Localização da physical interntet hub na Península Ibérica

Este relatório tem como principal objetivo realizar um estudo das possíveis localizações dos PI-hubs na Península Ibéria de modo a facilitar o transporte de mercadorias nesta área geográfica. Esta análise é feita com base numa abordagem de otimização de vários objetivos (multiobjectivo), utilizando a filosofia da physical internet. Através da physical internet é possível fazer o transporte das mercadorias eficazmente e mais rapidamente, este conceito tem como base o tema da localização de nós hubs, que muito resumidamente, são instalações preparadas para facilitar a movimentação de grandes quantidades de mercadorias, para distribuir por vários destinos, proveniente de várias origens, tendo uma maior ou menor capacidade para armazenar essas mesmas mercadorias. Isto leva ao grande problema da atualidade que é tentar fazer com que o transporte de mercadorias seja mais eficaz e mais eficiente. Ao longo deste relatório será analisado as possíveis localizações dos nós hubs numa rede de distribuição somente da Península Ibérica. A localização dos nós hubs, é influenciada pela componente de cariz social de cada motorista, nomeadamente, na redução do número de dias que o mesmo tem de dormir fora de casa, além da redução do custo globais de transporte. No final deste relatório e após várias análises computacionais, chega-se à conclusão de que as cidades da rede que são consideradas de nós hubs ficam situadas mais ou menos a nível visual no centro desta mesma rede, e que à medida que se dá mais importância à redução do número de noites dormidas fora pelos motoristas a função objetivo tende a ser menor.This report has the main goal to carry out a study of the possible locations of PI-hubs in the Iberian Peninsula, in order to simplify the transportation of goods in this geographic location. Thought this analysis it`s optimized an approach of different objectives (multiobjective), using the philosophy of physical internet. With physical internet is possible to transport goods efficiently and more quickly, this concept is based on the theme of the location of the nós hubs, which are very briefly, installations prepared to facilitate the movement of big amounts of goods to allocate to different destinations, prevenient from a variety of origins and by that having a greater or lesser capacity to store those same goods. This take us to a big actual problem of assembly the transportation more efficiently. Throughout this report it will be analysed the possible locations of nós hubs into a distribution network in the Iberian Peninsula. The location of the nós hubs is influenced by the social aspect of each driver, specifically, the reduction of the number of days that he must sleep outside is home and in addition the reduction of global costs of transport.+a In the end of this report and through different computer analysis, its make to the conclusion that the cities in the network considerate by nós hubs are situated more or less at a visual point in the centre of the network, as more emphasis is placed into reducing the number of outside home nights by the driver, the objective function tends to be minor

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit