Efficient management of available technologies. Aplication to mining operations for industry supplies

Nowadays, processing Industry Sector is going through a series of changes, including right management and reduction of environmental affections. Any productive process which looks for sustainable management is incomplete if Cycle of Life of mineral resources sustainability is not taken into account. Raw materials for manufacturing are provided by mineral resources extraction processes, such as copper, aluminum, iron, gold, silver, silicon, titanium? Those elements are necessary for Mankind development and are obtained from the Earth through mineral extractive processes. Mineral extraction processes are operations which must take care about the environmental consequences. Extraction of huge volumes of rock for their transformation into raw materials for industry must be optimized to reduce ecological cost of the final product as l was possible. Reducing the ecological balance on a global scale has no sense to design an efficient manufacturing in secondary industry (transformation), if in first steps of the supply chain (extraction) impact exceeds the savings of resources in successive phases. Mining operations size suggests that it is an environmental aggressive activity, but precisely because of its great impact must be the first element to be considered. That idea implies that a new concept born: Reduce economical and environmental cost This work aims to make a reflection on the parameters that can be modified to reduce the energy cost of the process without an increasing in operational costs and always ensuring the same production capacity. That means minimize economic and environmental cost at same time. An efficient design of mining operation which has taken into account that idea does not implies an increasing of the operating cost. To get this objective is necessary to think in global operation view to make that all departments involved have common guidelines which make you think in the optimization of global energy costs. Sometimes a single operational cost must be increased to reduce global cost. This work makes a review through different design parameters of surface mining setting some key performance indicators (KPIs) which are estimated from an efficient point of view. Those KPIs can be included by HQE Policies as global indicators. The new concept developed is that a new criteria has to be applied in company policies: improve management, improving OPERATIONAL efficiency. That means, that is better to use current resources properly (machinery, equipment,?) than to replace them with new things but not used correctly. As a conclusion, through an efficient management of current technologies in each extractive operation an important reduction of the energy can be achieved looking at downstream in the process. That implies a lower energetic cost in the whole cycle of life in manufactured product.

The potential of organic fertilizers and water management to reduce N2O emissions in Mediterranean climate cropping systems. A review.

Environmental problems related to the use of synthetic fertilizers and to organic waste management have led to increased interest in the use of organic materials as an alternative source of nutrients for crops, but this is also associated with N2O emissions. There has been an increasing amount of research into the effects of using different types of fertilization on N2O emissions under Mediterranean climatic conditions, but the findings have sometimes been rather contradictory. Available information also suggests that water management could exert a high influence on N2O emissions. In this context, we have reviewed the current scientific knowledge, including an analysis of the effect of fertilizer type and water management on direct N2O emissions. A meta-analysis of compliant reviewed experiments revealed significantly lower N2O emissions for organic as opposed to synthetic fertilizers (23% reduction). When organic materials were segregated in solid and liquid, only solid organic fertilizer emissions were significantly lower than those of synthetic fertilizers (28% reduction in cumulative emissions). The EF is similar to the IPCC factor in conventionally irrigated systems (0.98% N2O-N N applied−1), but one order of magnitude lower in rainfed systems (0.08%). Drip irrigation produces intermediate emission levels (0.66%). Differences are driven by Mediterranean agro-climatic characteristics, which include low soil organic matter (SOM) content and a distinctive rainfall and temperature pattern. Interactions between environmental and management factors and the microbial processes involved in N2O emissions are discussed in detail. Indirect emissions have not been fully accounted for, but when organic fertilizers are applied at similar N rates to synthetic fertilizers, they generally make smaller contributions to the leached NO3− pool. The most promising practices for reducing N2O through organic fertilization include: (i) minimizing water applications; (ii) minimizing bare soil; (iii) improving waste management; and (iv) tightening N cycling through N immobilization. The mitigation potential may be limited by: (i) residual effect; (ii) the long-term effects of fertilizers on SOM; (iii) lower yield-scaled performance; and (iv) total N availability from organic sources. Knowledge gaps identified in the review included: (i) insufficient sampling periods; (ii) high background emissions; (iii) the need to provide N2O EF and yield-scaled EF; (iv) the need for more research on specific cropping systems; and (v) the need for full GHG balances. In conclusion, the available information suggests a potential of organic fertilizers and water-saving practices to mitigate N2O emissions under Mediterranean climatic conditions, although further research is needed before it can be regarded as fully proven, understood and developed.

Contribution towards intelligent service management in wearable and ubiquitous devices

Hoy en día asistimos a un creciente interés por parte de la sociedad hacia el cuidado de la salud. Esta afirmación viene apoyada por dos realidades. Por una parte, el aumento de las prácticas saludables (actividad deportiva, cuidado de la alimentación, etc.). De igual manera, el auge de los dispositivos inteligentes (relojes, móviles o pulseras) capaces de medir distintos parámetros físicos como el pulso cardíaco, el ritmo respiratorio, la distancia recorrida, las calorías consumidas, etc. Combinando ambos factores (interés por el estado de salud y disponibilidad comercial de dispositivos inteligentes) están surgiendo multitud de aplicaciones capaces no solo de controlar el estado actual de salud, también de recomendar al usuario cambios de hábitos que lleven hacia una mejora en su condición física. En este contexto, los llamados dispositivos llevables (weareables) unidos al paradigma de Internet de las cosas (IoT, del inglés Internet of Things) permiten la aparición de nuevos nichos de mercado para aplicaciones que no solo se centran en la mejora de la condición física, ya que van más allá proponiendo soluciones para el cuidado de pacientes enfermos, la vigilancia de niños o ancianos, la defensa y la seguridad, la monitorización de agentes de riesgo (como bomberos o policías) y un largo etcétera de aplicaciones por llegar. El paradigma de IoT se puede desarrollar basándose en las existentes redes de sensores inalámbricos (WSN, del inglés Wireless Sensor Network). La conexión de los ya mencionados dispositivos llevables a estas redes puede facilitar la transición de nuevos usuarios hacia aplicaciones IoT. Pero uno de los problemas intrínsecos a estas redes es su heterogeneidad. En efecto, existen multitud de sistemas operativos, protocolos de comunicación, plataformas de desarrollo, soluciones propietarias, etc. El principal objetivo de esta tesis es realizar aportaciones significativas para solucionar no solo el problema de la heterogeneidad, sino también de dotar de mecanismos de seguridad suficientes para salvaguardad la integridad de los datos intercambiados en este tipo de aplicaciones. Algo de suma importancia ya que los datos médicos y biométricos de los usuarios están protegidos por leyes nacionales y comunitarias. Para lograr dichos objetivos, se comenzó con la realización de un completo estudio del estado del arte en tecnologías relacionadas con el marco de investigación (plataformas y estándares para WSNs e IoT, plataformas de implementación distribuidas, dispositivos llevables y sistemas operativos y lenguajes de programación). Este estudio sirvió para tomar decisiones de diseño fundamentadas en las tres contribuciones principales de esta tesis: un bus de servicios para dispositivos llevables (WDSB, Wearable Device Service Bus) basado en tecnologías ya existentes tales como ESB, WWBAN, WSN e IoT); un protocolo de comunicaciones inter-dominio para dispositivos llevables (WIDP, Wearable Inter-Domain communication Protocol) que integra en una misma solución protocolos capaces de ser implementados en dispositivos de bajas capacidades (como lo son los dispositivos llevables y los que forman parte de WSNs); y finalmente, la tercera contribución relevante es una propuesta de seguridad para WSN basada en la aplicación de dominios de confianza. Aunque las contribuciones aquí recogidas son de aplicación genérica, para su validación se utilizó un escenario concreto de aplicación: una solución para control de parámetros físicos en entornos deportivos, desarrollada dentro del proyecto europeo de investigación “LifeWear”. En este escenario se desplegaron todos los elementos necesarios para validar las contribuciones principales de esta tesis y, además, se realizó una aplicación para dispositivos móviles por parte de uno de los socios del proyecto (lo que contribuyó con una validación externa de la solución). En este escenario se usaron dispositivos llevables tales como un reloj inteligente, un teléfono móvil con sistema operativo Android y un medidor del ritmo cardíaco inalámbrico capaz de obtener distintos parámetros fisiológicos del deportista. Sobre este escenario se realizaron diversas pruebas de validación mediante las cuales se obtuvieron resultados satisfactorios. ABSTRACT Nowadays, society is shifting towards a growing interest and concern on health care. This phenomenon can be acknowledged by two facts: first, the increasing number of people practising some kind of healthy activity (sports, balanced diet, etc.). Secondly, the growing number of commercial wearable smart devices (smartwatches or bands) able to measure physiological parameters such as heart rate, breathing rate, distance or consumed calories. A large number of applications combining both facts are appearing. These applications are not only able to monitor the health status of the user, but also to provide recommendations about routines in order to improve the mentioned health status. In this context, wearable devices merged with the Internet of Things (IoT) paradigm enable the proliferation of new market segments for these health wearablebased applications. Furthermore, these applications can provide solutions for the elderly or baby care, in-hospital or in-home patient monitoring, security and defence fields or an unforeseen number of future applications. The introduced IoT paradigm can be developed with the usage of existing Wireless Sensor Networks (WSNs) by connecting the novel wearable devices to them. In this way, the migration of new users and actors to the IoT environment will be eased. However, a major issue appears in this environment: heterogeneity. In fact, there is a large number of operating systems, hardware platforms, communication and application protocols or programming languages, each of them with unique features. The main objective of this thesis is defining and implementing a solution for the intelligent service management in wearable and ubiquitous devices so as to solve the heterogeneity issues that are presented when dealing with interoperability and interconnectivity of devices and software of different nature. Additionally, a security schema based on trust domains is proposed as a solution to the privacy problems arising when private data (e.g., biomedical parameters or user identification) is broadcasted in a wireless network. The proposal has been made after a comprehensive state-of-the-art analysis, and includes the design of a Wearable Device Service Bus (WDSB) including the technologies collected in the requirement analysis (ESB, WWBAN, WSN and IoT). Applications are able to access the WSN services regardless of the platform and operating system where they are running. Besides, this proposal also includes the design of a Wearable Inter-Domain communication Protocols set (WIDP) which integrates lightweight protocols suitable to be used in low-capacities devices (REST, JSON, AMQP, CoAP, etc...). Furthermore, a security solution for service management based on a trustworthy domains model to deploy security services in WSNs has been designed. Although the proposal is a generic framework for applications based on services provided by wearable devices, an application scenario for testing purposes has been included. In this validation scenario it has been presented an autonomous physical condition performance system, based on a WSN, bringing the possibility to include several elements in an IoT scenario: a smartwatch, a physiological monitoring device and a smartphone. In summary, the general objective of this thesis is solving the heterogeneity and security challenges arising when developing applications for WSNs and wearable devices. As it has been presented in the thesis, the solution proposed has been successfully validated in a real scenario and the obtained results were satisfactory.

