review identifies the achievements and limitations of the research in the areas and proposes a future research agenda.

Serial multiple mediation of perceived professional healthcare support and social structural factors in the relationship between care-seeking behavior and perinatal mental health in Chinese mothers

BackgroundIn previous studies, it has been observed that mother’s perinatal mental health (PMH) problems can be improved by engaging in appropriate health care-seeking behaviors. However, the exact mechanism that influences the relationship between these two factors is still not fully understood. This cross-sectional study aims to examine the serial multiple mediating effects of perceived professional healthcare support (PPHS) and social structural factors on the association between care-seeking behavior and PMH.MethodsThe cross-sectional study evaluated 1705 Chinese mothers (pregnancy 12 to 41 weeks) through questionnaires from October 2021 to November 2022. These mothers were selected from three hospitals in Wuxi, with an annual delivery volume of at least 5000. We conducted a structural equation model (SEM) analysis to examine the multiple mediating effect of PPHS and social structural factors (social stigma or social trust) between care-seeking behavior and PMH. After analyzing the results of the SEM, we used bootstrapping to further test the mediating effect.ResultsAmong the 1705 Chinese mothers surveyed, 636 (37.3%) sought help from professionals. It was observed that more women tended to seek professional help during the early stages of pregnancy (12 to 28 weeks) compared to the later stages (28 to 41 weeks) (t = 1.47, p < 0.05). The results of the SEM analysis indicated that the mother’s care-seeking behavior did not have a significant direct effect on PMH. However, it was identified as a crucial distal variable, with its significant effect being fully mediated by PPHS and social structural factors. The mediation effect of PPHS and social stigma on the pathway from care-seeking behavior to PMH was found to be 92.9% (direct effect = 0.002; indirect effect = 0.026). Additionally, the mediating effect of stigma contributed to 21.9% of the association between care-seeking behavior and PPHS (direct effect = 0.405; indirect effect = 0.114). Similarly, the mediation effect of PPHS and social trust on the pathway from care-seeking behavior to PMH was 73.3% (direct effect = 0.008; indirect effect = 0.022). Moreover, the mediating effect of social trust contributed to 22.0% of the association between care-seeking behavior and PPHS (direct effect = 0.407; indirect effect = 0.115). The proposed model showed a good fit with the collected data.ConclusionThis study examines the serial multiple mediation effect, in which PPHS and social structural factors mediate the relationship between PMH and professional care-seeking behavior. We suggest three levels of intervention: implementing mental health in all policies, providing training for healthcare providers, and establishing healthcare channels with easily accessible information.

Optimization of cargo delivery volumes by road carries in the system of providing transport services

The work considers the formulation of the problem of optimizing the transport process in transport service supply chains and the method of its solution. The study of the transport process of servicing incoming flows of cargo transportation orders showed that in the conditions of competition, motor transport companies try to optimize their activities. However, such optimization leads to the fact that carriers unreasonably refuse obviously promising orders, if the properties of the relevant transport processes are taken into account. It becomes quite difficult to achieve further improvement of the execution of a set of orders at the individual level. This means that transport processes for servicing a single incoming flow of orders should be based on new principles of synthesis. Despite the random nature of the orders, organizational relationships can be established between them, which can serve as signs for building an optimally structured integrated transport process. In order to solve the problem of optimization of the transport process, from the point of view of satisfaction the need for fulfilling orders for the transportation of goods, in transport service supply chains the use of structural modeling is proposed, which makes it possible to carry out the distribution of own vehicles of enterprises that interact with each other, to determine the need for their rental and in the amount of necessary information that, in aggregate, leads to the maximum profit of the enterprise.The initial data and conditions of the formulated task of order fulfillment planning were performed according to the criterion of the maximum profit of the motor vehicle enterprise. The purpose of these studies was the development of methodological bases for optimizing the volume of truck transportation of transport companies, taking into account the potential of their interaction at various levels.Keywords: transportation process, motor vehicle enterprise, supply chain, transportation order, optimization, profit.

Agricultural exports of Ukraine in the conditions of war.

