Managing daily surgery schedules in a teaching hospital: a mixed-integer optimization approach

Background: This study examined the daily surgical scheduling problem in a teaching hospital. This problem relates to the use of multiple operating rooms and different types of surgeons in a typical surgical day with deterministic operation durations (preincision, incision, and postincision times). Teaching hospitals play a key role in the health-care system; however, existing models assume that the duration of surgery is independent of the surgeon's skills. This problem has not been properly addressed in other studies. We analyze the case of a Spanish public hospital, in which continuous pressures and budgeting reductions entail the more efficient use of resources. Methods: To obtain an optimal solution for this problem, we developed a mixed-integer programming model and user-friendly interface that facilitate the scheduling of planned operations for the following surgical day. We also implemented a simulation model to assist the evaluation of different dispatching policies for surgeries and surgeons. The typical aspects we took into account were the type of surgeon, potential overtime, idling time of surgeons, and the use of operating rooms. Results: It is necessary to consider the expertise of a given surgeon when formulating a schedule: such skill can decrease the probability of delays that could affect subsequent surgeries or cause cancellation of the final surgery. We obtained optimal solutions for a set of given instances, which we obtained through surgical information related to acceptable times collected from a Spanish public hospital. Conclusions: We developed a computer-aided framework with a user-friendly interface for use by a surgical manager that presents a 3-D simulation of the problem. Additionally, we obtained an efficient formulation for this complex problem. However, the spread of this kind of operation research in Spanish public health hospitals will take a long time since there is a lack of knowledge of the beneficial techniques and possibilities that operational research can offer for the health-care system.

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

Integrated robust airline schedule development

In air transportation, airline profitability is influenced by the airline's ability to build flight schedules. In order to generate operational schedules, airlines engage in a complex decision-making process, referred to as airline schedule planning. Up to now, the generation of flight schedules has been separated and optimized sequentially. The schedule design has been traditionally decomposed into two sequential steps. The frequency planning and the timetable development. The purpose of the second problem of schedule development, fleet assignment, is to assign available aircraft types to flight legs such that seating capacity on an assigned aircraft matches closely with flight demand and such that costs are minimized. Our work integrates these planning phases into one single model in order to produce more economical solutions and create fewer incompatibilities between the decisions. We propose an integrated robust approach for the schedule development step. We design the timetable ensuring that enough time is available to perform passengers’ flight connections, making the system robust avoiding misconnected passengers. An application of the model for a simplified IBERIA network is shown.

Airport Taxi Planning: Lagrangian Decomposition

The airport taxi planning (TP) module is a decision tool intended to guide airport surface management operations. TP is defined by a flow network optimization model that represents flight ground movements and improves aircraft taxiing routes and schedules during periods of aircraft congestion. TP is not intended to operate as a stand‐alone tool for airport operations management: on the contrary, it must be used in conjunction with existing departing and arriving traffic tools and overseen by the taxi planner of the airport, also known as the aircraft ground controller. TP must be flexible in order to accommodate changing inputs while maintaining consistent routes and schedules already delivered from past executions. Within this dynamic environment, the execution time of TP may not exceed a few minutes. Classic methods for solving binary multi‐commodity flow networks with side constraints are not efficient enough; therefore, a Lagrangian decomposition methodology has been adapted to solve it. We demonstrate TP Lagrangian decomposition using actual data from the Madrid‐Barajas Airport

Impact of nitrogen uptake on field water balance in fertirrigated melon.

Agronomic management in Ciudad Real, a province in central Spain, is characteristic of semi-arid cropped areas whose water supplies have high nitrate (NO3?) content due to environmental degradation. This situation is aggravated by the existence of a restrictive subsurface layer of ?caliche? or hardpan at a depth of 0.60 m. Under these circumstances, fertirrigation rates, including nitrogen (N) fertilizer schedules, must be carefully calibrated to optimize melon yields while minimizing the N pollution and water supply. Such optimization was sought by fertilizing with different doses of N and irrigating at 100% of the ETc (crop evapotranspiration), adjusted for this crop and area. The N content in the four fertilizer doses used was: 0, 55, 82 and 109 kg N ha?1. Due to the NO3? content in the irrigation water, however, the actual N content was 30 kg ha?1 higher in all four treatments repeated in two different years. The results showed correlation between melon plant N uptake and drainage (Dr), which in turn affects the amount of N leached, as well as correlation between Dr and LAI (leaf area index) for each treatment. A fertilizer factor (?) was estimated through two methods, from difference in Dr and in LAI ratio with respect to the maximum N dose, to correct ETc based on N doses. The difference was found in the adjusted evapotranspiration in both years using the corresponding ? achieved 42?49 mm at vegetative period, depending on the method, and it was not significant at senescent period. Finally, a growth curve between N uptake and plant dry weight (DW) for each treatment was defined to confirm that the observed higher plant vigour, showing higher LAI and reduced Dr, was due mainly to higher N doses.

An integral model for natural regeneration of Pinus pinea L. in the Northern Plateau (Spain) = Modelo integral de regeneración natural para Pinus pinea L. en la Meseta Norte (España)

Natural regeneration is an ecological key-process that makes plant persistence possible and, consequently, it constitutes an essential element of sustainable forest management. In this respect, natural regeneration in even-aged stands of Pinus pinea L. located in the Spanish Northern Plateau has not always been successfully achieved despite over a century of pine nut-based management. As a result, natural regeneration has recently become a major concern for forest managers when we are living a moment of rationalization of investment in silviculture. The present dissertation is addressed to provide answers to forest managers on this topic through the development of an integral regeneration multistage model for P. pinea stands in the region. From this model, recommendations for natural regeneration-based silviculture can be derived under present and future climate scenarios. Also, the model structure makes it possible to detect the likely bottlenecks affecting the process. The integral model consists of five submodels corresponding to each of the subprocesses linking the stages involved in natural regeneration (seed production, seed dispersal, seed germination, seed predation and seedling survival). The outputs of the submodels represent the transitional probabilities between these stages as a function of climatic and stand variables, which in turn are representative of the ecological factors driving regeneration. At subprocess level, the findings of this dissertation should be interpreted as follows. The scheduling of the shelterwood system currently conducted over low density stands leads to situations of dispersal limitation since the initial stages of the regeneration period. Concerning predation, predator activity appears to be only limited by the occurrence of severe summer droughts and masting events, the summer resulting in a favourable period for seed survival. Out of this time interval, predators were found to almost totally deplete seed crops. Given that P. pinea dissemination occurs in summer (i.e. the safe period against predation), the likelihood of a seed to not be destroyed is conditional to germination occurrence prior to the intensification of predator activity. However, the optimal conditions for germination seldom take place, restraining emergence to few days during the fall. Thus, the window to reach the seedling stage is narrow. In addition, the seedling survival submodel predicts extremely high seedling mortality rates and therefore only some individuals from large cohorts will be able to persist. These facts, along with the strong climate-mediated masting habit exhibited by P. pinea, reveal that viii the overall probability of establishment is low. Given this background, current management –low final stand densities resulting from intense thinning and strict felling schedules– conditions the occurrence of enough favourable events to achieve natural regeneration during the current rotation time. Stochastic simulation and optimisation computed through the integral model confirm this circumstance, suggesting that more flexible and progressive regeneration fellings should be conducted. From an ecological standpoint, these results inform a reproductive strategy leading to uneven-aged stand structures, in full accordance with the medium shade-tolerant behaviour of the species. As a final remark, stochastic simulations performed under a climate-change scenario show that regeneration in the species will not be strongly hampered in the future. This resilient behaviour highlights the fundamental ecological role played by P. pinea in demanding areas where other tree species fail to persist.

Analysis of a thermal system through remote laboratories

This paper describes the experiences using remote laboratories for thorough analysis of a thermal system, including disturbances. Remote laboratories for education in subjects of control, is a common resorted method, used by universities. This method is applied to offer a flexible service in schedules so as to obtain greater and better results of available resources. Remote laboratories have been used for controlling physical devices remotely. Furthermore, remote labs have been used for transfer function identification of real equipment. Nevertheless, remote analyses of disturbances have not been done. The aim of this contribution is thereby to apply the experience of remote laboratories in the study of disturbances. Some experiments are carried out to demonstrate the effectiveness in using remote laboratories for complete analysis of a thermal system. Considering the remote access to thermal system, “Sistema de Laboratorios a Distancia” (SLD) was used.

Robustness and Recoverability in Transport Logistics

Abstract Transport is the foundation of any economy: it boosts economic growth, creates wealth, enhances trade, geographical accessibility and the mobility of people. Transport is also a key ingredient for a high quality of life, making places accessible and bringing people together. The future prosperity of our world will depend on the ability of all of its regions to remain fully and competitively integrated in the world economy. Efficient transport is vital in making this happen. Operations research can help in efficiently planning the design and operating transport systems. Planning and operational processes are fields that are rich in combinatorial optimization problems. These problems can be analyzed and solved through the application of mathematical models and optimization techniques, which may lead to an improvement in the performance of the transport system, as well as to a reduction in the time required for solving these problems. The latter aspect is important, because it increases the flexibility of the system: the system can adapt in a faster way to changes in the environment (i.e.: weather conditions, crew illness, failures, etc.). These disturbing changes (called disruptions) often enforce the schedule to be adapted. The direct consequences are delays and cancellations, implying many schedule adjustments and huge costs. Consequently, robust schedules and recovery plans must be developed in order to fight against disruptions. This dissertation makes contributions to two different fields: rail and air applications. Robust planning and recovery methods are presented. In the field of railway transport we develop several mathematical models which answer to RENFE’s (the major railway operator in Spain) needs: 1. We study the rolling stock assignment problem: here, we introduce some robust aspects in order to ameliorate some operations which are likely to fail. Once the rolling stock assignment is known, we propose a robust routing model which aims at identifying the train units’ sequences while minimizing the expected delays and human resources needed to perform the sequences. 2. It is widely accepted that the sequential solving approach produces solutions that are not global optima. Therefore, we develop an integrated and robust model to determine the train schedule and rolling stock assignment. We also propose an integrated model to study the rolling stock circulations. Circulations are determined by the rolling stock assignment and routing of the train units. 3. Although our aim is to develop robust plans, disruptions will be likely to occur and recovery methods will be needed. Therefore, we propose a recovery method which aims to recover the train schedule and rolling stock assignment in an integrated fashion all while considering the passenger demand. In the field of air transport we develop several mathematical models which answer to IBERIA’s (the major airline in Spain) needs: 1. We look at the airline-scheduling problem and develop an integrated approach that optimizes schedule design, fleet assignment and passenger use so as to reduce costs and create fewer incompatibilities between decisions. Robust itineraries are created to ameliorate misconnected passengers. 2. Air transport operators are continuously facing competition from other air operators and different modes of transport (e.g., High Speed Rail). Consequently, airline profitability is critically influenced by the airline’s ability to estimate passenger demands and construct profitable flight schedules. We consider multi-modal competition including airline and rail, and develop a new approach that estimates the demand associated with a given schedule; and generates airline schedules and fleet assignments using an integrated schedule design and fleet assignment optimization model that captures the impacts of schedule decisions on passenger demand.

Efficient speed advisories for multi-stage-metering arrival management

This paper presents a methodology and algorithm for Air Traffic Control (ATC) to efficiently achieve schedules arrival times through speed control in the presence of uncertainty. The methodology does not assume the availability of airborne time of arrival control and can therefore be applied to legacy aircraft. The speed advisories are calculated in a manner that allows for sufficient control margin to, if required, adjust the aircraft's trajectory at a later stage to correct for estimated arrival time drift at the lowest impact to efficiency. The methodology is therefore envisioned to prevent major last-minute interventions and instead assists ATC in allowing more continuous descent approaches to be conducted by aircraft leading to more efficient operations.

Intelligent Therapy Assistant (ITA) for cognitive rehabilitation in patients with Acquired Brain Injury

This paper presents the design, development and first evaluation of an algorithm, named Intelligent Therapy Assistant (ITA), which automatically selects, configures and schedules rehabilitation tasks for patients with cognitive impairments after an episode of Acquired Brain Injury. The ITA is integrated in "Guttmann, Neuro Personal Trainer" (GNPT), a cognitive tele-rehabilitation platform that provides neuropsychological services.

Recovery of Disruptions in Rapid Transit Networks

This paper studies the disruption management problem of rapid transit rail networks. Besides optimizing the timetable and the rolling stock schedules, we explicitly deal with the effects of the disruption on the passenger demand. We propose a two-step approach that combines an integrated optimization model (for the timetable and rolling stock) with a model for the passengers’ behavior. We report our computational tests on realistic problem instances of the Spanish rail operator RENFE. The proposed approach is able to find solutions with a very good balance between various managerial goals within a few minutes. Se estudia la gestión de las incidencias en redes de metro y cercanías. Se optimizan los horarios y la asignación del material rodante, teniendo en cuenta el comportamiento de los pasajeros. Se reallizan pruebas en varias líneas de la red de cercanías de Madrid, con resultados satisfactorios.

WSM : metodología de web scraping para Android y ejemplificación mediante la aplicación UPMDroid

En la realización de este proyecto se ha tratado principalmente la temática del web scraping sobre documentos HTML en Android. Como resultado del mismo, se ha propuesto una metodología para poder realizar web scraping en aplicaciones implementadas para este sistema operativo y se desarrollará una aplicación basada en esta metodología que resulte útil a los alumnos de la escuela. Web scraping se puede definir como una técnica basada en una serie de algoritmos de búsqueda de contenido con el fin de obtener una determinada información de páginas web, descartando aquella que no sea relevante. Como parte central, se ha dedicado bastante tiempo al estudio de los navegadores y servidores Web, y del lenguaje HTML presente en casi todas las páginas web en la actualidad así como de los mecanismos utilizados para la comunicación entre cliente y servidor ya que son los pilares en los que se basa esta técnica. Se ha realizado un estudio de las técnicas y herramientas necesarias, aportándose todos los conceptos teóricos necesarios, así como la proposición de una posible metodología para su implementación. Finalmente se ha codificado la aplicación UPMdroid, desarrollada con el fin de ejemplificar la implementación de la metodología propuesta anteriormente y a la vez desarrollar una aplicación cuya finalidad es brindar al estudiante de la ETSIST un soporte móvil en Android que le facilite el acceso y la visualización de aquellos datos más importantes del curso académico como son: el horario de clases y las calificaciones de las asignaturas en las que se matricule. Esta aplicación, además de implementar la metodología propuesta, es una herramienta muy interesante para el alumno, ya que le permite utilizar de una forma sencilla e intuitiva gran número de funcionalidades de la escuela solucionando así los problemas de visualización de contenido web en los dispositivos. ABSTRACT. The main topic of this project is about the web scraping over HTML documents on Android OS. As a result thereof, it is proposed a methodology to perform web scraping in deployed applications for this operating system and based on this methodology that is useful to the ETSIST school students. Web scraping can be defined as a technique based on a number of content search algorithms in order to obtain certain information from web pages, discarding those that are not relevant. As a main part, has spent considerable time studying browsers and Web servers, and the HTML language that is present today in almost all websites as well as the mechanisms used for communication between client and server because they are the pillars which this technique is based. We performed a study of the techniques and tools needed, providing all the necessary theoretical concepts, as well as the proposal of a possible methodology for implementation. Finally it has codified UPMdroid application, developed in order to illustrate the implementation of the previously proposed methodology and also to give the student a mobile ETSIST Android support to facilitate access and display those most important data of the current academic year such as: class schedules and scores for the subjects in which you are enrolled. This application, in addition to implement the proposed methodology is also a very interesting tool for the student, as it allows a simple and intuitive way of use these school functionalities thus fixing the viewing web content on devices.