A management model for closed-loop supply chains of reusable articles

This PhD dissertation is framed in the emergent fields of Reverse Logistics and ClosedLoop Supply Chain (CLSC) management. This subarea of supply chain management has gained researchers and practitioners' attention over the last 15 years to become a fully recognized subdiscipline of the Operations Management field. More specifically, among all the activities that are included within the CLSC area, the focus of this dissertation is centered in direct reuse aspects. The main contribution of this dissertation to current knowledge is twofold. First, a framework for the so-called reuse CLSC is developed. This conceptual model is grounded in a set of six case studies conducted by the author in real industrial settings. The model has also been contrasted with existing literature and with academic and professional experts on the topic as well. The framework encompasses four building blocks. In the first block, a typology for reusable articles is put forward, distinguishing between Returnable Transport Items (RTI), Reusable Packaging Materials (RPM), and Reusable Products (RP). In the second block, the common characteristics that render reuse CLSC difficult to manage from a logistical standpoint are identified, namely: fleet shrinkage, significant investment and limited visibility. In the third block, the main problems arising in the management of reuse CLSC are analyzed, such as: (1) define fleet size dimension, (2) control cycle time and promote articles rotation, (3) control return rate and prevent shrinkage, (4) define purchase policies for new articles, (5) plan and control reconditioning activities, and (6) balance inventory between depots. Finally, in the fourth block some solutions to those issues are developed. Firstly, problems (2) and (3) are addressed through the comparative analysis of alternative strategies for controlling cycle time and return rate. Secondly, a methodology for calculating the required fleet size is elaborated (problem (1)). This methodology is valid for different configurations of the physical flows in the reuse CLSC. Likewise, some directions are pointed out for further development of a similar method for defining purchase policies for new articles (problem (4)). The second main contribution of this dissertation is embedded in the solutions part (block 4) of the conceptual framework and comprises a two-level decision problem integrating two mixed integer linear programming (MILP) models that have been formulated and solved to optimality using AIMMS as modeling language, CPLEX as solver and Excel spreadsheet for data introduction and output presentation. The results obtained are analyzed in order to measure in a client-supplier system the economic impact of two alternative control strategies (recovery policies) in the context of reuse. In addition, the models support decision-making regarding the selection of the appropriate recovery policy against the characteristics of demand pattern and the structure of the relevant costs in the system. The triangulation of methods used in this thesis has enabled to address the same research topic with different approaches and thus, the robustness of the results obtained is strengthened.

