Impact of aleatoric, stochastic and epistemic uncertainties on project cost contingency reserves

Producción CientíficaIn construction projects, contingency reserves have traditionally been estimated based on a percentage of the total project cost, which is arbitrary and, thus, unreliable in practical cases. Monte Carlo simulation provides a more reliable estimation. However, works on this topic have focused exclusively on the effects of aleatoric uncertainty, but ignored the impacts of other uncertainty types. In this paper, we present a method to quantitatively determine project cost contingency reserves based on Monte Carlo Simulation that considers the impact of not only aleatoric uncertainty, but also of the effects of other uncertainty kinds (stochastic, epistemic) on the total project cost. The proposed method has been validated with a real-case construction project in Spain. The obtained results demonstrate that the approach will be helpful for construction Project Managers because the obtained cost contingency reserves are consistent with the actual uncertainty type that affects the risks identified in their projects.Junta de Castilla y Leon (grant VA180P20

On the project risk baseline: Integrating aleatory uncertainty into project scheduling

Producción CientíficaObtaining a viable schedule baseline that meets all project constraints is one of the main issues for project managers. The literature on this topic focuses mainly on methods to obtain schedules that meet resource restrictions and, more recently, financial limitations. The methods provide different viable schedules for the same project, and the solutions with the shortest duration are considered the best-known schedule for that project. However, no tools currently select which schedule best performs in project risk terms. To bridge this gap, this paper aims to propose a method for selecting the project schedule with the highest probability of meeting the deadline of several alternative schedules with the same duration. To do so, we propose integrating aleatory uncertainty into project scheduling by quantifying the risk of several execution alternatives for the same project. The proposed method, tested with a well-known repository for schedule benchmarking, can be applied to any project type to help managers to select the project schedules from several alternatives with the same duration, but the lowest risk

Reusing newspaper kiosks for last-mile delivery in urban areas

Producción CientíficaThe current increase in e-commerce is generating growing problems in urban areas in terms of both traffic flow (increasing traffic, no parking spaces) and environmental issues (noise, atmospheric pollution, etc.). In parallel, an iconic element of historic districts is disappearing: more and more newspaper kiosks are closing their business as their work dwindles. In this scenario, the objective of this paper is to propose a model for last-mile parcel delivery that exploits the current available newspaper kiosk network by using them as parcel lockers. To demonstrate the benefits of this proposal, we map the kiosk network of the city of Valladolid (Spain), and compare the environmental impact of a traditional (door-to-door) delivery and the proposed model which reuses old kiosks as parcel lockers. The necessary steps to carry out simulations are described in detail so that experiments can be replicated in other cities that face the same issues.Ministerio de Economía, Industria y Competitividad - (Project DPI2016-78902-P)Ayuntamiento de Valladolid - (Project AI-19/2018

New Business Models for Sustainable Spare Parts Logistics: A Case Study

Producción CientíficaAdditive manufacturing of spare parts significantly impacts industrial, social, and environmental aspects. However, a literature review shows that: (i) academic papers on the adoption of additive manufacturing have focused mainly on large companies; (ii) the methods required by SMEs to adopt new technologies differ from those employed by large companies; and (iii) recent studies suggest that a suitable way to help small- and medium-sized enterprises (SMEs) to adopt new additive manufacturing technologies from the academic world is by presenting case studies in which SMEs are involved. Given the increasing number of global SMEs (i.e., SMEs that manufacture locally and sell globally), we claim that these companies need to be assisted in adopting spare-parts additive manufacturing for the sake of resource and environmental sustainability. To bridge this gap, the purpose of this article is to present a case study approach that shows how a digital supply chain for spare parts has the potential to bring about changes in business models with significant benefits for both global SMEs (more effective logistic management), customers (response time), and the environment (reduced energy, emissions, raw materials, and waste).Junta de Castilla y León - Fondo Europeo de Desarrollo Regional (grant VA049P17

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified