2,696 research outputs found

    Fuzzy set methods for object recognition in space applications

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    Progress on the following tasks is reported: (1) fuzzy set-based decision making methodologies; (2) feature calculation; (3) clustering for curve and surface fitting; and (4) acquisition of images. The general structure for networks based on fuzzy set connectives which are being used for information fusion and decision making in space applications is described. The structure and training techniques for such networks consisting of generalized means and gamma-operators are described. The use of other hybrid operators in multicriteria decision making is currently being examined. Numerous classical features on image regions such as gray level statistics, edge and curve primitives, texture measures from cooccurrance matrix, and size and shape parameters were implemented. Several fractal geometric features which may have a considerable impact on characterizing cluttered background, such as clouds, dense star patterns, or some planetary surfaces, were used. A new approach to a fuzzy C-shell algorithm is addressed. NASA personnel are in the process of acquiring suitable simulation data and hopefully videotaped actual shuttle imagery. Photographs have been digitized to use in the algorithms. Also, a model of the shuttle was assembled and a mechanism to orient this model in 3-D to digitize for experiments on pose estimation is being constructed

    A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study

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    [EN] Performance evaluation is relevant for supporting managerial decisions related to the improvement of public emergency departments (EDs). As different criteria from ED context and several alternatives need to be considered, selecting a suitable Multicriteria Decision-Making (MCDM) approach has become a crucial step for ED performance evaluation. Although some methodologies have been proposed to address this challenge, a more complete approach is still lacking. This paper bridges this gap by integrating three potent MCDM methods. First, the Fuzzy Analytic Hierarchy Process (FAHP) is used to determine the criteria and sub-criteria weights under uncertainty, followed by the interdependence evaluation via fuzzy Decision-Making Trial and Evaluation Laboratory(FDEMATEL). The fuzzy logic is merged with AHP and DEMATEL to illustrate vague judgments. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used for ranking EDs. This approach is validated in a real 3-ED cluster. The results revealed the critical role of Infrastructure (21.5%) in ED performance and the interactive nature of Patient safety (C+R =12.771). Furthermore, this paper evidences the weaknesses to be tackled for upgrading the performance of each ED.Ortiz-Barrios, M.; Alfaro Saiz, JJ. (2020). A Hybrid Fuzzy Multi-criteria Decision Making Model to Evaluate the Overall Performance of Public Emergency Departments: A Case Study. International Journal of Information Technology & Decision Making. 19(6):1485-1548. https://doi.org/10.1142/S0219622020500364S14851548196Lord, K., Parwani, V., Ulrich, A., Finn, E. B., Rothenberg, C., Emerson, B., … Venkatesh, A. K. (2018). Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal of Emergency Medicine, 36(7), 1246-1248. doi:10.1016/j.ajem.2018.03.043Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). 