Optimization methods for the operating room management under uncertainty: stochastic programming vs. decomposition approach

The operating theatres are the engine of the hospitals; proper management of the operating rooms and its staff represents a great challenge for managers and its results impact directly in the budget of the hospital. This work presents a MILP model for the efficient schedule of multiple surgeries in Operating Rooms (ORs) during a working day. This model considers multiple surgeons and ORs and different types of surgeries. Stochastic strategies are also implemented for taking into account the uncertain in surgery durations (pre-incision, incision, post-incision times). In addition, a heuristic-based methods and a MILP decomposition approach is proposed for solving large-scale ORs scheduling problems in computational efficient way. All these computer-aided strategies has been implemented in AIMMS, as an advanced modeling and optimization software, developing a user friendly solution tool for the operating room management under uncertainty.

Service capacity reserve under uncertainty by hospital's ER's analogies: a practical model for car services

El objetivo de esta investigación consiste en definir un modelo de reserva de capacidad, por analogías con emergencias hospitalarias, que pueda ser implementado en el sector de servicios. Este está específicamente enfocado a su aplicación en talleres de servicio de automóviles. Nuestra investigación incorpora la incertidumbre de la demanda en un modelo singular diseñado en etapas que agrupa técnicas ARIMA, teoría de colas y simulación Monte Carlo para definir los conceptos de capacidad y ocupación de servicio, que serán utilizados para minimizar el coste implícito de la reserva capacidad necesaria para atender a clientes que carecen de cita previa. Habitualmente, las compañías automovilísticas estiman la capacidad de sus instalaciones de servicio empíricamente, pero los clientes pueden llegar bajo condiciones de incertidumbre que no se tienen en cuenta en dichas estimaciones, por lo que existe una diferencia entre lo que el cliente realmente demanda y la capacidad que ofrece el servicio. Nuestro enfoque define una metodología válida para el sector automovilístico que cubre la ausencia genérica de investigaciones recientes y la habitual falta de aplicación de técnicas estadísticas en el sector. La equivalencia con la gestión de urgencias hospitalarias se ha validado a lo largo de la investigación en la se definen nuevos indicadores de proceso (KPIs) Tal y como hacen los hospitales, aplicamos modelos estocásticos para dimensionar las instalaciones de servicio de acuerdo con la distribución demográfica del área de influencia. El modelo final propuesto integra la predicción del coste implícito en la reserva de capacidad para atender la demanda no prevista. Asimismo, se ha desarrollado un código en Matlab que puede integrarse como un módulo adicional a los sistemas de información (DMS) que se usan actualmente en el sector, con el fin de emplear los nuevos indicadores de proceso definidos en el modelo. Los resultados principales del modelo son nuevos indicadores de servicio, tales como la capacidad, ocupación y coste de reserva de capacidad, que nunca antes han sido objeto de estudio en la industria automovilística, y que están orientados a gestionar la operativa del servicio. ABSTRACT Our aim is to define a Capacity Reserve model to be implemented in the service sector by hospital's emergency room (ER) analogies, with a practical approach to passenger car services. A stochastic model has been implemented using R and a Monte Carlo simulation code written in Matlab and has proved a very useful tool for optimal decision making under uncertainty. The research integrates demand uncertainty in a unique model which is built in stages by implementing ARIMA forecasting, Queuing Theory and a Monte Carlo simulation to define the concepts of service capacity and occupancy, minimizing the implicit cost of the capacity that must be reserved to service unexpected customers. Usually, passenger car companies estimate their service facilities capacity using empirical methods, but customers arrive under uncertain conditions not included in the estimations. Thus, there is a gap between customer’s real demand and the dealer’s capacity. This research sets a valid methodology for the passenger car industry to cover the generic absence of recent researches and the generic lack of statistical techniques implementation. The hospital’s emergency room (ER) equalization has been confirmed to be valid for the passenger car industry and new process indicators have been defined to support the study. As hospitals do, we aim to apply stochastic models to dimension installations according to the demographic distribution of the area to be serviced. The proposed model integrates the prediction of the cost implicit in the reserve capacity to serve unexpected demand. The Matlab code could be implemented as part of the existing information technology systems (ITs) to support the existing service management tools, creating a set of new process indicators. Main model outputs are new indicators, such us Capacity, Occupancy and Cost of Capacity Reserve, never studied in the passenger car service industry before, and intended to manage the service operation.

Analysing the complexity of the model-based decision making processes within the industrial management context

PURPOSE The decision-making process plays a key role in organizations. Every decision-making process produces a final choice that may or may not prompt action. Recurrently, decision makers find themselves in the dichotomous question of following a traditional sequence decision-making process where the output of a decision is used as the input of the next stage of the decision, or following a joint decision-making approach where several decisions are taken simultaneously. The implication of the decision-making process will impact different players of the organization. The choice of the decision- making approach becomes difficult to find, even with the current literature and practitioners’ knowledge. The pursuit of better ways for making decisions has been a common goal for academics and practitioners. Management scientists use different techniques and approaches to improve different types of decisions. The purpose of this decision is to use the available resources as well as possible (data and techniques) to achieve the objectives of the organization. The developing and applying of models and concepts may be helpful to solve managerial problems faced every day in different companies. As a result of this research different decision models are presented to contribute to the body of knowledge of management science. The first models are focused on the manufacturing industry and the second part of the models on the health care industry. Despite these models being case specific, they serve the purpose of exemplifying that different approaches to the problems and could provide interesting results. Unfortunately, there is no universal recipe that could be applied to all the problems. Furthermore, the same model could deliver good results with certain data and bad results for other data. A framework to analyse the data before selecting the model to be used is presented and tested in the models developed to exemplify the ideas. METHODOLOGY As the first step of the research a systematic literature review on the joint decision is presented, as are the different opinions and suggestions of different scholars. For the next stage of the thesis, the decision-making process of more than 50 companies was analysed in companies from different sectors in the production planning area at the Job Shop level. The data was obtained using surveys and face-to-face interviews. The following part of the research into the decision-making process was held in two application fields that are highly relevant for our society; manufacturing and health care. The first step was to study the interactions and develop a mathematical model for the replenishment of the car assembly where the problem of “Vehicle routing problem and Inventory” were combined. The next step was to add the scheduling or car production (car sequencing) decision and use some metaheuristics such as ant colony and genetic algorithms to measure if the behaviour is kept up with different case size problems. A similar approach is presented in a production of semiconductors and aviation parts, where a hoist has to change from one station to another to deal with the work, and a jobs schedule has to be done. However, for this problem simulation was used for experimentation. In parallel, the scheduling of operating rooms was studied. Surgeries were allocated to surgeons and the scheduling of operating rooms was analysed. The first part of the research was done in a Teaching hospital, and for the second part the interaction of uncertainty was added. Once the previous problem had been analysed a general framework to characterize the instance was built. In the final chapter a general conclusion is presented. FINDINGS AND PRACTICAL IMPLICATIONS The first part of the contributions is an update of the decision-making literature review. Also an analysis of the possible savings resulting from a change in the decision process is made. Then, the results of the survey, which present a lack of consistency between what the managers believe and the reality of the integration of their decisions. In the next stage of the thesis, a contribution to the body of knowledge of the operation research, with the joint solution of the replenishment, sequencing and inventory problem in the assembly line is made, together with a parallel work with the operating rooms scheduling where different solutions approaches are presented. In addition to the contribution of the solving methods, with the use of different techniques, the main contribution is the framework that is proposed to pre-evaluate the problem before thinking of the techniques to solve it. However, there is no straightforward answer as to whether it is better to have joint or sequential solutions. Following the proposed framework with the evaluation of factors such as the flexibility of the answer, the number of actors, and the tightness of the data, give us important hints as to the most suitable direction to take to tackle the problem. RESEARCH LIMITATIONS AND AVENUES FOR FUTURE RESEARCH In the first part of the work it was really complicated to calculate the possible savings of different projects, since in many papers these quantities are not reported or the impact is based on non-quantifiable benefits. The other issue is the confidentiality of many projects where the data cannot be presented. For the car assembly line problem more computational power would allow us to solve bigger instances. For the operation research problem there was a lack of historical data to perform a parallel analysis in the teaching hospital. In order to keep testing the decision framework it is necessary to keep applying more case studies in order to generalize the results and make them more evident and less ambiguous. The health care field offers great opportunities since despite the recent awareness of the need to improve the decision-making process there are many opportunities to improve. Another big difference with the automotive industry is that the last improvements are not spread among all the actors. Therefore, in the future this research will focus more on the collaboration between academia and the health care sector.