The article is devoted to the study of the problems and challenges of agricultural exports of Ukraine in the conditions of war. It was determined that before the beginning of the full-scale invasion, the country occupied a leading position in the world production of major agricultural crops (sunflower, rapeseed, barley, corn, wheat, soybeans). A comprehensive assessment of Ukraine's export positions in the world was carried out and the countries most dependent on the import of Ukrainian grain were identified. The dynamics of the domestic export of cereals, legumes (with products of their processing) and flour for the period from 2020/2021 MR to August 2023/2024 MR have been analyzed. The author has researched and systematized the problems of reducing the volume of export deliveries of Ukrainian grain to the world market. It is substantiated that part of the problems and challenges are macroeconomic in nature and complicate the development of the country's economy, distort market pricing mechanisms and reduce the competitiveness of domestic products. Among them is the risk of losing the country's reputation as a reliable supplier; loss of markets and trading partners; destruction of logistics and transport infrastructure; reduction of production volumes; change in demand; limiting access to resources; devaluation of the national currency, etc. A systematic analysis of the problems and challenges complicating agricultural export made it possible to single out the main ones: reduction in agricultural production volumes and loss of resource potential; limited financial resources; disruption of logistics chains. Special attention was paid to the problem of sea transportation, which before the beginning of the war provided about 95 % of agricultural exports. The dynamics of Ukraine's export volumes within the framework of the "grain initiative" during 2022- 2023 are analyzed. The role and significance of its implementation to mitigate the negative impact of Russia's military aggression on domestic agricultural exports is described. The reasons for the importance of sea transportation for Ukrainian exports have been determined: large volumes of supplies and their low cost. Emphasis is placed on the need to export by sea, even without the participation of Russia. The author researched the measures implemented by the Ukrainian government to support agricultural production and export and justified the need to develop a set of measures to stabilize and further develop the industry and restore the export of agricultural products. Among them are the following: reduction of bureaucratic barriers; state support for the development of logistics infrastructure, optimization of taxation and lending; adaptation of agricultural production to EU requirements; increasing the quality and safety of products in accordance with international standards; technological development and digitalization; restoration and transition of the agricultural sector to sustainable production. Key words: agricultural production, export, agricultural export, agricultural export problems, "grain initiative".

The impact of SyncPlus on workflow in an independent pharmacy

BackgroundMedication Synchronization (Med Sync) is a medication management strategy that aligns two or more medications to be refilled on the same date. Med Sync may improve several patient outcomes when implemented in a community pharmacy. SyncPlus is a Med Sync service developed at Crosby’s Drugs. Objectives for assessment of SyncPlus included evaluation of changes to delivery volume, number of delivered prescriptions, and number of medication therapy management interventions before and after SyncPlus implementation. Practice descriptionCrosby’s Drugs is an independent pharmacy in downtown Columbus, Ohio. The pharmacy offers several services to a largely Medicare-insured population. Practice innovationSyncPlus patients must fill all prescription medications at Crosby’s Drugs and take at least 5 chronic medications, excluding controlled substances and gabapentin. To enroll, patients verbally agree to review their profile with a technician. Patients complete a clinical consult with a pharmacist to address medication-related problems. Through shared decision-making, the patient and pharmacist determine an anchor drug and next fill date. Medications are short-filled as insurance coverage allows. Pharmacists and interns address medication-related problems and contact prescriber offices for refills and clarifications. Documentation and billing are conducted via the Outcomes platform. Evaluation methodsA 3-month retrospective chart review was performed before and after SyncPlus implementation. Internal pharmacy data and Outcomes data provided reports to address objectives. ResultsIn the three months after SyncPlus implementation, 10 patients were enrolled over three months. The sum of total deliveries dropped from 4478 to 3974. The number of prescriptions delivered were similar before and after SyncPlus implementation. During the 3 months post-implementation 89 Outcomes interventions were completed compared with 18 interventions in the three months prior. ConclusionsA medication synchronization program in an independent pharmacy may improve workflow efficiency by reducing deliveries and increasing opportunities for medication management for patients.

