Apoio à decisão em problemas de localização distribuição: uma proposta

Mestrado em Gestão de OperaçõesA presente dissertação apresenta uma proposta de um sistema de apoio à decisão para problemas de localização-distribuição. Esta proposta é orientada essencialmente para decisores, tendo por esse motivo grandes preocupações ao nível da interface com o utilizador. Os problemas de localização e distribuição estão cada vez mais presentes no quotidiano das empresas e instituições, exigindo cada vez mais tomadas de decisão que, se forem mal fundamentadas, podem comprometer o seu futuro. Neste trabalho é feito um enquadramento deste tipo de problemas na logística, apresentando uma evolução histórica da sua percepção e abrangência para, com base nesse estudo, apresentar uma proposta de aproximação a um sistema de apoio à decisão. Em primeiro lugar é feita uma introdução aos sistemas logísticos e às questões relacionadas com a localização e com a distribuição. De seguida, é feita a interligação entre estas duas vertentes logísticas, apresentando os motivos para o seu estudo ser realizado de uma forma integrada. Com base nessa necessidade de um estudo integrado surge então uma revisão bibliográfica aos problemas de localização-distribuição e, mais especificamente, aos problemas de localização-distribuição com capacidade. Após a introdução e classificação dos problemas de localização-distribuição com capacidade é descrita a evolução histórica dos sistemas de apoio à decisão, apresentando-se também como se processa, tipicamente, uma tomada de decisão. Uma vez realizada a fundamentação de ambos os temas é descrita a metodologia adoptada para o desenvolvimento do sistema de apoio à decisão, sendo posteriormente apresentado o sistema desenvolvido e as suas funcionalidades principais. Dentro desta descrição é também apresentada a heurística utilizada no sistema de apoio à decisão, com a respectiva formulação matemática. Finalmente, é apresentada uma ilustração do sistema de apoio à decisão, recorrendo-se a um problema da literaturaThis thesis presents a proposal of a decision support system for locationrouting problems. This proposal is essentially oriented to decision-makers, hence having a considerable concern regarding the user interface. Location and routing problems are nowadays, more than ever, present in the quotidian of companies and institutions, increasingly demanding decisions that, if not correctly supported, may compromise their future. In this study an approach to this type of problems in logistics is presented, as well as its historical evolution and scope, in order to underpin the proposal of a decision support system in this area. First an introduction to logistic systems is made and the main issues concerning location and routing are briefly addressed. Subsequently, the associations between these two areas are tackled and the interest of their integrated study is clarified. This interest leads to a bibliographic review of location-routing problems in general and, more specifically, of capacitatedlocation routing problems. The historical evolution of decision support systems is addressed, as well as how the decision process is typically made. The methodology used to develop a prototype of the decision support system as well as its main functionality are presented. Moreover, the heuristics used to solve the location-routing problem, and their mathematical formulations, are also described. Finally, the application of the decision support system to a problem in the literature is shown

Problemas de localização-distribuição de serviços semiobnóxios: aproximações e apoio à decisão

Doutoramento em Gestão IndustrialA presente tese resulta de um trabalho de investigação cujo objectivo se centrou no problema de localização-distribuição (PLD) que pretende abordar, de forma integrada, duas actividades logísticas intimamente relacionadas: a localização de equipamentos e a distribuição de produtos. O PLD, nomeadamente a sua modelação matemática, tem sido estudado na literatura, dando origem a diversas aproximações que resultam de diferentes cenários reais. Importa portanto agrupar as diferentes variantes por forma a facilitar e potenciar a sua investigação. Após fazer uma revisão e propor uma taxonomia dos modelos de localização-distribuição, este trabalho foca-se na resolução de alguns modelos considerados como mais representativos. É feita assim a análise de dois dos PLDs mais básicos (os problema capacitados com procura nos nós e nos arcos), sendo apresentadas, para ambos, propostas de resolução. Posteriormente, é abordada a localização-distribuição de serviços semiobnóxios. Este tipo de serviços, ainda que seja necessário e indispensável para o público em geral, dada a sua natureza, exerce um efeito desagradável sobre as comunidades contíguas. Assim, aos critérios tipicamente utilizados na tomada de decisão sobre a localização destes serviços (habitualmente a minimização de custo) é necessário adicionar preocupações que reflectem a manutenção da qualidade de vida das regiões que sofrem o impacto do resultado da referida decisão. A abordagem da localização-distribuição de serviços semiobnóxios requer portanto uma análise multi-objectivo. Esta análise pode ser feita com recurso a dois métodos distintos: não interactivos e interactivos. Ambos são abordados nesta tese, com novas propostas, sendo o método interactivo proposto aplicável a outros problemas de programação inteira mista multi-objectivo. Por último, é desenvolvida uma ferramenta de apoio à decisão para os problemas abordados nesta tese, sendo apresentada a metodologia adoptada e as suas principais funcionalidades. A ferramenta desenvolvida tem grandes preocupações com a interface de utilizador, visto ser direccionada para decisores que tipicamente não têm conhecimentos sobre os modelos matemáticos subjacentes a este tipo de problemas.This thesis main objective is to address the location-routing problem (LRP) which intends to tackle, using an integrated approach, two highly related logistics activities: the location of facilities and the distribution of materials. The LRP, namely its mathematical formulation, has been studied in the literature, and several approaches have emerged, corresponding to different real-world scenarios. Therefore, it is important to identify and group the different LRP variants, in order to segment current research and foster future studies. After presenting a review and a taxonomy of location-routing models, the following research focuses on solving some of its variants. Thus, a study of two of the most basic LRPs (capacitated problems with demand either on the nodes or on the arcs) is performed, and new approaches are presented. Afterwards, the location-routing of semi-obnoxious facilities is addressed. These are facilities that, although providing useful and indispensible services, given their nature, bring about an undesirable effect to adjacent communities. Consequently, to the usual objectives when considering their location (cost minimization), new ones must be added that are able to reflect concerns regarding the quality of life of the communities impacted by the outcome of these decisions. The location-routing of semi-obnoxious facilities therefore requires to be analysed using multi-objective approaches, which can be of two types: noninteractive or interactive. Both are discussed and new methods proposed in this thesis; the proposed interactive method is suitable to other multi-objective mixed integer programming problems. Finally, a newly developed decision-support tool to address the LRP is presented (being the adopted methodology discussed, and its main functionalities shown). This tool has great concerns regarding the user interface, as it is directed at decision makers who typically don’t have specific knowledge of the underlying models of this type of problems

Book of abstracts of the ICIEOM-CIO-IIIE International Conference 2015

BOOK OF ABSTRACTS OF THE ICIEOM-CIO-IIIE INTERNATIONAL CONFERENCE 2015: ENGINEERING SYSTEMS AND NETWORKS: The way ahead for industrial engineering and operations managemen

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Engineering systems and networks: the way ahead for industrial engineering and operations management: book of proceedings of the ICIEOM-CIO-IIIE, International Conference 2015

We live in an interconnected world. Every day, increasing flows of goods, information and individuals strengthen the links among companies and nations. This scenario is reinforced everyday by the rising prosperity and participation of emerging economies, and by the dissemination of digital technologies. Aiming at an effective participation in todays’ interconnected production contexts requires the development of specific knowledge that can inform managerial practice for taking full advantage of the existing opportunities. To this end academic conferences are privileged forums for the dissemination of the most recent and relevant research, theories and practices. The ICIEOM-CIO-IIIE 2015, “XXI International Conference on Industrial Engineering and Operations Management”, “9th International Conference on Industrial Engineering and Industrial Management” (XIX Congreso de Ingeniería de Organización) and “International IIE Conference 2015” called for contributions under the moto “Engineering Systems and Networks: the way ahead for industrial engineering and operations management”. An impressive number of 353 submissions were received, addressing a multidisciplinary range of industrial engineering and operations management topics, and creating a rich setting for three Conference days of vibrant debate. A total of 200 of such submissions were selected for presentation at the Conference, after a rigorous process of selection, review and feedback to authors. This book presents 160 of these articles. A selection of 40 papers was gathered for publication in the series of Lecture Notes in Management and Industrial Engineering. (...

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

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status