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A review and ranking of operators in adaptive large neighborhood search for vehicle routing problems
No full textThis article systematically reviews the literature on adaptive large neighborhood search (ALNS) to gain insights into the operators used for vehicle routing problems (VRPs) and their effectiveness. The ALNS has been successfully applied to a variety of optimization problems, particularly variants of the VRP. The ALNS gradually improves an initial solution by modifying it using removal and insertion operators. However, relying solely on adaptive operator selection is not advisable. Instead, authors often conduct experiments to identify operators that improve the solution quality or remove detrimental ones. This process is mostly cumbersome due to the wide variety of operators, further complicated by inconsistent nomenclature. The objectives of this review are threefold: First, to classify ALNS operators using a unified terminology; second, to analyze their performance; and third, to present guidelines for the development and analysis of ALNS algorithms in the future based on the outcomes of the performance evaluation. In this review, we conduct a network meta-analysis of 211 articles published between 2006 and 2023 that have applied ALNS algorithms in the context of VRPs. We employ incomplete pairwise comparison matrices, similar to rankings used in sports, to rank the operators. We identify 57 distinct removal and 42 insertion operators, and the analysis ranks them based on their effectiveness. Sequence-based removal operators, which remove sequences of customers in the current solution, are found to be the most effective. The best-performing insertion operators are those that exhibit foresight, such as regret insertion operators. Finally, guidelines and possible future research directions are discussed
Pflegetätigkeiten im ambulanten und stationären Bereich - Bedarf und Anforderungen
No full textDie sektorale Fragmentierung der Gesundheitsversorgung, die demografische Entwicklung und die zunehmende Prävalenz chronischer Krankheiten in allen Altersgruppen sowie die damit einhergehenden Unterstützungsbedarfe stellen die Gesundheitssysteme weltweit vor Herausforderungen. Neben der Finanzierung und dem weiter zunehmenden Fachpersonalmangel geht es um Fragen einer angemessenen Versorgungsqualität der Betroffenen sowie ihrer An- und Zugehörigen (u.a. Statistisches Bundesamt 2025). Diese Entwicklungen werden zu einer quantitativen Zunahme und gleichzeitig zu qualitativen Veränderungen des Bedarfs an Gesundheits- und Sozialleistungen führen. Um diese Herausforderungen zu adressieren, werden auch in Deutschland neue Versorgungsformen und -strukturen erprobt, die eine bedarfsgerechte und qualitativ angemessene Gesundheitsversorgung der Bevölkerung ermöglichen.
Bereits 1978 betonte die Weltgesundheitsorganisation hinsichtlich nachhaltiger Versorgungsformen die Bedeutung einer qualitativ hochwertigen Primärversorgung (WHO 1978). Grundlegend sind hierbei interprofessionelle Teams, die sich bedarfsorientiert aus Gesundheitsfachpersonen unterschiedlicher Berufsgruppen zusammensetzen und die Versorgung der Betroffenen sowie ihrer An- und Zugehörigen sicherstellen. Ziele sind neben der Verbesserung der gesundheitlichen Situation der Bevölkerung vor allem auch wirksame Interventionen zur Prävention und Gesundheitsförderung (u.a. Bayerisches Staatsministerium für Gesundheit und Pflege 2022). In Ländern mit entwickelten Primärversorgungssystemen stellen entsprechend qualifizierte Pflegepersonen, wie z.B. Advanced Practice Nurses, Community Health Nurses, School Health Nurses (DBfK 2022, DIP 2022, WHO 2014, Kultusministerkonferenz 2012) eine zentrale Säule der interprofessionellen Versorgung dar, die zu einer stärkeren Personzentrierung beiträgt und eine Fokussierung der ärztlichen Aufgaben ermöglicht (Doppelfeld et al. 2023, Robert Bosch Stiftung 2021, Laurant et al. 2018).
Insgesamt müssen neben der Ausrichtung auf bedarfsgerechte Versorgungsformen und -strukturen in der Primärversorgung zudem Anreize für die verschiedenen Gesundheitsfachberufe, u.a. in Form von entsprechenden Aufgaben- und Handlungsfeldern, geschaffen werden, um eine angemessene Versorgung aller Altersgruppen in den jeweiligen Versorgungssettings zu ermöglichen (SVR 2024). Des Weiteren müssen Anforderungen wie die Stärkung der pflegenden An- und Zugehörigen, die bedarfsorientierte Personalbemessung mit dem passenden Skill- und Grademix, die Einbindung des Ehrenamts sowie der Einsatz von digitalen und assistenzrobotischen Unterstützungssystemen/Künstliche Intelligenz als Interventionen der Regelversorgung ermöglicht werden.