A pedagogically-supported TEL solution for learning nontechnical minimally invasive surgical skills across Europe

Residents learning nontechnical skills in Europe face two problems: (1) the difficulty to fit learning time in their overloaded schedules; and (2) the lack of standard pedagogical models for all countries. Online video-based repositories such as WeBSurg or WebOP provide ubiquitous access to surgical contents. However, their pedagogical facets have not been fully exploited and they are often seen as quick-reference repositories rather than full e-learning alternatives. We present a new pedagogically-supported Technology Enhanced Learning (TEL) solution, MISTELA, designed by surgeons, pedagogical experts and engineers. MISTELA aims at building a common European pedagogical model supported by ICT technologies and elearning. The solution proposes a pedagogical model based on a framework for pedagogically-informed design of e-learning platforms. It is composed of (1) an authoring tool for editing and augmenting videos; (2) a media asset management system; and (3) a virtual learning environment. Support of the European Association for Endoscopic Surgery (EAES) and validation of the solution, will help to determine its full potential.

A framework for adaptive e-learning for continuum mechanics and structural analysis

This paper presents a project for providing the students of Structural Engineering with the flexibility to learn outside classroom schedules. The goal is a framework for adaptive E-learning based on a repository of open educational courseware with a set of basic Structural Engineering concepts and fundamentals. These are paramount for students to expand their technical knowledge and skills in structural analysis and design of tall buildings, arch-type structures as well as bridges. Thus, concepts related to structural behaviour such as linearity, compatibility, stiffness and influence lines have traditionally been elusive for students. The objective is to facilitate the student a teachinglearning process to acquire the necessary intuitive knowledge, cognitive skills and the basis for further technological modules and professional development in this area. As a side effect, the system is expected to help the students improve their preparation for exams on the subject. In this project, a web-based open-source system for studying influence lines on continuous beams is presented. It encompasses a collection of interactive user-friendly applications accessible via Web, written in JavaScript under JQuery and Dygraph Libraries, taking advantage of their efficiency and graphic capabilities. It is performed in both Spanish and English languages. The student is enabled to set the geometric, topologic, boundary and mechanic layout of a continuous beam. While changing the loading and the support conditions, the changes in the beam response prompt on the screen, so that the effects of the several issues involved in structural analysis become apparent. This open interaction with the user allows the student to simulate and virtually infer the structural response. Different levels of complexity can be handled, whereas an ongoing help is at hand for any of them. Students can freely boost their experiential learning on this subject at their own pace, in order to further share, process, generalize and apply the relevant essential concepts of Structural Engineering analysis. Besides, this collection is being added to the "Virtual Lab of Continuum Mechanics" of the UPM, launched in 2013 (http://serviciosgate.upm.es/laboratoriosvirtuales/laboratorios/medios-continuos-en-construcci%C3%B3n)

A methodology proposal to obtain operational parameter forecasts and operational risk assessment in container terminals