Modelling forest road trafficability with satellite-based soil moisture variables

ABSTRACT Recent decades have seen increased temperatures and precipitation in the Nordic countries with long-term projections for reduced frost duration and depth. The consequence of these trends has been a gradual shift of delivery volumes to the frost-free season, requiring more agile management to exploit suitable weather conditions. Bearing capacity and trafficability are dependent on soil moisture state and in this context two satellite missions offer potenially useful information on soil moisture levels; NASA’s SMAP (Soil Moisture Active Passive) and ESA’s Sentinel-1. The goal of this pilot study was to quantify the performance of such satellite-based soil moisture variables for modeling forest road bearing capacity (e-module) during the frost-free season. The study was based on post-transport registrations of 103 forest road segments on the coastal and interior side of the Scandinavian mountain range. The analysis focused on roads of three types of surface deposits. Weekly SMAP soil moisture values better explained the variation in road e-module than soil water index (SWI) derived from Sentinel-1. Soil Water Index (SWI), however, reflected the weather conditions typical for operations on the respective surface deposit types. Regression analysis using (i) SMAP-based soil dryness index and (ii) its interaction with surface deposit types, together with (iii) the ratio between a combined SMAP_SWI dryness index and segment-specific depth to water (DTW) explained over 70% of the variation in road e-module. The results indicate a future potential to monitor road trafficability over large supply areas on a weekly level, given further refinement of study methods and variables for improved prediction.

Large volume subcutaneous delivery using multi-orifice jet injection

Needle-free jet injection is an alternative drug delivery technique that uses the liquid drug itself to penetrate through the skin. This technology is not only a promising alternative to hypodermic needles but also has the potential to replace intravenous delivery with rapid, needle-free subcutaneous delivery for large-volume treatments. In this work we propose a parallelised, ‘multi-orifice’ approach to overcome the volume constraints of subcutaneous tissue. We present a prototype multi-orifice nozzle with up to seven orifices and use this nozzle to perform injections into samples of ex vivo porcine tissue. These injections demonstrated the rapid (<0.15 s) delivery of up to 2 mL into the tissue using both three and seven orifices. Delivery success (measured as the percentage of fluid deposited in the tissue relative to the total volume that left the device) was very similar when using three versus seven injection orifices. A computational fluid dynamic model of multi-orifice jet injection is also presented. This model predicts that jet production is largely unaffected as the spacing between orifices is changed from 3 mm to 48 mm. This finding is supported by measurements of the speed, volume, and shape of the jets produced by the prototype nozzle that showed very similar jets were produced through all seven orifices. These findings demonstrate the feasibility of multi-orifice jet injection for needle-free delivery of large volumes. This promising technique has the potential to improve patient experience and reduce healthcare costs in large volume parenteral delivery applications.

Racial Disparities in Cesarean Delivery Rates: Do Hospital-Level Factors Matter?

This study aimed to assess whether racial disparities in nulliparous, term, singleton, vertex cesarean delivery rates vary among hospitals of different type (academic vs. nonacademic), setting (urban vs. rural), delivery volume, and patient population. This is a retrospective cohort study including singleton term vertex live births in nulliparous Black and non-Hispanic White birthing people in California between 2011 and 2017. Cesarean delivery rates were obtained using birth certificate data and International Classification of Diseases, 9th/10th Revision codes. Risk of cesarean delivery was compared among Black versus White birthing people by hospital type (academic, nonacademic), setting (rural, suburban, urban), volume (< 1,200, 1,200-2,300, 2,400-3,599, ≥3,600 deliveries annually), and patient population (proportion Black-serving). Federal Information Processing codes were used to designate hospital setting. Risks were calculated using univariable and multivariable logistic regression and adjusted for birthing person age, body mass index, medical comorbidities, gestational age, labor type (spontaneous vs. induction), and infant birthweight. The sample included 59,441 Black (cesarean delivery rate: 30.2%) and 363,624 White birthing people (cesarean delivery rate: 26.1%). Black birthing people were significantly more likely than White birthing people to have a cesarean delivery across nearly all hospital-level factors considered with adjusted relative risks ranging from 1.1 to 1.3. The only exception was rural settings in which the adjusted relative risk was 1.3 but did not reach statistical significance. Black-White disparities in nulliparous, term, singleton, vertex cesarean delivery rates were persistent across all hospital-level factors we considered: academic status, rurality, delivery volume, and patient population. Furthermore, disparities existed at roughly the same magnitude regardless of hospital characteristics. These global increased risks likely reflect structural inequities in care, which contribute to disparities in pregnancy-related morbidity and mortality. These data should encourage providers, hospital systems, and quality collaboratives to further investigate racial disparities in cesarean delivery rates and develop strategies for eliminating them. · Nulliparous Black birthing people are more likely than White to undergo cesarean delivery.. · This persists across hospitals of all academic status, rurality, delivery volume, and patient population.. · These findings likely reflect structural rather than institutional inequities in obstetric care..

REstrictive versus StandarD FlUid Management in Mechanically Ventilated ChildrEn Admitted to PICU: study protocol for a pilot randomised controlled trial (REDUCE-1)

IntroductionIntravenous fluid therapy is the most common intervention in critically ill children. There is an increasing body of evidence questioning the safety of high-volume intravenous fluid administration in these patients....

Development of an integrated scenario-based stochastic rolling-planning multistage logistics model considering various risks

In this study, a new integrated scenario-based stochastic rolling-planning multistage logistics model is proposed to reduce overall logistics costs. To achieve this goal, two phases were considered in the model. In the first phase, a multi-criteria group decision-making model was developed to select a trustworthy supplier. In the second stage, the selected suppliers were integrated with other stakeholders to develop a rolling-planning-based logistics model using a variety of risky scenarios. Several risk factors including price variability, demand, and quality risks were considered in the model. By considering these risk factors, a new risk-embedded rolling-planning logistics method was established that regulates inventory, stock-out, and overstock problems by constantly controlling the production volume at the manufacturing site based on actual demands. In this model, the supplier's side material quality, price fluctuation risks, and customer-side demand risks were considered simultaneously. To evaluate the performance of the proposed model, a numerical example was set up, and the obtained results were compared with those of another model where fixed volume production and delivery approach was used instead of the rolling-planning approach. To verify the superiority and robustness of the proposed model, its performance was verified through a sensitivity analysis under different experimental conditions. The findings show that in a risk environment, the proposed model estimates lower logistics costs of 2697648.00 units compared to another model whose costs were 2721843.00 units.

CO2 emissions and delivery time of last‐mile drone delivery using trucks

AbstractThe shift in consumer behaviour from in‐person to online shopping has led to an increase in parcel delivery volume and its associated negative impacts, such as CO2 emissions in cities. With the emergence of drone‐delivery technologies, the authors analyzed a joint delivery method using drones and trucks, which is an emerging alternative solution for last‐mile delivery in terms of CO2 emissions and delivery time. The analysis verified the highest possible level of reduction in CO2 emissions for the simultaneous and strategic operation of drones and trucks compared to diesel‐ or electric‐only truck operations. Moreover, this approach leads to reduced delivery times. A sensitivity analysis was performed to optimize the delivery‐drone flight performance in a drone‐and‐truck delivery strategy. It was found that a 1.5‐km drone flight performance was sufficient when considering the reasonable assumptions adopted in this study. Furthermore, based on the analysis results, drone‐and‐truck cooperative delivery strategies may not provide a significant advantage in terms of CO2 emissions compared with alternative transportation modes, such as fuel‐cell trucks with sufficiently low emissions. It has been empirically verified that changes in CO2 emissions are proportional to the number of clusters. However, there is a risk of local optima due to microscopic fluctuations among neighbouring cluster numbers, which occurs during the search for the optimal number of clusters.

부산 A공동주택 내 택배물류 공동화센터(LDC)의 운영실태 분석

The logistics environment has experienced rapid growth and diversification, and the areas of city logistics and life logistics have grown significantly compared to the past. After COVID-19, the volume of online purchases and courier deliveries has increased significantly due to the continuation of the non-face-to-face environment and digitalization. In addition, as the importance of safety and security in the place where I live is increasing, small and large conflicts in last-mile delivery are becoming a social issue, and one of the ways to resolve them is the LDC (Last-mile Delivery Center). Compared to its importance, the actual status of existing operating facilities is insufficient, so it can be said that it is of primary importance to examine the operation status and identify problems focusing on specific centers that are actually in operation. It is expected that it can be greatly utilized as basic data for step-by-step application of smart substantiation projects that are considered through convergence with the 4th Industrial Revolution technology. The case area, Busan A apartment house, is an apartment complex with approximately 1,150 households and 9 buildings, completed in 2007. It is an area with more than 10,000 apartment complexes and officetels nearby. Above all, it has been in operation for 8 years from 2015 to 2023. It can be said that the fact that this is the area where the above center is operated is consistent with this study. As a result of the analysis of the operation status, it was figured out that the LDC operation in the case area has developed to a stable level. However, only three of the initial large number of delivery companies are currently participating, so there is a limit to creating additional logistics demand, and most of the work is done by hand. These areas were identified as major limitations. LDC not only improves the efficiency of life logistics-scale delivery and enhances the safety of the complex, but also has the advantage of reducing unnecessary vehicles in the city and thereby reducing adverse environmental impacts. Related policies are also being promoted at the public level. This is being actively explored. The results of this study are expected to be a great reference in promoting related policies, so they can be said to have a different significance from existing studies that only argued for facility expansion.

Bayesian Neural Network-Based Demand Forecasting for Express Transportation

The rapid development of e-commerce in recent years has driven the growth of the logistics service industry, which in turn has led to a significant increase in express delivery volume. Predicting express delivery volume accurately and in advance can help companies allocate various resources reasonably and provide the basis for predicting express delivery demand. To predict the specific transport volume of XX Express Company's logistics routes on April 28th and 29th, 2023, this article builds two Bayesian prediction models based on the company's historical transportation data as the training set, one for predicting the opening of logistics routes and the other for predicting express delivery quantity. This approach reduces the impact of inaccurate predictions due to logistics routes not being opened properly and improves the accuracy of the prediction model. It provides decision support for optimizing resource layout for express delivery companies.

Marketing Strategy Analysis in Increasing the Volume of Package Delivery Services PT. Xyz

Logistics is one of the main needs and various efforts are being made to fulfill it. These efforts include trading and exchanging goods and conducting social relations, namely by sending goods by individuals, companies and social groups. PT. XYZ is present as an expedition service startup company that offers various types of services with digital technology-based selling points that can be accessed via smartphones to make it easier for consumers. However, the very tight competition makes the company must determine an effective and efficient marketing strategy in increasing the volume of package delivery. This is what makes the author want to know how the right marketing strategy in increasing package delivery, the obstacles encountered and the solutions made by PT. XYZ. In this research method is descriptive qualitative approach, with data collection techniques through interviews, observation and documentation. Based on the results of marketing strategy research conducted by PT. XYZ is doing quite well in increasing the volume of package delivery, by collaborating with the marketing mix in the form of product, price, promotion and place to the fullest. Which at the same time can be used to overcome obstacles and present the solutions needed for companies.

냉동창고 건설공사 화재예방시스템 개선에 관한 연구

The domestic logistics environment must provide services in real time, regardless of time and place, due to increased delivery volume, increased logistics warehouse functions, increased delivery speed, increased low-temperature products, and the 4th Industrial Revolution. In order to survive in this logistics environment, logistics companies and others are pursuing profits on a large scale and short construction periods as business survival strategies, so the exposure of risks to logistics warehouse construction is very serious. Among them, more than 1,000 fire accidents with very serious disaster intensity have continued to occur over the past 10 years since 2010, and fire accidents have caused dozens of lives and property damage of tens of billions of won every year. The purpose of this study is to reveal the problems of the fire prevention system of the frozen warehouse construction work through case analysis and related laws and literature that occurred in the construction of the frozen warehouse among the logistics warehouses and to suggest ways to improve them.&#x0D; The research method was to investigate and analyze fire status, accident cases (centered on accidents at frozen warehouses in Icheon, Gyeonggi-do in 2008), theoretical consideration such as 4M techniques, and suggest ways to improve the fire prevention system.&#x0D; Fire prevention mechanisms of 4M refrigeration warehouse construction were investigated. Fire control by unqualified firemen, fire monitors, and lack of management by supervisors existed mechanically. The construction method of fire prevention was improved S.H.P(Safety Hold Point) operation, replacement of frozen warehouse insulation with semi-non-combustible urethane foam, introducing a mandatory fire prevention education system, strengthening emergency simulation training, and finally operating a one-out system for those who do not fulfill fire prevention guidelines.&#x0D; While conducting this study, it was an opportunity to examine the seriousness of fire accidents in frozen warehouse construction work, and I hope that the measures proposed through this study will help prevent fire in frozen warehouse construction work.

Evaluating the Effects of Bone Marrow Sparing Radiotherapy on Acute Hematologic Toxicity for Patients with Locoregionally Advanced Cervical Cancer: A Prospective Phase II Randomized Controlled Trial

Bone marrow sparing intensity modulated radiotherapy (BMS-IMRT) can reduce the incidence of acute hematologic toxicity (HT) for locoregionally advanced cervical cancer (LACC) patients receiving concurrent chemoradiotherapy (CCRT), but the norm has been controversial. The purpose of the study was to evaluate the effects of bone marrow (BM) V40 <25% on decreasing the incidence of acute HT in a prospective clinical trial. A total of 242 LACC patients were recruited from May 2021 to May 2022, who were evenly randomized into BMS-IMRT group and standard IMRT group according to a computer-generated random number list. All patients received pelvic irradiation with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. For patients in BMS-IMRT group, the outer contour of pelvic bone, lumbar spine and left and right femur heads were additionally delineated as a surrogate for BM, and V40 <25% was prescribed. Blood counts were tested weekly, of which nadirs during external beam radiotherapy (EBRT) were graded to assess acute HT as primary observation index. Second observation index were dosimetric parameters of EBRT plan from the dose volume histograms (DVHs). Binary logistic regression model and receiver operating characteristic (ROC) curve were used for predictive value analysis. Baseline demographic, disease and treatment characteristics were all balanced between BMS-IMRT group and standard IMRT group. BMS-IMRT was associated with a lower incidence of grade ≥2 and grade ≥3 acute HT, leukopenia and neutropenia (72.70% vs 90.90%, P <0.001*; 16.50% vs 65.30%, P <0.001*; 66.10% vs 85.10%, P = 0.001*; 13.20% vs 54.50%, P <0.001*; 37.20% vs 66.10%, P <0.001*; 10.70% vs 43.80%, P <0.001*). Plan target volume (PTV) for all patients satisfied the clinical requirement of V(100%) ≥95%, and conformity and homogeneity were both comparable between 2 groups. BMS also decreased dose delivered to the organs at risk (OARs) including rectum, bladder and left and right femur head. Univariate and multivariate analyses showed that BM V40 was an independent risk factor for grade ≥3 acute HT (odds ratio [OR] = 2.734, 95% confidence interval [CI] = 1.959-3.815, P <0.001*). Cutoff value was 25.036% and area under the curve (AUC) was 0.786. The nomogram was constructed, which was rigorously evaluated and internally cross-validated, showing good predictive performance. BM V40 <25% can reduce the risks of acute HT for LACC patients receiving CCRT while the dose delivery of target volume and other normal tissues were not compromised. With great practicality and applicability, BM V40 <25% is a promising strategy, making BMS-IMRT widespread especially in the area where application of image guided radiotherapy (IGRT) such as 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET)/CT is not popularized. Chinese clinical trial registry (ChiCTR2200066485).

The Driver-Aide Problem: Coordinated Logistics for Last-Mile Delivery

Problem definition: Last-mile delivery is a critical component of logistics networks, accounting for approximately 30%–35% of costs. As delivery volumes have increased, truck route times have become unsustainably long. To address this issue, many logistics companies, including FedEx and UPS, have resorted to using a “driver aide” to assist with deliveries. The aide can assist the driver in two ways. As a “jumper,” the aide works with the driver in preparing and delivering packages, thus reducing the service time at a given stop. As a “helper,” the aide can independently work at a location delivering packages, and the driver can leave to deliver packages at other locations and then return. Given a set of delivery locations, travel times, service times, jumper’s savings, and helper’s service times, the goal is to determine both the delivery route and the most effective way to use the aide (e.g., sometimes as a jumper and sometimes as a helper) to minimize the total routing time. Methodology/results: We model this problem as an integer program with an exponential number of variables and an exponential number of constraints and propose a branch-cut-and-price approach for solving it. Our computational experiments are based on simulated instances built on real-world data provided by an industrial partner and a data set released by Amazon. The instances based on the Amazon data set show that this novel operation can lead to, on average, a 35.8% reduction in routing time and 22.0% in cost savings. More importantly, our results characterize the conditions under which this novel operation mode can lead to significant savings in terms of both the routing time and cost. Managerial implications: Our computational results show that the driver aide with both jumper and helper modes is most effective when there are denser service regions and when the truck’s speed is higher (≥10 miles per hour). Coupled with an economic analysis, we come up with rules of thumb (that have close to 100% accuracy) to predict whether to use the aide and in which mode. Empirically, we find that the service delivery routes with greater than 50% of the time devoted to delivery (as opposed to driving) are the ones that provide the greatest benefit. These routes are characterized by a high density of delivery locations. Supplemental Material: The e-companion is available at https://doi.org/10.1287/msom.2022.0211 .

Hyperoxia but not high tidal volume contributes to ventilator-induced lung injury in healthy mice

BackgroundMechanical ventilation is a supportive therapy used to maintain respiratory function in several clinical and surgical cases but is always accompanied by lung injury risk due to improper treatment. We investigated how tidal volume and oxygen delivery would contribute independently or synergistically to ventilator-induced lung injury (VILI).MethodsUnder general anesthesia and tracheal intubation, healthy female C57BL/6 N mice (9 weeks old) were randomly ventilated for 2 h by standard (7 ml/kg) or high (14 ml/kg) tidal volume at positive end-expiratory pressure (PEEP) of 2 cmH2O, with room air, 50% O2 (moderate hyperoxia), or 100% O2 (severe hyperoxia); respectively. Mice were sacrificed 4 h after mechanical ventilation, and lung tissues were collected for experimental assessments on lung injury.ResultsCompared with the healthy control, severe hyperoxia ventilation by either standard or high tidal volume resulted in significantly higher wet-to-dry lung weight ratio and higher levels of IL-1β and 8-OHdG in the lungs. However, moderate hyperoxia ventilation, even by high tidal volume did not significantly increase the levels of IL-1β and 8-OHdG in the lungs. Western blot analysis showed that the expression of RhoA, ROCK1, MLC2, and p-MLC2 was not significantly induced in the ventilated lungs, even by high tidal volume at 2 cmH2O PEEP.ConclusionSevere hyperoxia ventilation causes inflammatory response and oxidative damage in mechanically ventilated lungs, while high tidal volume ventilation at a reasonable PEEP possibly does not cause VILI.

Preintubation Machine-Delivered Pressure Support Ventilation With Positive End-Expiratory Pressure Versus Manual Bag-Mask Ventilation for Oxygenation in Overweight and Obese Patients: A Randomized, Pilot Study.

Noninvasive positive pressure ventilation (NIPPV) maintains mean airway pressures well, and its usability for preoxygenation is well described. Anesthesia machine-delivered NIPPV-based preoxygenation has recently been evaluated against the traditional manual bag-mask ventilation (BMV). The efficiency of such a technique over the traditional one is yet to be established well. The present study evaluated the feasibility of machine-delivered preoxygenation using pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and compared the effectiveness with BMV. Thirty overweight and obese adults belonging to the American Society of Anesthesiologist's physical status I-II were randomized to receive PSV+PEEP or BMV for preintubation preoxygenation targeted to a fraction of expired oxygen (FeO2)of 85% and 90% or for a maximum period of five minutes, whichever came first. Postintubation, the patient was observed for the time taken until 1% desaturation without ventilation. Arterial blood gases, respiratory variables, FeO2 achieved, and different times were collected and compared. The baseline characteristics and arterial blood gases were similar between the two groups. The PSV+PEEP group had consistent and favorable tidal volume and airway pressure delivery. The difference in time to reach aFeO2 of 85% between the two groups was not statistically different. Only two patients achieved a FeO2 of 90% in the PSV+PEEP group versus none in the BMV group. However, partial pressure of oxygenat 1% desaturation (217.42±109.47 versus 138.073±71.319 mmHg, p 0.0259) was higher in thePSV+PEEP group. Similarly, the time until1% desaturation was significantly prolonged in the PSV+PEEP group (206.6±76.952 versus 140.466±54.245 seconds, p 0.0111). The present pilot study findings indicate that preintubation machine-delivered PSV+PEEP-based preoxygenation is feasible and might be more effective than traditional BMV in overweight and obese patients.