6 research outputs found

    Multiobjective metaheuristic approaches for mean-risk combinatorial optimisation with applications to capacity expansion

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    Tese de doutoramento. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 200

    Uma abordagem orientada por objectos para meta-heurísticas multiobjectivo

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    Nesta dissertação convergem algumas linhas de investigação na área das meta-heurísticas que, recentemente, têm vindo a ser objecto de particular atenção: a flexibilização, ou seja, a introdução de mecanismos de modificação de componentes e estratégias elementares, o desenvolvimento de abordagens orientadas por objectos, e a adaptação a contextos multiobjectivo. Esta convergência justifica-se pelo facto de as abordagens orientadas por objectos promoverem naturalmente a flexibilização, e pela constatação da inexistência, até ao momento, de abordagens orientadas por objectos para a área das metaheurísticas multiobjectivo. Foi feita uma análise e sistematização do domínio e, em particular, das metaheurísticas multiobjectivo, com ênfase na perspectiva da flexibilização. Esta sistematização fundamenta a proposta de um template para pesquisa local multiobjectivo, e de um conjunto de estratégias genéricas de flexibilização

    Levantamento das possibilidades de utilização de funções inteligentes em robótica móvel autónoma : relatório de estágio PRODEP

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    Relatório de estágio PRODEP III - Medida 4.3 - Acção de Formação n.º 4Estágio realizado no INEBRelatório de estágio curricular da LEEC 1992/1993A informação relativa à instituição de acolhimento de estágio foi fornecida pelo SR

    Igreja Católica e mercados: a ambivalência entre a solidariedade e a competição

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    A Igreja Católica enfrenta, de forma ambígua, as vicissitudes dos mercados, o religioso e o econômico propriamente dito. Na década de 90, isso se tornou evidente por causa de dois movimentos opostos. De um lado, a Renovação Carismática - resposta católica à concorrência pentecostal no mercado religioso - fomentou o uso de técnicas de marketing e a projeção de padres cantores na grande mídia. De outro, a Teologia da Libertação, corrente politizada de esquerda que desencadeou, entre outras coisas, o engajamento em atividades associativas de produção econômica em um conjunto chamado economia solidária, apontado como resposta à "exclusão do mercado de trabalho" ou ao desemprego. O artigo contextualiza a relação do catolicismo com esses mercados na sociedade brasileira.<br>The Catholic Church faces in an ambiguous way the market's setbacks, the religious one and the economic itself. In the 1990s, it became obvious because of two opposites movements. On the one hand, the Charismatic Renewal, catholic reply to the Pentecostal (Pentecostal) competition at the religious market, has stimulated the use of marketing techniques and the projection of singer priests at the big media. On the other hand, the Liberation Theology, progressist tendency that has generated, among other things, the participation of militants in associatives economic enterprises, that belong to a set named solidary economy, which has been spread as a reply to "the labour market exclusion", that is, the unemployment. This article deals with the catholic relationship with those markets at the Brazilian society

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

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    © 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

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

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    © 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
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