AVALIAÇÃO DE DESEMPENHO DOS SETORES PRODUTIVOS DE UM HOSPITAL ESCOLA VETERINÁRIO: USO DE UM MODELO HIERARQUICO MULTICRITERIAL.

O curso de Medicina Veterinária compõe-se essencialmente de aulas práticas e teóricas desenvolvidas pelas mais diversas disciplinas presentes em sua matriz curricular. Para que as aulas práticas, principalmente aquelas relacionadas às disciplinas profissionalizantes, possam ser ministradas, o curso deve apresentar um Hospital Escola. Este local tem como missões: o ensino (aulas práticas), a pesquisa (desenvolvimento de novas tecnologias e conhecimentos) e a extensão ou assistência (atendimento aos anseios e necessidades das comunidades onde está inserido). Apesar de estar inserido no contexto do curso, o hospital deve apresentar um controle, não só sob o ponto de vista financeiro, mas de acordo com suas premissas a fim de garantir tanto a satisfação das pessoas que ali trabalham e a continuidade de suas atividades, bem como permitir que seus clientes internos (os alunos) e externos (a comunidade) possam ser atendidos em suas necessidades. O termo controle predispõe um pensamento de comando, que tem como objetivo principal permitir que a organização cumpra com os seus objetivos. O processo de controle gerencial é o processo que os líderes encontram para assegurar que os outros membros da organização respeitem as estratégias determinadas. Instituições de saúde e ensino desenvolvem suas atividades através de seus centros de responsabilidades, que existem para cumprir suas finalidades. Como a organização é o conjunto de centro de responsabilidades, e se cada centro de responsabilidade cumpre com suas estratégias a própria organização atinge suas metas. Cabe ao gestor hospitalar decidir qual a estratégia a seguir congruindo com as premissas ou objetivos da organização. Esta decisão deve ser fundamentada em parâmetros e resultados que podem ser conseguidos através de ferramentas de decisão. Muitas organizações utilizam a avaliação do desempenho financeiro de seus centros de responsabilidade para tomar suas decisões. O presente trabalho é uma pesquisa ação, que propõe a apresentação de um modelo teórico, aqui representado por uma ferramenta de decisão que disponibilizará como indicadores de avaliação de desempenho as premissas de ensino, pesquisa e extensão, bem como as de cunho financeiro que permitirão ao gestor hospitalar decidir qual o foco ou caminho a seguir, auxiliando-o em situações de decisões administrativas. Foi realizada a comparação da classificação ou ranqueamento de cada um dos setores produtivos de acordo com o desempenho financeiro, neste caso, a margem de contribuição própria e seu ranqueamento após os cálculos apresentados pelo modelo proposto a fim de demonstrar que ocorreu mudança no ranqueamento dos setores. Este modelo baseou-se em uma ferramenta de hierarquização multicriterial. O fato mais importante foi de perceber que todos os setores produtivos tiveram seu ranqueamento modificado após os cálculos com a ferramenta apresentada. Assim, esta ferramenta torna-se uma forma de decisão mais abrangente, pois contempla outros critérios, ou neste caso, premissas importantes para a decisão, sendo muito útil também para identificar entre as premissas apresentadas quais foram as de pior desempenho em cada setor. Desta forma, o gestor pode determinar ações de melhorias, buscando metas que possam ser alcançadas e determinando aporte financeiro, sendo este o caso, para alcançá-las.(AU)

AVALIAÇÃO DE DESEMPENHO DOS SETORES PRODUTIVOS DE UM HOSPITAL ESCOLA VETERINÁRIO: USO DE UM MODELO HIERARQUICO MULTICRITERIAL.

O curso de Medicina Veterinária compõe-se essencialmente de aulas práticas e teóricas desenvolvidas pelas mais diversas disciplinas presentes em sua matriz curricular. Para que as aulas práticas, principalmente aquelas relacionadas às disciplinas profissionalizantes, possam ser ministradas, o curso deve apresentar um Hospital Escola. Este local tem como missões: o ensino (aulas práticas), a pesquisa (desenvolvimento de novas tecnologias e conhecimentos) e a extensão ou assistência (atendimento aos anseios e necessidades das comunidades onde está inserido). Apesar de estar inserido no contexto do curso, o hospital deve apresentar um controle, não só sob o ponto de vista financeiro, mas de acordo com suas premissas a fim de garantir tanto a satisfação das pessoas que ali trabalham e a continuidade de suas atividades, bem como permitir que seus clientes internos (os alunos) e externos (a comunidade) possam ser atendidos em suas necessidades. O termo controle predispõe um pensamento de comando, que tem como objetivo principal permitir que a organização cumpra com os seus objetivos. O processo de controle gerencial é o processo que os líderes encontram para assegurar que os outros membros da organização respeitem as estratégias determinadas. Instituições de saúde e ensino desenvolvem suas atividades através de seus centros de responsabilidades, que existem para cumprir suas finalidades. Como a organização é o conjunto de centro de responsabilidades, e se cada centro de responsabilidade cumpre com suas estratégias a própria organização atinge suas metas. Cabe ao gestor hospitalar decidir qual a estratégia a seguir congruindo com as premissas ou objetivos da organização. Esta decisão deve ser fundamentada em parâmetros e resultados que podem ser conseguidos através de ferramentas de decisão. Muitas organizações utilizam a avaliação do desempenho financeiro de seus centros de responsabilidade para tomar suas decisões. O presente trabalho é uma pesquisa ação, que propõe a apresentação de um modelo teórico, aqui representado por uma ferramenta de decisão que disponibilizará como indicadores de avaliação de desempenho as premissas de ensino, pesquisa e extensão, bem como as de cunho financeiro que permitirão ao gestor hospitalar decidir qual o foco ou caminho a seguir, auxiliando-o em situações de decisões administrativas. Foi realizada a comparação da classificação ou ranqueamento de cada um dos setores produtivos de acordo com o desempenho financeiro, neste caso, a margem de contribuição própria e seu ranqueamento após os cálculos apresentados pelo modelo proposto a fim de demonstrar que ocorreu mudança no ranqueamento dos setores. Este modelo baseou-se em uma ferramenta de hierarquização multicriterial. O fato mais importante foi de perceber que todos os setores produtivos tiveram seu ranqueamento modificado após os cálculos com a ferramenta apresentada. Assim, esta ferramenta torna-se uma forma de decisão mais abrangente, pois contempla outros critérios, ou neste caso, premissas importantes para a decisão, sendo muito útil também para identificar entre as premissas apresentadas quais foram as de pior desempenho em cada setor. Desta forma, o gestor pode determinar ações de melhorias, buscando metas que possam ser alcançadas e determinando aporte financeiro, sendo este o caso, para alcançá-las.(AU)

Is routine hospital episode data sufficient for identifying individuals with chronic kidney disease? : A comparison study with laboratory data

© The Author(s) 2014. Acknowledgements We thank the Information Services Division, Scotland, who provided the SMR01 data, and NHS Grampian, who provided the biochemistry data. We also thank the University of Aberdeen’s Data Management Team. Funding This work was supported by the Chief Scientists Office for Scotland (grant no. CZH/4/656).

Sustainable materials: The business case for green chemistry design practices

Product manufacturers face increasing environmental and human health regulations with certain regulations targeting specific chemicals of concern that must be removed from the supply chain. This study examines a green chemistry approach to choosing between flame retardant alternatives in electronic products during the design phase of product development. An aggregated score based on five criteria was generated for each flame retardant. To address subjectivity and cognitive bias concerns probabilistic sensitivity analysis was applied to the weighting factors used to generate the scores to examine the reliability of the results. The highest scoring flame retardants based on the comprehensive green chemistry approach were different from the flame retardants chosen using cost as the primary selection criteria.

Assessment of Natural and Manmade Materials in US Artificial Reef Programs

Natural coral reefs are in a state of serious decline worldwide. The pressures of over fishing, recreational activities, environmental pollutants, and global warming have stressed these marine ecosystems to the breaking point. One of the oldest methods of augmenting natural reef systems is the implementation of artificial reefs. These projects are not as simple as dumping waste or scrap materials in offshore areas. Proper material selection is vital to produce a healthy artificial marine habitat that is completed on schedule and on budget. This Capstone Project will evaluate the most commonly used materials and provide a comparison of their strengths and weaknesses. This comparison provides a valuable tool for project managers as they begin the reef planning process.