Las terminales de contenedores son sistemas complejos en los que un elevado número de actores económicos interactúan para ofrecer servicios de alta calidad bajo una estricta planificación y objetivos económicos. Las conocidas como "terminales de nueva generación" están diseñadas para prestar servicio a los mega-buques, que requieren tasas de productividad que alcanzan los 300 movimientos/ hora. Estas terminales han de satisfacer altos estándares dado que la competitividad entre terminales es elevada. Asegurar la fiabilidad de las planificaciones del atraque es clave para atraer clientes, así como reducir al mínimo el tiempo que el buque permanece en el puerto. La planificación de las operaciones es más compleja que antaño, y las tolerancias para posibles errores, menores. En este contexto, las interrupciones operativas deben reducirse al mínimo. Las principales causas de dichas perturbaciones operacionales, y por lo tanto de incertidumbre, se identifican y caracterizan en esta investigación. Existen una serie de factores que al interactuar con la infraestructura y/o las operaciones desencadenan modos de fallo o parada operativa. Los primeros pueden derivar no solo en retrasos en el servicio sino que además puede tener efectos colaterales sobre la reputación de la terminal, o incluso gasto de tiempo de gestión, todo lo cual supone un impacto para la terminal. En el futuro inmediato, la monitorización de las variables operativas presenta gran potencial de cara a mejorar cualitativamente la gestión de las operaciones y los modelos de planificación de las terminales, cuyo nivel de automatización va en aumento. La combinación del criterio experto con instrumentos que proporcionen datos a corto y largo plazo es fundamental para el desarrollo de herramientas que ayuden en la toma de decisiones, ya que de este modo estarán adaptadas a las auténticas condiciones climáticas y operativas que existen en cada emplazamiento. Para el corto plazo se propone una metodología con la que obtener predicciones de parámetros operativos en terminales de contenedores. Adicionalmente se ha desarrollado un caso de estudio en el que se aplica el modelo propuesto para obtener predicciones de la productividad del buque. Este trabajo se ha basado íntegramente en datos proporcionados por una terminal semi-automatizada española. Por otro lado, se analiza cómo gestionar, evaluar y mitigar el efecto de las interrupciones operativas a largo plazo a través de la evaluación del riesgo, una forma interesante de evaluar el effecto que eventos inciertos pero probables pueden generar sobre la productividad a largo plazo de la terminal. Además se propone una definición de riesgo operativo junto con una discusión de los términos que representan con mayor fidelidad la naturaleza de las actividades y finalmente, se proporcionan directrices para gestionar los resultados obtenidos. Container terminals are complex systems where a large number of factors and stakeholders interact to provide high-quality services under rigid planning schedules and economic objectives. The socalled next generation terminals are conceived to serve the new mega-vessels, which are demanding productivity rates up to 300 moves/hour. These terminals need to satisfy high standards because competition among terminals is fierce. Ensuring reliability in berth scheduling is key to attract clients, as well as to reduce at a minimum the time that vessels stay the port. Because of the aforementioned, operations planning is becoming more complex, and the tolerances for errors are smaller. In this context, operational disturbances must be reduced at a minimum. The main sources of operational disruptions and thus, of uncertainty, are identified and characterized in this study. External drivers interact with the infrastructure and/or the activities resulting in failure or stoppage modes. The later may derive not only in operational delays but in collateral and reputation damage or loss of time (especially management times), all what implies an impact for the terminal. In the near future, the monitoring of operational variables has great potential to make a qualitative improvement in the operations management and planning models of terminals that use increasing levels of automation. The combination of expert criteria with instruments that provide short- and long-run data is fundamental for the development of tools to guide decision-making, since they will be adapted to the real climatic and operational conditions that exist on site. For the short-term a method to obtain operational parameter forecasts in container terminals. To this end, a case study is presented, in which forecasts of vessel performance are obtained. This research has been entirely been based on data gathered from a semi-automated container terminal from Spain. In the other hand it is analyzed how to manage, evaluate and mitigate disruptions in the long-term by means of the risk assessment, an interesting approach to evaluate the effect of uncertain but likely events on the long-term throughput of the terminal. In addition, a definition for operational risk evaluation in port facilities is proposed along with a discussion of the terms that better represent the nature of the activities involved and finally, guidelines to manage the results obtained are provided.