Literatur:
Bayerisches Staatsministerium für Gesundheit und Pflege (2022): Gesundheitsregionen plus. Gesundheitsregionen plus – Entscheidungen vor Ort treffen (bayern.de) (21.08.2022)
DBfK (2022): Community Health Nursing. Aufgaben und Praxisprofile. www.dbfk.de/chn (25.10.2022)
DIP, Deutsches Institut für angewandte Pflegeforschung e.V. (2022): Die erweiterte pflegerische Versorgungspraxis. Abschlussbericht der begleitenden Reflexion zum Förderprogramm „360° Pflege – Qualifikationsmix für Patient:innen – in der Praxis“. Abschlussbericht-360Grad_Pflege_Qualifikationsmix.pdf (20.06.2022)
Doppelfeld, S.; Sappok-Laue, H.; Klein, S.: Faber, E., Lauven,, G. (2023): Pflegeexpert_innen in der Primärversorgung von chronisch kranken Menschen. Einblicke in ein laufendes Projekt. Pflege 36(1):56-63. https://doi.org/10.1024/1012-5302/a000926
Kultusministerkonferenz (2012: Empfehlung zur Gesundheitsförderung und Prävention in der Schule, Beschluss der Kultusministerkonferenz vom 15.11.2012, http://li.hamburg.de/contentblob/3853640/data/kmk-2012.pdf (11.08.2018)
Laurant, M.; van der Biezen, M.; Wijers, N.; Watananirun, K.; Kontopantelis, E.; van Vught, A.J.A.H (2018): Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD001271. DOI: 10.1002/14651858.CD001271.pub3
Robert Bosch Stiftung (2021): PORT – Patientenorientierte Zentren zur Primär- und Langzeitversorgung. PORT Patientenorientierte Zentren zur Primär- und Langzeitversorgung | Robert Bosch Stiftung (bosch-stiftung.de) (21.03.23)
Statistisches Bundesamt (2025): Pflege. Zahl der Pflegebedürftigen steigt bis 2070 deutlich an - Statistisches Bundesamt (08.01.2025)
SVR, Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen und in der Pflege (2024):Fachkräfte im Gesundheitswesen. Nachhaltiger Einsatz einer knappen Ressource. DOI: 10.4126/FRL01-006400072.. Gutachten_2024_barrierefrei.pdf (svr-gesundheit.de) (23.04.2024)
WHO (1978): Primary Health Care. Report of the International Conference on Primary Health Care. Alma Ata, USSR, 6-12 September 1978. https://iris.who.int/bitstream/handle/10665/39228/9241800011.pdf?sequence=1 (13.09.2024
Episodic forgiveness in young American adults and its pathways to distress by health, outlook, spirituality, aggression, and social support
No full textBackground:
Forgiveness is one form of emotion-focused coping, and the positive effects of such a practice on mental well-being have been confirmed by numerous meta-analyses. The biopsychosocial model assumes that feeling burdened is determined by a number of physical, psychological, and social factors, suggesting a multidimensional relationship between forgiveness and distress. In this study, we tested a model according to which various sociopsychological variables (i.e., health, outlook, spirituality, aggression, and social support) mediate the negative association between episodic forgiveness (also known as state forgiveness) and distress.
Participants and procedure:
We tested the model on a cross-sectional sample of 436 young adults from the United States (62% of whom were women) using structural equation modelling (SEM).
Results:
The results of the overall model supported our indirect effects hypotheses. An analysis of specific indirect effects revealed that variables such as health, a negative outlook, aggressiveness, and social support play a special role in adaptation to stressful life events in forgiving individuals.
Conclusions:
The relationship between episodic forgiveness and distress can be explained through complex sociopsychological mechanisms, including feelings of health, outlook, or social support, and attitudes, experiences, and behaviours related to these mechanisms can influence each other and collectively contribute to preventing or reducing perceived burden in young American adults
Exploring Community Music and Gezek in Music Education Context in Türkiye
No full textCommunity music is grounded in principles of participation, bottom-up learning, accessibility, inclusion, and cultural democracy. In Türkiye, the concept of community music is relatively new, but it holds significant potential for cultural preservation and social cohesion. Although community music lacks a universally established definition in academia, scholars and practitioners embrace this openness as a means to foster ongoing development and exploration (Higgins, 2012; Bartleet & Higgins, 2018). This flexibility is especially beneficial in intercultural and transcultural contexts, allowing for diverse and evolving interpretations. For instance, in Germany, the Munich Action Research Group has contributed to defining community music within a German context, aligning closely with English-language interpretations while also addressing specific cultural and educational nuances. This definition considers a variety of settings, including formal, informal, and non-formal contexts (de Bánffy-Hall, 2019). Furthermore, de Bánffy-Hall developed a comparative framework positioning community music alongside various music education forms in Germany, such as volksmusik, elementary music education, music mediation, and school music education. Her research indicates that community music in Germany can act as a “boundary walker,” fluidly navigating different educational settings and bridging gaps in the German music education system (de Bánffy-Hall, 2017; 2019).
Using this framework as a model, the authors propose a similar comparative approach in Türkiye to develop a Turkish-specific understanding of community music. By focusing on Gezek - a traditional Turkish form of community music making - this study aims to explore how traditional musical practices can be reinterpreted and revitalized through community music principles. Through document analysis, this study will review academic literature, policy papers, and historical documents on both Gezek and community music. This will help to identify how and where community music principles can be effectively integrated into the context of music education in Türkiye, providing a basis for future program development
Emotion and mentalisation-promoting behavioural therapy in the group (EMVT-G)
No full textPublications on the new therapy approach of Emotion and Mentalisation Supporting Therapy EMVT will be available from 2021. It is a modular psychotherapy that remains completely focussed on the individual patient in terms of goal formulation and treatment plan. In the first module, attachment security is established in the therapeutic relationship.
The second module aims to replace the dysfunctional survival rule as a maladaptive schema with a new permission-giving rule of life in order to reduce therapeutic resistance. The third module promotes acceptance through mindfulness. The fourth module uses Emotion Tracking dialogue techniques to keep track of feelings. The fifth module serves to promote mentalisation or metacognition in order to elaborate the Theory of Mind (Tom). The sixth module uses Piaget's stage theory to help the patient develop from the affect stage (where feelings and needs determine every action) to the thinking stage, where causal thinking and goal-orientation become possible. Finally, in the seventh module, the development from the thinking stage to the empathy stage takes place, in which a change of perspective leads to empathy and compassion (also with oneself). There are particularly many therapeutic possibilities when the treatment is carried out in a group setting (EMVT-G). This article reports on this