Donación voluntaria de sangre de cordón umbilical en el Hospital Universitario Virgen de la Arrixaca (2010-2011). Situación actual e influencia de las variables obstétrico-fetales

Objetivos: A principios de 2010 el Hospital Universitario Virgen de la Arrixaca puso en marcha, en el servicio de partos, el protocolo de donación voluntaria de sangre de cordón umbilical (SCU). Desde la reflexión y la autoevaluación, planteamos un análisis de nuestra situación actual a través del estudio de la influencia de las variables obstétrico-fetales en la calidad de las muestras. Métodos: Con este fin hemos planteado un trabajo de tipo observacional, descriptivo, retrospectivo y de corte transversal desde mayo de 2010 a noviembre de 2011, con el objetivo de aumentar la calidad de las unidades de SCU y optar por una gestión eficiente que haga sostenible el proyecto. Resultados: Se obtuvieron 123 donaciones potenciales de sangre de cordón y del análisis multivariable de las mismas obtuvimos una correlación positiva significativa entre el número de leucocitos, las semanas de gestación y el parto vaginal. El peso inicial de la unidad se incrementó significativamente a mayor peso del recién nacido y paridad de la donante. Conclusiones: Como conclusiones del estudio nos planteamos esbozar posibles factores predictivos que permitan seleccionar las muestras de mayor calidad y sean complemento de los actuales estándares elaborados por el Banco Público de Málaga. En este sentido nuestros resultados sugieren que en los partos con más semanas de gestación, paridad de la gestante y peso del recién nacido, así como en los partos vaginales, encontramos mayores posibilidades de obtener muestras de alta calidad.

La gestión de los cuidados enfermeros en el hospital San Juan de Dios de Alicante: a propósito de tres fuentes documentales inéditas del siglo XVIII

Se propone como objetivo principal mostrar y analizar tres fuentes documentales inéditas del siglo XVIII, localizadas en el Archivo Municipal Sant Joan d’Alacant que aportan información sobre la gestión de enfermería realizada en el Hospital San Juan de Dios de Alicante. Son tres las fuentes documentales que se transcriben y analizan, una “relación jurada de Fray Joseph Martínez Maza”, fechando el documento entre 1710 y 1718; un “Real privilegio de S.M. para amortizar la cantidad de 120 libras libres de sello y demás”. Dado en 23 de enero de 1794, a favor del convento hospital de N.P. San Juan de Dios de la ciudad de Alicante y un “formulario o modelo para dar cumplimiento a la orden del nuncio de su Santidad referente a las rentas, gravámenes, limosnas y otras entradas, con la curación a pobres, enfermos, con arreglo a los libros de caja”, datando el documento entre 1748 y 1760.

Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7 g/dL and 9 g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e. g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0 - 1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250 mg given 30 - 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper GI endoscopy. Very early (< 12 hours) upper GI endoscopy may be considered in patients with high risk clinical features, namely: hemodynamic instability (tachycardia, hypotension) that persists despite ongoing attempts at volume resuscitation; in-hospital bloody emesis/nasogastric aspirate; or contraindication to the interruption of anticoagulation (strong recommendation, moderate quality evidence). MR8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (Forrest classification Ia and Ib, respectively) or with a nonbleeding visible vessel (Forrest classification IIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or rebleeding (strong recommendation, high quality evidence). MR9. ESGE recommends that peptic ulcers with an adherent clot (Forrest classification IIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (Forrest classification Ia or Ib) or nonbleeding visible vessel (Forrest classification IIa) should receive endoscopic hemostasis (weak recommendation, moderate quality evidence). MR10. In patients with peptic ulcers having a flat pigmented spot (Forrest classification IIc) or clean base (Forrest classification III), ESGE does not recommend endoscopic hemostasis as these stigmata present a low risk of recurrent bleeding. In selected clinical settings, these patients may be discharged to home on standard PPI therapy, e. g., oral PPI once-daily (strong recommendation, moderate quality evidence). MR11. ESGE recommends that epinephrine injection therapy not be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality (strong recommendation, high quality evidence). MR12. ESGE recommends PPI therapy for patients who receive endoscopic hemostasis and for patients with adherent clot not receiving endoscopic hemostasis. PPI therapy should be high dose and administered as an intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour) for 72 hours post endoscopy (strong recommendation, high quality evidence). MR13. ESGE does not recommend routine second-look endoscopy as part of the management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e. g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence).