Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?

Marco conceptual: La enfermedad renal crónica es un serio problema de salud pública en nuestro país por la gran cantidad de recursos económicos que requiere su atención. La hemodiálisis es el tratamiento más usado en nuestro medio; el acceso vascular y sus complicaciones derivadas son el principal aspecto que incrementa los costos de atención en éstos pacientes. Materiales y métodos: Se realizó un estudio económico de los accesos vasculares en pacientes incidentes de hemodiálisis en el año 2012 en la agencia RTS-Fundación Cardio Infantil. Se estableció el costo de creación y mantenimiento del acceso con catéter central, fístula arteriovenosa nativa, fístula arteriovenosa con injerto; y el costo de atención de las complicaciones para cada acceso. Se determinó la probabilidad de ocurrencia de complicaciones. Mediante un árbol de decisiones se trazó el comportamiento de cada acceso en un período de 5 años. Se establecieron los años de vida ajustados por calidad (QALY) en cada acceso y el costo para cada uno de éstos QALY. Resultados: de 36 pacientes incidentes de hemodiálisis en 2012 el 100% inició con catéter central, 16 pacientes cambiaron a fístula arteriovenosa nativa, 1 a fístula arteriovenosa con injerto que posteriormente pasó a CAPD, 15 continuaron su acceso con catéter y 4 pacientes fallecieron. En 5 años se obtuvieron 2,36 QALY para los pacientes con catéter central que costarían $ 24.813.036,39/QALY y 2,535 QALY para los pacientes con fístula nativa que costarían $ 6.634.870,64/QALY. Conclusiones: el presente estudio muestra que el acceso vascular mediante fístula arteriovenosa nativa es el más costo-efectivo que mediante catéter

Multi-objective optimization scheme for static and dynamic multicast flows

Muchas de las nuevas aplicaciones emergentes de Internet tales como TV sobre Internet, Radio sobre Internet,Video Streamming multi-punto, entre otras, necesitan los siguientes requerimientos de recursos: ancho de banda consumido, retardo extremo-a-extremo, tasa de paquetes perdidos, etc. Por lo anterior, es necesario formular una propuesta que especifique y provea para este tipo de aplicaciones los recursos necesarios para su buen funcionamiento. En esta tesis, proponemos un esquema de ingeniería de tráfico multi-objetivo a través del uso de diferentes árboles de distribución para muchos flujos multicast. En este caso, estamos usando la aproximación de múltiples caminos para cada nodo egreso y de esta forma obtener la aproximación de múltiples árboles y a través de esta forma crear diferentes árboles multicast. Sin embargo, nuestra propuesta resuelve la fracción de la división del tráfico a través de múltiples árboles. La propuesta puede ser aplicada en redes MPLS estableciendo rutas explícitas en eventos multicast. En primera instancia, el objetivo es combinar los siguientes objetivos ponderados dentro de una métrica agregada: máxima utilización de los enlaces, cantidad de saltos, el ancho de banda total consumido y el retardo total extremo-a-extremo. Nosotros hemos formulado esta función multi-objetivo (modelo MHDB-S) y los resultados obtenidos muestran que varios objetivos ponderados son reducidos y la máxima utilización de los enlaces es minimizada. El problema es NP-duro, por lo tanto, un algoritmo es propuesto para optimizar los diferentes objetivos. El comportamiento que obtuvimos usando este algoritmo es similar al que obtuvimos con el modelo. Normalmente, durante la transmisión multicast los nodos egresos pueden salir o entrar del árbol y por esta razón en esta tesis proponemos un esquema de ingeniería de tráfico multi-objetivo usando diferentes árboles para grupos multicast dinámicos. (en el cual los nodos egresos pueden cambiar durante el tiempo de vida de la conexión). Si un árbol multicast es recomputado desde el principio, esto podría consumir un tiempo considerable de CPU y además todas las comuicaciones que están usando el árbol multicast serán temporalmente interrumpida. Para aliviar estos inconvenientes, proponemos un modelo de optimización (modelo dinámico MHDB-D) que utilice los árboles multicast previamente computados (modelo estático MHDB-S) adicionando nuevos nodos egreso. Usando el método de la suma ponderada para resolver el modelo analítico, no necesariamente es correcto, porque es posible tener un espacio de solución no convexo y por esta razón algunas soluciones pueden no ser encontradas. Adicionalmente, otros tipos de objetivos fueron encontrados en diferentes trabajos de investigación. Por las razones mencionadas anteriormente, un nuevo modelo llamado GMM es propuesto y para dar solución a este problema un nuevo algoritmo usando Algoritmos Evolutivos Multi-Objetivos es propuesto. Este algoritmo esta inspirado por el algoritmo Strength Pareto Evolutionary Algorithm (SPEA). Para dar una solución al caso dinámico con este modelo generalizado, nosotros hemos propuesto un nuevo modelo dinámico y una solución computacional usando Breadth First Search (BFS) probabilístico. Finalmente, para evaluar nuestro esquema de optimización propuesto, ejecutamos diferentes pruebas y simulaciones. Las principales contribuciones de esta tesis son la taxonomía, los modelos de optimización multi-objetivo para los casos estático y dinámico en transmisiones multicast (MHDB-S y MHDB-D), los algoritmos para dar solución computacional a los modelos. Finalmente, los modelos generalizados también para los casos estático y dinámico (GMM y GMM Dinámico) y las propuestas computacionales para dar slución usando MOEA y BFS probabilístico.

Modelling of Johne's disease control options in beef cattle: a decision support approach

Johne's disease in cattle is a contagious wasting disease caused by Mycobacterium avium subspecies paratuberculosis (MAP). Johne's infection is characterised by a long subclinical phase and can therefore go undetected for long periods of time during which substantial production losses can occur. The protracted nature of Johne's infection therefore presents a challenge for both veterinarians and farmers when discussing control options due to a paucity of information and limited test performance when screening for the disease. The objectives were to model Johne's control decisions in suckler beef cattle using a decision support approach, thus implying equal focus on ‘end user’ (veterinarian) participation whilst still focusing on the technical disease modelling aspects during the decision support model development. The model shows how Johne's disease is likely to affect a herd over time both in terms of physical and financial impacts. In addition, the model simulates the effect on production from two different Johne's control strategies; herd management measures and test and cull measures. The article also provides and discusses results from a sensitivity analysis to assess the effects on production from improving the currently available test performance. Output from running the model shows that a combination of management improvements to reduce routes of infection and testing and culling to remove infected and infectious animals is likely to be the least-cost control strategy.

Asset liability modelling and pension schemes: the application of robust optimization to USS

This paper uses a novel numerical optimization technique - robust optimization - that is well suited to solving the asset-liability management (ALM) problem for pension schemes. It requires the estimation of fewer stochastic parameters, reduces estimation risk and adopts a prudent approach to asset allocation. This study is the first to apply it to a real-world pension scheme, and the first ALM model of a pension scheme to maximise the Sharpe ratio. We disaggregate pension liabilities into three components - active members, deferred members and pensioners, and transform the optimal asset allocation into the scheme’s projected contribution rate. The robust optimization model is extended to include liabilities and used to derive optimal investment policies for the Universities Superannuation Scheme (USS), benchmarked against the Sharpe and Tint, Bayes-Stein, and Black-Litterman models as well as the actual USS investment decisions. Over a 144 month out-of-sample period robust optimization is superior to the four benchmarks across 20 performance criteria, and has a remarkably stable asset allocation – essentially fix-mix. These conclusions are supported by six robustness checks.

The multiple team formation problem using sociometry

The Team Formation problem (TFP) has become a well-known problem in the OR literature over the last few years. In this problem, the allocation of multiple individuals that match a required set of skills as a group must be chosen to maximise one or several social positive attributes. Speci�cally, the aim of the current research is two-fold. First, two new dimensions of the TFP are added by considering multiple projects and fractions of people's dedication. This new problem is named the Multiple Team Formation Problem (MTFP). Second, an optimization model consisting in a quadratic objective function, linear constraints and integer variables is proposed for the problem. The optimization model is solved by three algorithms: a Constraint Programming approach provided by a commercial solver, a Local Search heuristic and a Variable Neighbourhood Search metaheuristic. These three algorithms constitute the first attempt to solve the MTFP, being a variable neighbourhood local search metaheuristic the most effi�cient in almost all cases. Applications of this problem commonly appear in real-life situations, particularly with the current and ongoing development of social network analysis. Therefore, this work opens multiple paths for future research.

One rapidly growing market of Sweden: organic food : A qualitative study portraying some consumers’ decision to purchase organic food

In recent years there has been a significantly rising trend amongst consumers for health and environmental issues, which has resulted in greater attention for and sales of organic food. Organic food production strives to use natural resources, such as land, energy and water in a sustainable way and the products does not contain artificial fertilizers or chemical pesticides. However, organic food products are also often more expensive and less available in comparison to conventional food products. Despite this, interest for and sales of organic food products have increased around the globe, and in Sweden particularly, the increase in sales has grown largely from an international perspective. This thesis is of qualitative character and is focused on studying some consumers from the Swedish market of organic food. The purpose of this thesis is to contribute with a better understanding on the buying decision process regarding organic food purchase. To achieve this, the authors have studied some consumers that purchase organic food and have searched for patterns that could be identified in the decision process. The consumer buying decision process model has been used for portrayal of the chosen consumers’ decision to purchase organic food products. Interviews with six Swedish consumers were conducted, whereas each respondent continuously purchase organic food products. Results show that the purchase of organic food products begins with discovering an unsatisfied need state, which the consumers of this study desired to change with the purchase of organic food products. This study show how six consumers reason when passing through the stages of the buying decision process, in order to satisfy their desired need state. The authors found that the respondents feel satisfied with purchasing organic food products, which lead them in to continuously buying these products. Altogether, the findings contribute with knowledge that can come to be helpful when wanting to understand more about the consumer decision to purchase organic food.

O uso gerencial das informações contábeis tratadas por métodos que reconhecem os efeitos das flutuações de preços sobre o patrimônio e resultado empresarial: uma verificação empírica

O objetivo central desta pesquisa foi o de explorar, descrever e discutir de que forma e em que extensão as empresas se utilizam das informações contábeis tratadas por mecanismos que considerem os reflexos das variações no poder aquisitivo da moeda (Inflação) e das flutuações específicas de preços sobre os resultado e patrimônio empresarial, nos seus sistemas de controles internos e, consequentemente, em seus processos de tomada de decisão, avaliação de desempenho e fixação de tendências para o empreendimento. Em função dos objetivos propostos, a operacionalização desta pesquisa foi desenvolvida em duas etapas. A primeira fase, de caráter qualitativo, constituiu-se no levantamento dos dados básicos necessários ao atingimento dos objetivos desejados, através da aplicação de questionários em 12 (doze) empresas. Através dos dados levantados, foi possível inferir-se que o sistema contábil configura-se na base primária dos relatórios gerenciais das empresas pesquisadas. o modelo da Correção Integral teve sua validade conceitual confirmada, não obstante algumas simpliflcações metodológicas adotadas e o problema da lnadequacidade do padrão monetário utilizado principalmente em 1990. Em que pese ter havido consenso na indicação das distorções provocadas pelo problema do indexador, apenas duas empresas adotaram mecanismos tendentes a anular seus efeitos. Uma importante constatação também, foi o fato de que nas empresas em que se utilizavam sistemas contábeis baseados na metodologia da Lei Societária, como fonte primária, para geração de relatórios gerenciais, as suas adminlstrações não utilizavam tais relatórios como suporte aos seus processos de tomada de decisão, como por exemplo, no processo de estabelecimento de preços. Ressalte-se, também, que o pouco conhecimento da filosofia conceitual e vantagens informativas do modelo da Contabilidade a Custo Corrente Corrigido, tem impedido a sua implantação de forma mais ampla. Saliente-se que 60% das empresas da amostra já se utilizam de mecanismos de avaliação de ativos não monetários, com base em valores correntes (captaçao dos efeitos das flutuações especificas de preços), só que restritos aos itens circulantes (estoques) . Este é, certamente, o caminho para a aplicação plena do modelo, principalmente no âmbito gerencial. A segunda fase, cujo enfoque direcionou-se aos aspectos quantitativos, através do cálculo de indicadores econômicos-financeiros extraídos das demonstrações contábeis das empresas pesquisadas, relativos ao exercício de 1990, e elaborados em consonân ia com as metodologias da Correção Integral e da Lei Societária, buscou-se , mediante análise comparativa, avaliar as pricipais distorções encolvidas, que corroboram, de certa forma, os comentários feitos no parágrafo anterior. A natureza exploratória deste assunto, com deslocamento da ênfase da análise quantitativa, e com enfoque estritamente gerencial, é que o diferencia dos demais desenvolvidos em tempos recentes. Além disso, apresenta como caraterística acessória a busca por informações sugestivas para o desenvolvimento de pesquisas futuras.

Modelagem da decisão por pacotes de viagem: um estudo usando processo de hierarquia analítica AHP

The objective of this dissertation is to propose a Multi Criteria Decision Aid Model to be used by the costumers of the travel agencies and help them to choose the best package travel. The main objective is to contribute for the simplification of the travel package decision choice from the identification of the models of values and preference of the customers and applying them to the existing package. It is used the Analytic Hierarchy Process (AHP) method to structuralize a decision hierarchic model composed by six criteria (package cost, hotel category, security of the city, travel time, direct flight and position in ranking of the 10 most visited destination) and five real alternatives of packages for a holiday of three days created from travel agency data. The decision analysis was realized for the choice of a travel package by a group composed by two couples that regularly travels together, to which was asked to do a pairwise judgment of the criteria and the alternatives. The mains results show that, although been a group that travels together, there are different models of values in the weights of the criteria and a certain convergence in the scales of preferences of the alternatives in the criteria. It was not pointed a dominant alternative for all the members of the group separately, but an analysis of a total utility of the group shows a classification and an order of the travel packages and an alternative clearly in front of the others. The sensitivity analysis revels that there are changes in the ranking, but the two alternatives best classified in the normal analysis are the same ones in the sensitivity analysis, although with the positions changed. The analysis also led to a simplification of the process with the exclusion of alternatives dominated for the others ones. As main conclusion, it is evaluated that the model and method suggested allow a simplification of the decision process in the choice of travel packages

Modelo de programação matemática para controle do crescimento da vegetação sob redes de distribuição de energia elétrica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Lot sizing and furnace scheduling in small foundries

A lot sizing and scheduling problem prevalent in small market-driven foundries is studied. There are two related decision levels: (1) the furnace scheduling of metal alloy production, and (2) moulding machine planning which specifies the type and size of production lots. A mixed integer programming (MIP) formulation of the problem is proposed, but is impractical to solve in reasonable computing time for non-small instances. As a result, a faster relax-and-fix (RF) approach is developed that can also be used on a rolling horizon basis where only immediate-term schedules are implemented. As well as a MIP method to solve the basic RF approach, three variants of a local search method are also developed and tested using instances based on the literature. Finally, foundry-based tests with a real-order book resulted in a very substantial reduction of delivery delays and finished inventory, better use of capacity, and much faster schedule definition compared to the foundry's own practice. © 2006 Elsevier Ltd. All rights reserved.

Sustainable urban energy planning: The case study of a tropical city

The urbanization of modern societies has imposed to the planners and decision-makers a more precise attention to facts not considered before. Several aspects, such as the energy availability and the deleterious effect of pollution on the populations, must be considered in the policy decisions of cities urbanization. The current paradigm presents centralized power stations supplying a city, and a combination of technologies may compose the energy mix of a country, such as thermal power plants, hydroelectric plants, wind systems and solar-based systems, with their corresponding emission pattern. A goal programming multi-objective optimization model is presented for the electric expansion analysis of a tropical city, and also a case study for the city of Guaratinguetá, Brazil, considering a particular wind and solar radiation patterns established according to actual data and modeled via the time series analysis method. Scenarios are proposed and the results of single environmental objective, single economic objective and goal programming multi-objective modeling are discussed. The consequences of each dispatch decision, which considers pollutant emission exportation to the neighborhood or the need of supplementing electricity by purchasing it from the public electric power grid, are discussed. The results revealed energetic dispatch for the alternatives studied and the optimum environmental and economic solution was obtained. © 2012 Elsevier Ltd.

A heuristic algorithm based on multi-assignment procedures for nurse scheduling

This paper tackles a Nurse Scheduling Problem which consists of generating work schedules for a set of nurses while considering their shift preferences and other requirements. The objective is to maximize the satisfaction of nurses' preferences and minimize the violation of soft constraints. This paper presents a new deterministic heuristic algorithm, called MAPA (multi-assignment problem-based algorithm), which is based on successive resolutions of the assignment problem. The algorithm has two phases: a constructive phase and an improvement phase. The constructive phase builds a full schedule by solving successive assignment problems, one for each day in the planning period. The improvement phase uses a couple of procedures that re-solve assignment problems to produce a better schedule. Given the deterministic nature of this algorithm, the same schedule is obtained each time that the algorithm is applied to the same problem instance. The performance of MAPA is benchmarked against published results for almost 250,000 instances from the NSPLib dataset. In most cases, particularly on large instances of the problem, the results produced by MAPA are better when compared to best-known solutions from the literature. The experiments reported here also show that the MAPA algorithm finds more feasible solutions compared with other algorithms in the literature, which suggest that this proposed approach is effective and robust. © 2013 Springer Science+Business Media New York.

Estilo de liderança de técnicos de futebol

Psychological factors are gaining more space in sports, and increasingly common related professional psychology are inserted in the sporting context. Seeking a better understanding of the manifestations of leadership in football between technicians of different categories this study aimed to verify whether there is a preferred style of leadership among the football coaches and if there are differences between the leadership style ideal and real seconded by same. The methodology used the Search Specification (CERVO and BERVIAN, 2004) relying on the implementation of the Revised Leadership Scale for Sport (ELRE), ideal and real versions Profile, With the participation of twenty football coaches in the field (n = 20), working in teams of males in the City of São Bernardo do Campo - SP, and to process the data we calculated the Cronbach alpha to verify the reliability of the scale, and the average of the results relying on the software application SPSS version 17.0 for Windows. Of the total participants 30% have a degree in Physical Education and are inserted in the football an average of 8 years in different roles and the prevalence of autocratic decision-making model, with an alpha of 0.87 results in the ideal profile and the actual profile of alpha 0.86 , So the scale is stable and reliable. We conclude that the model of autocratic decision not differ very significantly compared to the model of democratic decision. Regarding the interaction with the group of technicians the situational model is highlighted in research showing that technicians take into account situational factors.

Chronic VEGF Blockade Worsens Glomerular Injury in the Remnant Kidney Model

VEGF inhibition can promote renal vascular and parenchymal injury, causing proteinuria, hypertension and thrombotic microangiopathy. The mechanisms underlying these side effects are unclear. We investigated the renal effects of the administration, during 45 days, of sunitinib (Su), a VEGF receptor inhibitor, to rats with 5/6 renal ablation (Nx). Adult male Munich-Wistar rats were distributed among groups S+V, sham-operated rats receiving vehicle only; S+Su, S rats given Su, 4 mg/kg/day; Nx+V, Nx rats receiving V; and Nx+Su, Nx rats receiving Su. Su caused no change in Group S. Seven and 45 days after renal ablation, renal cortical interstitium was expanded, in association with rarefaction of peritubular capillaries. Su did not worsen hypertension, proteinuria or interstitial expansion, nor did it affect capillary rarefaction, suggesting little angiogenic activity in this model. Nx animals exhibited glomerulosclerosis (GS), which was aggravated by Su. This effect could not be explained by podocyte damage, nor could it be ascribed to tuft hypertrophy or hyperplasia. GS may have derived from organization of capillary microthrombi, frequently observed in Group Nx+Su. Treatment with Su did not reduce the fractional glomerular endothelial area, suggesting functional rather than structural cell injury. Chronic VEGF inhibition has little effect on normal rats, but can affect glomerular endothelium when renal damage is already present.

Optimization of Large-Scale Hydrothermal System Operation

This paper presents the development of a mathematical model to optimize the management and operation of the Brazilian hydrothermal system. The system consists of a large set of individual hydropower plants and a set of aggregated thermal plants. The energy generated in the system is interconnected by a transmission network so it can be transmitted to centers of consumption throughout the country. The optimization model offered is capable of handling different types of constraints, such as interbasin water transfers, water supply for various purposes, and environmental requirements. Its overall objective is to produce energy to meet the country's demand at a minimum cost. Called HIDROTERM, the model integrates a database with basic hydrological and technical information to run the optimization model, and provides an interface to manage the input and output data. The optimization model uses the General Algebraic Modeling System (GAMS) package and can invoke different linear as well as nonlinear programming solvers. The optimization model was applied to the Brazilian hydrothermal system, one of the largest in the world. The system is divided into four subsystems with 127 active hydropower plants. Preliminary results under different scenarios of inflow, demand, and installed capacity demonstrate the efficiency and utility of the model. From this and other case studies in Brazil, the results indicate that the methodology developed is suitable to different applications, such as planning operation, capacity expansion, and operational rule studies, and trade-off analysis among multiple water users. DOI: 10.1061/(ASCE)WR.1943-5452.0000149. (C) 2012 American Society of Civil Engineers.