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A new multi-criteria decision making approach for sustainable material selection problem: A critical study on rank reversal problem. Journal of Cleaner Production, 182, 466-484. doi:10.1016/j.jclepro.2018.02.062Chen, Z., Ming, X., Zhang, X., Yin, D., & Sun, Z. (2019). A rough-fuzzy DEMATEL-ANP method for evaluating sustainable value requirement of product service system. Journal of Cleaner Production, 228, 485-508. doi:10.1016/j.jclepro.2019.04.145Jumaah, F. M., Zadain, A. A., Zaidan, B. B., Hamzah, A. K., & Bahbibi, R. (2018). Decision-making solution based multi-measurement design parameter for optimization of GPS receiver tracking channels in static and dynamic real-time positioning multipath environment. Measurement, 118, 83-95. doi:10.1016/j.measurement.2018.01.011Singh, A., & Prasher, A. (2017). Measuring healthcare service quality from patients’ perspective: using Fuzzy AHP application. Total Quality Management & Business Excellence, 30(3-4), 284-300. doi:10.1080/14783363.2017.1302794Otay, İ., Oztaysi, B., Cevik Onar, S., & Kahraman, C. (2017). Multi-expert performance evaluation of healthcare institutions using an integrated intuitionistic fuzzy AHP&DEA methodology. Knowledge-Based Systems, 133, 90-106. doi:10.1016/j.knosys.2017.06.028Awasthi, A., Govindan, K., & Gold, S. (2018). Multi-tier sustainable global supplier selection using a fuzzy AHP-VIKOR based approach. International Journal of Production Economics, 195, 106-117. doi:10.1016/j.ijpe.2017.10.013Gul, M., Guneri, A. F., & Nasirli, S. M. (2018). A fuzzy-based model for risk assessment of routes in oil transportation. International Journal of Environmental Science and Technology, 16(8), 4671-4686. doi:10.1007/s13762-018-2078-zKazancoglu, Y., Kazancoglu, I., & Sagnak, M. (2018). Fuzzy DEMATEL-based green supply chain management performance. Industrial Management & Data Systems, 118(2), 412-431. doi:10.1108/imds-03-2017-0121Abdullah, L., & Zulkifli, N. (2015). Integration of fuzzy AHP and interval type-2 fuzzy DEMATEL: An application to human resource management. Expert Systems with Applications, 42(9), 4397-4409. doi:10.1016/j.eswa.2015.01.021Ashtiani, M., & Azgomi, M. A. (2016). A hesitant fuzzy model of computational trust considering hesitancy, vagueness and uncertainty. Applied Soft Computing, 42, 18-37. doi:10.1016/j.asoc.2016.01.023Zyoud, S. H., & Fuchs-Hanusch, D. (2017). A bibliometric-based survey on AHP and TOPSIS techniques. Expert Systems with Applications, 78, 158-181. doi:10.1016/j.eswa.2017.02.016Scholz, S., Ngoli, B., & Flessa, S. (2015). Rapid assessment of infrastructure of primary health care facilities – a relevant instrument for health care systems management. BMC Health Services Research, 15(1). doi:10.1186/s12913-015-0838-8Ivlev, I., Vacek, J., & Kneppo, P. (2015). Multi-criteria decision analysis for supporting the selection of medical devices under uncertainty. European Journal of Operational Research, 247(1), 216-228. doi:10.1016/j.ejor.2015.05.075Kovacs, E., Strobl, R., Phillips, A., Stephan, A.-J., Müller, M., Gensichen, J., & Grill, E. (2018). Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care. Journal of General Internal Medicine, 33(7), 1142-1154. doi:10.1007/s11606-018-4435-5Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. doi:10.1371/journal.pone.0203316Hermann, R. M., Long, E., & Trotta, R. L. (2019). Improving Patients’ Experiences Communicating With Nurses and Providers in the Emergency Department. Journal of Emergency Nursing, 45(5), 523-530. doi:10.1016/j.jen.2018.12.001Hawley, K. L., Mazer-Amirshahi, M., Zocchi, M. S., Fox, E. R., & Pines, J. M. (2015). Longitudinal Trends in U.S. Drug Shortages for Medications Used in Emergency Departments (2001-2014). Academic Emergency Medicine, 23(1), 63-69. doi:10.1111/acem.12838Stang, A. S., Crotts, J., Johnson, D. W., Hartling, L., & Guttmann, A. (2015). Crowding Measures Associated With the Quality of Emergency Department Care: A Systematic Review. Academic Emergency Medicine, 22(6), 643-656. doi:10.1111/acem.12682Chanamool, N., & Naenna, T. (2016). Fuzzy FMEA application to improve decision-making process in an emergency department. Applied Soft Computing, 43, 441-453. doi:10.1016/j.asoc.2016.01.007Farup, P. G. (2015). Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study. BMC Health Services Research, 15(1). doi:10.1186/s12913-015-0852-xCarter, E. J., Pouch, S. M., & Larson, E. L. (2013). The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review. Journal of Nursing Scholarship, 46(2), 106-115. doi:10.1111/jnu.12055Ebben, R. H. A., Siqeca, F., Madsen, U. R., Vloet, L. C. M., & van Achterberg, T. (2018). Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open, 8(11), e017572. doi:10.1136/bmjopen-2017-017572Innes, G. D., Sivilotti, M. L. A., Ovens, H., McLelland, K., Dukelow, A., Kwok, E., … Chochinov, A. (2018). Emergency overcrowding and access block: A smaller problem than we think. CJEM, 21(2), 177-185. doi:10.1017/cem.2018.446Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2014). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine, 10(2), 171-175. doi:10.1007/s11739-014-1154-8Uthman, O. A., Walker, C., Lahiri, S., Jenkinson, D., Adekanmbi, V., Robertson, W., & Clarke, A. (2018). General practitioners providing non-urgent care in emergency department: a natural experiment. BMJ Open, 8(5), e019736. doi:10.1136/bmjopen-2017-019736Razzak, J. A., Baqir, S. M., Khan, U. R., Heller, D., Bhatti, J., & Hyder, A. A. (2013). Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels. Emergency Medicine Journal, 32(3), 207-213. doi:10.1136/emermed-2013-202590Dart, R. C., Goldfrank, L. R., Erstad, B. L., Huang, D. T., Todd, K. H., Weitz, J., … Anderson, V. E. (2018). Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care. Annals of Emergency Medicine, 71(3), 314-325.e1. doi:10.1016/j.annemergmed.2017.05.021Mkoka, D. A., Goicolea, I., Kiwara, A., Mwangu, M., & Hurtig, A.-K. (2014). 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The Effect of Pay for Performance in the Emergency Department on Patient Waiting Times and Quality of Care in Ontario, Canada: A Difference-in-Differences Analysis. Annals of Emergency Medicine, 67(4), 496-505.e7. doi:10.1016/j.annemergmed.2015.06.028Singh, S., Lin, Y.-L., Nattinger, A. B., Kuo, Y.-F., & Goodwin, J. S. (2015). Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge. Journal of Hospital Medicine, 10(11), 705-710. doi:10.1002/jhm.2407Källberg, A.-S., Göransson, K. E., Florin, J., Östergren, J., Brixey, J. J., & Ehrenberg, A. (2015). Contributing factors to errors in Swedish emergency departments. International Emergency Nursing, 23(2), 156-161. doi:10.1016/j.ienj.2014.10.002Riga, M., Vozikis, A., Pollalis, Y., & Souliotis, K. (2015). MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: A health policy perspective. 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    Explaining Ovarian Cancer Gene Expression Profiles with Fuzzy Rules and Genetic Algorithms

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    The analysis of gene expression data is a complex task, and many tools and pipelines are available to handle big sequencing datasets for case-control (bivariate) studies. In some cases, such as pilot or exploratory studies, the researcher needs to compare more than two groups of samples consisting of a few replicates. Both standard statistical bioinformatic pipelines and innovative deep learning models are unsuitable for extracting interpretable patterns and information from such datasets. In this work, we apply a combination of fuzzy rule systems and genetic algorithms to analyze a dataset composed of 21 samples and 6 classes, useful for approaching the study of expression profiles in ovarian cancer, compared to other ovarian diseases. The proposed method is capable of performing a feature selection among genes that is guided by the genetic algorithm, and of building a set of if-then rules that explain how classes can be distinguished by observing changes in the expression of selected genes. After testing several parameters, the final model consists of 10 genes involved in the molecular pathways of cancer and 10 rules that correctly classify all samples

    Potential Risk: A New Approach

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    Harmonization of modeling systems for assessing the electric-power consumption levels at mining enterprises

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    Purpose. The purpose of the work is to study the system corporate features of electric-power consumption systems, the formation of applied scientific and methodological support, as well as economic and mathematical modeling tools to analyse the cost characteristics of the electric-power consumption. Methods. The research is based on the use of laws, patterns and categorical set. In the course of scientific research, the general scientific methods were used (comparison, generalization, analogue method, structural analysis and synthesis), methods of logical-theoretical analysis and special economic-mathematical methods. The official documents that reflect and regulate certain aspects of the power consumption system in the acquisition, processing and presentation of information were the normative basis of research. The materials of scientific conferences and seminars, the resources of the global Internet information system, the information from the State Statistics Service of Ukraine were used as information sources. The theoretical basis of research is confirmed by scientific works of domestic and foreign researchers in the field of power supply in a transition economy. The complex of regression and index methods, as well as models of electric-power consumption analysis are used to determine the transformational changes in the components of electric-power consumption. Findings. The parameters have been analysed of electric-power consumption in iron-ore enterprises of the Kryvyi Rih region. The process has been investigated of forming a system of models for solving the problem of the cost characteristics optimization of electric-power consumption. The system corporate features have been determined of the power consumption systems in iron-ore enterprises of the Kryvyi Rih region. The tools set has been formed of economic and mathematical modelling in order to analyse and assess the cost indicators of power consumption systems. The harmonization of modelling methods made it possible to determine the cost characteristics and prove the rationality of using the models, calculate the effective resources assignment, and make recommendations in accordance with rational management decisions on the formation of electric-power consumption. Originality. An innovative integrated approach to the formation of corporate models of electric-power supply systems has been proposed, which uses the index methodology in combination with the least modules methods. This approach allows to optimize electric-power costs and ensure rational management of electric-power consumption. Practical implications. The formation of corporate models is the basis for further research and the construction of multifactorial regression models, as well as models to predict the electric-power consumption. Practical experience in the use of the proposed methodology has proven its effectiveness in making management decisions to ensure optimal electric-power consumption characteristics.Мета. Вивчення системних корпоративних характеристик систем електроспоживання, формування прикладного науково-методичного забезпечення та інструменти економіко-математичного моделювання з метою аналізу й вартісних характеристик електроспоживання. Методика. Дослідження засноване на використанні законів, закономірностей та категоричного апарату. У процесі наукових досліджень були використані загальні наукові методи досліджень (порівняння, узагальнення, метод аналогій, структурний аналіз та синтез), методи логіко-теоретичного аналізу, спеціальні економіко-математичні методи. Нормативною базою для дослідження були офіційні документи, що відображають та регулюють певні аспекти системи споживання енергії при зборі, обробці та представленні інформації. Як інформаційні джерела використані матеріали наукових конференцій та семінарів, ресурси глобальної інформаційної системи Інтернету, інформація Державної служби статистики України. Теоретичні основи дослідження, що обслуговуються науковими роботами вітчизняних та зарубіжних дослідників у галузі енергозабезпечення в перехідній економіці. Комплекс регресійних та індексних методів та моделей аналізу споживання електроенергії для визначення трансформаційних змін компонентів споживання електричної енергії. Результати. Проаналізовано параметри споживання електроенергії на залізорудних підприємствах Криворізького регіону. Досліджено процес формування системи моделей для вирішення проблеми оптимізації вартісних характеристик споживання електроенергії. Визначено системні корпоративні характеристики систем енергоспоживання залізорудних підприємств Криворізького регіону. Сформовано інструментарій економічного та математичного моделювання з метою аналізу та оцінювання показників вартості систем енергоспоживання. Гармонізація методів моделювання дозволила визначити вартісні характеристики та довести раціональність застосування моделей, розрахувати ефективний розподіл ресурсів, надати рекомендації відповідно до раціональних управлінських рішень щодо формування споживання електроенергії. Наукова новизна. Запропоновано інноваційний комплексний підхід до формування корпоративних моделей систем електропостачання, що полягає у використанні індексної методології в поєднанні з методами найменших модулів. Це дозволяє оптимізувати витрати електроенергії і забезпечити раціональне управління електроспоживанням. Практична значимість. Формування корпоративних моделей є основою для подальшого дослідження і побудови багатофакторних регресійних моделей та моделей для прогнозування споживання електроенергії. Практичний досвід використання запропонованої методології довели свою ефективність при прийнятті управлінських рішень з метою забезпечення оптимальних витратних характеристик споживання електроенергії.Цель. Изучение корпоративных характеристик систем электроснабжения, формирования прикладного научно-методического обеспечения и инструментария экономико-математического моделирования для анализа и стоимостных характеристик электропотребления. Методика. Исследование основано на использовании законов, закономерностей и категорического аппарата. В процессе научных исследований были использованы общие научные методы исследования (сравнение, обобщение, метод аналогий, структурный анализ и синтез), методы логико-теоретического анализа, специальные экономико-математические методы. Нормативной базой для исследования были официальные документы, отражающие и регулирующие определенные аспекты системы потребления энергии при сборе, обработке и представлении информации. Как информационные источники, использованные материалы научных конференций и семинаров, ресурсы глобальной информационной системы Интернета, информация Государственной службы статистики Украины. Теоретические основы исследования, обслуживаемых научными работами отечественных и зарубежных исследователей в области энергообеспечения в переходной экономике. Комплекс регрессионных и индексных методов и моделей анализа потребления электроэнергии для определения трансформационных изменений компонентов потребления электрической энергии. Результаты. Проанализированы параметры потребления электроэнергии на железорудных предприятиях Криворожского региона. Исследован процесс формирования системы моделей для решения проблемы оптимизации стоимостных характеристик потребления электроэнергии. Определены корпоративные характеристики систем энергопотребления железорудных предприятий Криворожского региона. Сформирован инструментарий моделирования с целью анализа и оценки показателей стоимости систем энергопотребления. Гармонизация методов моделирования позволила определить стоимостные характеристики и доказать рациональность применения моделей, рассчитать эффективное распределение ресурсов, дать рекомендации в соответствии с рациональными управленческими решениями по формированию потребления электроэнергии. Научная новизна. Предложен инновационный комплексный подход к формированию корпоративных моделей систем электроснабжения заключающийся в использовании методологии индексов в сочетании с методами наименьших модулей, что позволяет оптимизировать затраты электроэнергии и осуществить рациональное управление электропотреблением. Практическая значимость. Формирование корпоративных моделей является основой для дальнейшего исследования и построения многофакторных регрессионных моделей и моделей для прогнозирования потребления электроэнергии. Практический опыт использования предложенной методологии доказали свою эффективность при принятии управленческих решений с целью обеспечения оптимальных расходных характеристик потребления электроэнергии.The author expresses particular gratitude to T.M. Beridze, Candidate of Engineering Sciences, Associate Professor, for consulting assistance in formulation of this scientific article

    Developing methods and algorithms for a decision-making intellectual support in personnel management systems

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    This paper proposes methods and algorithms for an intellectual support of decision-making management based on neuro-fuzzy networks. The algorithm for automatic generation of knowledge base is developed in accordance with the criteria of completeness and minimality. Reducing space is made on the basis of expert estimates

    Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

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    Tesis por compendio[ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US29,980/nodo.Enuˊltimolugar,unmodelocompuestopor8criteriosy35subcriteriosfuedisen~adoparaevaluarelrendimientogeneraldelosdepartamentosdeUrgencias.Losresultadosdelmodeloevidenciaronelrolcrıˊticodelainfraestructura(Pesoglobal=21,5igarantirladistribucioˊequitativadelsbeneficisfinancersderivatsdelacol´laboracioˊ.Finalment,esvaconstruirunmodelmulticriteriquevapermetreavaluarelrendimentdelsdepartamentsdUrgeˋnciaivaimpulsarlacreacioˊdestrateˋgiesdemillorafocalitzadesenincrementarlasevarespostadavantlademandacanviant,elscrıˊticsdesatisfaccioˊilescondicionsdoperacioˊestipuladesenlallei.ElsresultatsdaquestaaplicacioˊvanevidenciarqueelspacientsqueaccedeixenalaXarxatendeixenaesperardemitjana201,6minambdesviacioˊdestaˋndardde81,6minabansdeseratesosperurgeˋncia.Daltrabanda,dacordamblarevisioˊdeliteratura,lacombinacioˊdeteˋcniquesdinvestigacioˊdoperacions,enginyeriadelaqualitatianalıˊticadedadeseˊsaˋmpliamentrecomanadaperabordaraquestproblema.Enaquestsentit,unametodologiabasadaenmodelscol´lateralsdepagament,simulacioˊdeprocessosillegeixin6sigmavaserproposadaivalidadagenerantunredissenydeXarxalaoportunitatdatencioˊmitjanapodriadisminuirentre6,71mini9,08minambbeneficisfinancersmitjanadUS29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5%) en el rendimiento de los departamentos de Urgencia y la naturaleza interactiva de la Seguridad del Paciente (C + R = 12,771).[CA] L'oportunitat en l'atenció és un dels crítics de major rellevància en la satisfacció dels pacients que acudeixen als serveis d'Urgències. Per tal motiu, les institucions prestadores de servei i les organitzacions governamentals han de propendir conjuntament per una atenció cada vegada més oportuna a costos operacionals raonables. En el cas de la Xarxa Pública en Serveis d'Urgències de Barrannquilla, composta per 8 punts d'atenció i 2 hospitals, la tendència marca un continu creixement de l'oportunitat en l'atenció amb una taxa de 3,08 minuts / semestre i una probabilitat de l' 93,13% d'atendre els pacients després d'una espera major a 30 minuts. L'anterior es constitueix en un símptoma inequívoc de la incapacitat de la Xarxa per satisfer els estàndards d'oportunitat establerts pel Ministeri de Salut, fet que podria desencadenar el desenvolupament de simptomatologies de major complexitat, l'increment de la probabilitat de mortalitat, el requeriment de serveis clínics més complexos (hospitalització i cures intensives) i l'augment dels costos associats a el servei. En conseqüència, la present tesi doctoral presenta el redisseny de la Xarxa Pública en Serveis d'Urgències anteriorment esmentada a fi d'atorgar a la població diana un servei eficient i altament oportú on tant les institucions prestadores de el servei com els organismes governamentals convergeixin efectivament. Per a això, va ser necessària l'execució de 4 grans fases a través de les quals es va consolidar una proposta orientada a el desenvolupament efectiu i sostenible de les operacions de la Xarxa. Primer, es va caracteritzar la Xarxa Pública de Serveis d'Urgències en Salut considerant el seu comportament actual en termes de demanda i oportunitat de l'atenció. Després, a través d'una revisió sistemàtica de la literatura, es van identificar els enfocaments metodològics que s'han implementat per a la millora de l'oportunitat i altres indicadors de rendiment associats a el servei d'Urgències. Posteriorment, es va dissenyar una metodologia per a la creació de xarxes d'Urgències eficients i sostenibles la qual després es va validar a la Xarxa Pública sud-americana a fi de disminuir l'oportunitat d'atenció mitjana a Urgències i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771).[EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215TESISCompendi

    A fuzzy-based evaluation of financial risks in build-own-operate-transfer water supply projects

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    The build–own–operate–transfer (BOOT) scheme is widely used for the provision of new bulk water supply. However, this scheme is complex and carries significant financial risks because of the characteristics of the water sector and the involvement of public-private stakeholders with new and extended responsibilities, large private capital, and long contract duration. Drawing on the Nungua Seawater Desalination Plant (NSDP) in Ghana, this study seeks to identify and assess the critical financial risks associated with BOOT water supply projects and evaluate the financial risk level of the NSDP project. The risks and their relative criticality on the NSDP project are investigated by using a questionnaire survey method. The questionnaire was formulated with a set of 18 risks derived from extant literature and project documentation. Perceived critical financial risks affecting the NSDP project were assessed by a team of experts who had direct involvement in the project. A fuzzy synthetic evaluation suggests that the project is financially risky and that all the risks are critical to the project. Bankruptcy of consortium members, unfavorable economy of the host country, uncertainty in tariff adjustment of water products, rate of return restrictions, and availability problem of private capital are the five most highly-ranked risks. The fuzzy technique is used to represent and model experiential knowledge of the survey participants and to address the fuzziness of their expert judgments. The study’s results facilitate prioritization of risks and a comprehensive risk management program during the lifecycle of the case project and future projects. The fuzzy technique is suitable for early phases of BOOT projects to prioritize the risks that require a detailed analysis and to predict the risk level of a project
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