Variable neighborhood search to solve the vehicle routing problem for hazardous materials transportation.

This work focuses on the Heterogeneous Fleet Vehicle Routing problem (HFVRP) in the context of hazardous materials (HazMat) transportation. The objective is to determine a set of routes that minimizes the total expected routing risk. This is a nonlinear function, and it depends on the vehicle load and the population exposed when an incident occurs. Thus, a piecewise linear approximation is used to estimate it. For solving the problem, a variant of the Variable Neighborhood Search (VNS) algorithm is employed. To improve its performance, a post-optimization procedure is implemented via a Set Partitioning (SP) problem. The SP is solved on a pool of routes obtained from executions of the local search procedure embedded on the VNS. The algorithm is tested on two sets of HFVRP instances based on literature with up to 100 nodes, these instances are modified to include vehicle and arc risk parameters. The results are competitive in terms of computational efficiency and quality attested by a comparison with Mixed Integer Linear Programming (MILP) previously proposed.

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan.

OBJECTIVE: To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan. DESIGN AND METHODOLOGY: A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers. RESULTS: There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases. CONCLUSION: Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction (JPMA 52:21, 2002).

Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan.

OBJECTIVE: Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, undertaken in selected villages in northern Pakistan between 1997 and 2001, was designed to deliver an integrated package of activities to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour. METHODS: A case-control study was conducted during July-September 2001 to evaluate whether, after selected confounders were controlled for, children aged <6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed. FINDINGS: Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages (adjusted odds ratio, 1.331; P<0.049). Boys had 25% lower odds of having diarrhoea than girls (adjusted odds ratio, 0.748; P<0.049). A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age (adjusted odds ratio, 0.974; P<0.044) and a 1.4% decrease for every monthly increase in the child's age (adjusted odds ratio, 0.986; P<0.001). CONCLUSIONS: The findings in this study may help refine the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach taken by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type.

Factors affecting unsuccessful referral by the Lady Health Workers in Karachi, Pakistan.

OBJECTIVE: To estimate the proportion of patient referral and to identify the factors associated with unsuccessful referral in Karachi, Pakistan. METHODS: In a cross-sectional survey, a total of 347 patients referred to different health care facilities by the LHWs were interviewed. Data was collected using a structured questionnaire, on demographic characteristics of patients (age, sex, income etc) and potential factors (seriousness of medical condition, distance of health facility, attitude of health center staff etc) that can affect patient referral outcome. RESULTS: An overall referral rate of 55% was found in this study. Out of a total of 347 patients interviewed, 265 (76.4%) were successful while 82 (23.6%) were unsuccessful referrals. Multivariate logistic regression analysis showed that objection to referral (Adjusted OR, 2.96; CI: 1.44-5.52), never referred before (Adjusted OR, 1.25; CI: 1.34-6.90), not visited the referral site before (Adjusted OR, 4.04; CI: 2.50-6.08) and no knowledge of who to meet at the referral site (Adjusted OR, 1.30; CI: 1.01-2.96) were the factors associated with unsuccessful referral. Other factors found significant were duration of the illness of the patient, anyone not known at the referral site and failure of LHW to follow up. CONCLUSION: Our study found that a significant proportion of patients seen by the LHWs are referred to different health facilities. Improved management skills of LHWs for simple medical problems would probably reduce the number of referrals. Efforts should also be directed to enhance the communication and counseling skills of LHWs, which may reduce a significant proportion of unsuccessful referrals.

Health needs of clients as reported by medical practitioners from two districts of Sindh.

OBJECTIVE: To identify the major health and reproductive health problems for which people consult local medical practitioners. METHODOLOGY: Forty-one practitioners completed a self-administered questionnaire. A startified purposive sample of practitioners was selected by asking the community members from various towns and rural areas to identify practitioners who have most busy practices and are perceived as providing quality care. RESULTS: Nine of the forty-one practitioners were females. Twenty-two were consulted mainly by women and another seventeen by an equal number of women and men. Practitioners pointed to malnutrition, malaria, gastrointestinal and respiratory tract problems as being the most common ailments. They identified menstrual problems, malnutrition among pregnant women, burning micturition and vaginal discharge as the most common reproductive health problems of their clients. Only 16 medical practitioners said that they diagnosed someone in the last one-month as suffering from sexually transmitted infections. CONCLUSION: The survey helped in developing an understanding of health issues from provider perspective. Findings indicate a concordance between what has been revealed by previous population based studies in similar situations and to what health problems practitioners pointed as common. While a comprehensive needs-assessment requires surveys and qualitative interviews with communities, consultations with relatively fewer medical practitioners could also provide a quick and fair approximation of priority health problems in the area.

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan.

OBJECTIVE: To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan. DESIGN AND METHODOLOGY: A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers. RESULTS: There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases. CONCLUSION: Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction.

Separation of Cr(III) and Cr(VI) using melamine-formaldehyde resin and determination of both species in water by FAAS.

A method is described for the determination of Cr(VI) and total chromium by FAAS. Cr(VI) is separated from Cr(III) by adsorption on melamine-formaldehyde resin. After elution of Cr(VI) with 0.1 mol/l NaAc solution, it is analysed by FAAS. Total chromium is determined by FAAS after conversion of Cr(III) to Cr(VI) by oxidation with hydrogen peroxide, total Cr(VI) is concentrated as above. If the total concentration of chromium is sufficient, the determination can be directly made by FAAS. Cr(III) can then be calculated by subtracting Cr(VI) from the total Cr. This method was successfully applied to the determination of chromium in lake water.

Hydatid disease of the kidney: evaluation and features of diagnostic procedures.

We discuss 8 patients with hydatid cystic disease of the kidney. Diagnostic procedures included eosinophil count, Casoni's skin test, Ghedini-Weinberg complement fixation test, abdominal x-ray, excretory urogram, ultrasonography and computerized tomography. The combined findings of these different modalities aid greatly in establishing the correct diagnosis.

Ultrasound examination of scrotal masses.

The technique of renal time ultrasound of the scrotum is described. The examination was performed in 50 patients and 15 normal males at the Sahinbey Hospital. Given the clinical diagnosis ultrasound proved reliable in almost all cases. In this study ultrasonography of the scrotum has been found to be the most useful method demonstrating testicular diseases.

Hydatid disease of the kidney.

OBJECTIVE: To define the clinical manifestations of echinococcal involvement of the urinary tract and to propose guidelines for treatment. PATIENTS AND METHODS: A positive diagnosis of hydatid disease was made in seven patients and in all of these the cyst was located in the kidney only. The patients included four males and three females whose ages ranged from 6 to 56 years (mean 33.3). RESULTS: Surgical treatment involved total nephrectomy in six patients and partial nephrectomy in one patient. There was no operative or post-operative mortality and all patients were cured of the disease. CONCLUSION: Despite its rarity, hydatid disease should be considered in the differential diagnosis of space-occupying lesions of the urinary tract.

The Nesbit-Kelâmi procedure for congenital curvature of the erect penis. Report on 20 patients.

Twenty patients with a congenital deformity of the erect penis were operated upon using the Nesbit-Kelâmi technique. Excellent results were obtained in all patients.

Epididymo-orchitis due to brucellosis.

A diagnosis of epididymo-orchitis due to brucellosis was made in 13 patients between 1989 and 1991. Both testis and epididymis were involved in 8 patients, 3 had bilateral epididymo-orchitis and 2 presented with orchitis alone. Patients were treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 weeks and complete resolution was achieved in 10.

Urethral manipulation syndrome (Kelâmy syndrome): acquired ventral penile deviation.

Fibrosis of the corpus spongiosum penis, caused by urethral manipulation and the resulting ventral penile deviations are known as the urethral manipulation syndrome (Kelâmi Syndrome). This condition is due to fibrosis and scarring of the corpus spongiosum penis after any kind of urethral manipulation. We have observed 4 urethral manipulation syndromes developing after urethrocystoscopy and presented them.

Evaluation of the variation in chemical composition and surface topography of different brands of gutta percha cones.

There have been many studies on the gutta percha cones used in endodontic therapy. Variations exist between different brands of cone. Since an appropriate cone plays a very important role in the prognosis of therapy, this study examined the surface topography and chemical composition of eight different brands of cone by, a scanning electron microscopy (SEM) and atomic absorption spectrometry. There were some differences between all brands of gutta percha cones.

Meatal advancement and glanuloplasty: a report on 25 cases.

We report on 25 children who underwent repair of distal hypospadias with the meatal advancement and glanuloplasty technique. The principles of this operation were safe and there were no complications. Meatal advancement and glanuloplasty proved to be a successful and reliable procedure in the properly selected child with distal hypospadias.

Erectile dysfunction due to venous incompetence treated by dorsal vein ligation.

The authors describe 14 cases of erectile dysfunction. The sites of leakage were detected by duplex or colour flow Doppler sonography. Treatment by dorsal vein ligation resulted in fairly good early responses, however, at 4-month follow-up the great majority of patients returned to the original functional state.

Simple method for distinguishing maneb, zineb, mancozeb, and selected mixtures.

Maneb, zineb, mancozeb, and arbitrarily selected mixtures of those can be differentiated by a simple method. Compounds are differentiated on the basis of colors produced after treatment of saturated solutions of the fungicides in n-propanol-acetone mixture (1 + 1 v/v), first with dithizone and then with monosodium dihydrogen phosphate solution in the same solvent. The color depends on the type and concentration of metal present in the sample.