Diversos serviços de saúde no Brasil vem apresentado episódios de superlotação, em um contexto onde os recursos são limitados. A redução do tempo de permanência em internações hospitalares tem como consequência direta a disponibilização de mais leitos-dia. O gerenciamento e melhoria do fluxo de pacientes ao longo das internações hospitalares é importante, sendo que o uso eficiente dos leitos pode acontecer devido a uma série de fatores. Estudos demonstram que equipes multidisciplinares podem realizar uma assistência de qualidade, reduzindo custos e o tempo em que os pacientes permanecem internados, sem impacto na reinternação ou mortalidade. Também há trabalhos que apontam a eficácia de unidades dedicadas ao atendimento de doenças específicas. A admissão de pacientes dentro de critérios bem definidos aumenta o giro de leitos. Com o objetivo de analisar se a equipe multidisciplinar Medicina Interna – Emergência (MIE) poderia contribuir para a redução do tempo de permanência hospitalar dos pacientes portadores de doenças prevalentes, sem alterar os indicadores de reinternação e mortalidade, o presente estudo experimental, controlado, não-randomizado, comparou o período pré e pós-intervenção, ou seja, a criação de uma Unidade de Curta Permanência no Serviço de Medicina Interna, do Hospital de Clínicas de Porto Alegre (HCPA). Foram analisadas internações ocorridas através da Emergência do HCPA, de pacientes com 14 anos ou mais, com as doenças prevalentes classificadas conforme grupos do CID-10 (J09-J018; J40-J47; N30-N39; I30-I52; I60-I69; B20-B24; C15-C26; A30-A49; e E10-E14), no período compreendido entre 01 de dezembro de 2008 a 30 de novembro de 2010 (n = 11040). Os resultados do estudo demonstram que após a criação da equipe E-MEI e a sua unidade de curta permanência, houve uma redução do tempo de permanência dos pacientes internados pelas causas selecionadas (antes: 10,89 ± 13,17 dias, após: 9,47 ± 11,24 dias, p = 0,006), e uma diminuição mais acentuada nas internações do Serviço de Medicina Interna [antes (n = 680): 14,33 ± 14,57 dias, após (n = 1243): 9,77 ± 10,62 dias, p = 0,000]. Não ocorreu alteração na taxa de mortalidade de todos os pacientes admitidos para as causas selecionadas [antes (n = 3800): 11,3%, após (n = 3958): 11,8% p = 0,123]. Também não houve alteração na taxa de reinternação de 7 dias na amostra estudada [antes (n = 3369): 7,2%, depois de (n = 3491): 6,7%, p = 0,407]. / Several health services in Brazil has shown episodes of overcrowding, in a context where resources are limited. Reducing the length of stay in hospital has as a direct consequence the provision of more beds-day. Managing and improving the flow of patients throughout the hospital is important, and the efficient use of beds can happen due to a number of factors. Studies have shown that multidisciplinary teams can perform quality care, reducing costs and the time patients remain hospitalized, with no impact on mortality or rehospitalization. There are also studies that show the effectiveness of units dedicated to the treatment of specific diseases. The admission of patients into well-defined criteria increases the turnover of beds. With the objective of analyzing the multidisciplinary team Internal Medicine – Emergency, could help to reduce the length of hospital stay of patients with diseases prevalent, without changing the indicators of rehospitalization and mortality, the present study experimental, controlled, not -randomized study compared the pre-and post-intervention, ie the creation of a Short Stay Unit in the Department of Internal Medicine, Hospital de Clinicas de Porto Alegre (HCPA). We analyzed hospital admissions through the Emergency HCPA, for patients aged 14 years or older with prevalent disease groups classified according to the ICD-10 (J09-J018, J40-J47, N30-N39, I30-I52, I60-I69; B20-B24, C15-C26, A30-A49, and E10-E14), during the period from December 1, 2008 to November 30, 2010 (n = 11,040). The study results show that after the creation of the multidisciplinary team, and its Short Stay Unit, there was a reduction in the length of stay of inpatients by selected causes (before: 10.89 ± 13.17 days after: 9 47 ± 11.24 days, p = 0.006) and a greater reduction in hospitalizations Service of Internal Medicine [before (n = 680): 14.33 ± 14.57 days after (n = 1243): 9, 77 ± 10.62 days, p = 0.000]. No change in the mortality rate of all patients admitted to selected causes [before (n = 3800): 11.3% after (n = 3958): 11.8% p = 0.123]. There was also no change in the rate of readmission than 7 days in our sample [before (n = 3369): 7.2% after (n = 3491): 6.7%, p = 0.407].

Diversos serviços de saúde no Brasil vem apresentado episódios de superlotação, em um contexto onde os recursos são limitados. A redução do tempo de permanência em internações hospitalares tem como consequência direta a disponibilização de mais leitos-dia. O gerenciamento e melhoria do fluxo de pacientes ao longo das internações hospitalares é importante, sendo que o uso eficiente dos leitos pode acontecer devido a uma série de fatores. Estudos demonstram que equipes multidisciplinares podem realizar uma assistência de qualidade, reduzindo custos e o tempo em que os pacientes permanecem internados, sem impacto na reinternação ou mortalidade. Também há trabalhos que apontam a eficácia de unidades dedicadas ao atendimento de doenças específicas. A admissão de pacientes dentro de critérios bem definidos aumenta o giro de leitos. Com o objetivo de analisar se a equipe multidisciplinar Medicina Interna – Emergência (MIE) poderia contribuir para a redução do tempo de permanência hospitalar dos pacientes portadores de doenças prevalentes, sem alterar os indicadores de reinternação e mortalidade, o presente estudo experimental, controlado, não-randomizado, comparou o período pré e pós-intervenção, ou seja, a criação de uma Unidade de Curta Permanência no Serviço de Medicina Interna, do Hospital de Clínicas de Porto Alegre (HCPA). Foram analisadas internações ocorridas através da Emergência do HCPA, de pacientes com 14 anos ou mais, com as doenças prevalentes classificadas conforme grupos do CID-10 (J09-J018; J40-J47; N30-N39; I30-I52; I60-I69; B20-B24; C15-C26; A30-A49; e E10-E14), no período compreendido entre 01 de dezembro de 2008 a 30 de novembro de 2010 (n = 11040). Os resultados do estudo demonstram que após a criação da equipe E-MEI e a sua unidade de curta permanência, houve uma redução do tempo de permanência dos pacientes internados pelas causas selecionadas (antes: 10,89 ± 13,17 dias, após: 9,47 ± 11,24 dias, p = 0,006), e uma diminuição mais acentuada nas internações do Serviço de Medicina Interna [antes (n = 680): 14,33 ± 14,57 dias, após (n = 1243): 9,77 ± 10,62 dias, p = 0,000]. Não ocorreu alteração na taxa de mortalidade de todos os pacientes admitidos para as causas selecionadas [antes (n = 3800): 11,3%, após (n = 3958): 11,8% p = 0,123]. Também não houve alteração na taxa de reinternação de 7 dias na amostra estudada [antes (n = 3369): 7,2%, depois de (n = 3491): 6,7%, p = 0,407]. / Several health services in Brazil has shown episodes of overcrowding, in a context where resources are limited. Reducing the length of stay in hospital has as a direct consequence the provision of more beds-day. Managing and improving the flow of patients throughout the hospital is important, and the efficient use of beds can happen due to a number of factors. Studies have shown that multidisciplinary teams can perform quality care, reducing costs and the time patients remain hospitalized, with no impact on mortality or rehospitalization. There are also studies that show the effectiveness of units dedicated to the treatment of specific diseases. The admission of patients into well-defined criteria increases the turnover of beds. With the objective of analyzing the multidisciplinary team Internal Medicine – Emergency, could help to reduce the length of hospital stay of patients with diseases prevalent, without changing the indicators of rehospitalization and mortality, the present study experimental, controlled, not -randomized study compared the pre-and post-intervention, ie the creation of a Short Stay Unit in the Department of Internal Medicine, Hospital de Clinicas de Porto Alegre (HCPA). We analyzed hospital admissions through the Emergency HCPA, for patients aged 14 years or older with prevalent disease groups classified according to the ICD-10 (J09-J018, J40-J47, N30-N39, I30-I52, I60-I69; B20-B24, C15-C26, A30-A49, and E10-E14), during the period from December 1, 2008 to November 30, 2010 (n = 11,040). The study results show that after the creation of the multidisciplinary team, and its Short Stay Unit, there was a reduction in the length of stay of inpatients by selected causes (before: 10.89 ± 13.17 days after: 9 47 ± 11.24 days, p = 0.006) and a greater reduction in hospitalizations Service of Internal Medicine [before (n = 680): 14.33 ± 14.57 days after (n = 1243): 9, 77 ± 10.62 days, p = 0.000]. No change in the mortality rate of all patients admitted to selected causes [before (n = 3800): 11.3% after (n = 3958): 11.8% p = 0.123]. There was also no change in the rate of readmission than 7 days in our sample [before (n = 3369): 7.2% after (n = 3491): 6.7%, p = 0.407].

The thesis presents a business plan of establishment of R&D centre as a development project following from the strategy of a small enterprise. The project aspires to gain subsidy funding from EU structural funds and the design of the business plan thus comply with the subsidy programme. The business plan includes an analysis of financial feasibility of the project consisting of project cash flow plan, financial plan of the company and evaluation of the efectiveness of investment.

This diploma thesis deals with the proposal of improving company competition standing with the use of optimization and reorganization of production in ACO Industries k.s. This thesis also deals with supporting tools for reorganization and optimization of production, such as for example “slim production”. The main contribution of this work is reduction of time and money needed for production in order for the company to effectively increase the production rate, aiming at doubling the production and turnover in 2020.

With over 800,000 dams occurring globally and the construction of thousands more being proposed, successful restoration of regulated rivers will depend on the creation of broadly applicable frameworks that provide management solutions by generalizing patterns in habitat and ecology. Based on the prevailing scientific literature, restoring natural stream flows in disturbed rivers is dependent upon developing quantitative, transferable stream flow-ecology relationships. The purpose of my dissertation was to apply a framework to regulated and unregulated streams within an eight-state region of the southeastern US to test its ability to generalize patterns in natural and altered stream flow and develop flow-ecology relationships. I created a simplified, 5-step version of the Ecological Limits of Hydrologic Alteration (ELOHA) framework (Poff et al. 2010). I carried out each of the steps in sequential order for unregulated and dam-regulated streams found in my region. The steps of my restoration framework are as follows: 1. Develop a natural flow classification of unregulated streams 2. Develop a tool that uses landscape characteristics to predict flow class membership 3. Use the predictive tool or pre-disturbance hydrologic information to classify regulated rivers to natural flow classes 4. Based on class membership, generalize patterns in hydrologic alteration 5. Relate ecological patterns to patterns in hydrologic alteration in relation tomorphology, temperature, and landscape disturbance Altogether, the results of steps 1-4 suggest that patterns in natural flow dynamics and hydrologic alterations can successfully be placed within a framework and generalized to provide the basis and context for environmental flow management; however, results of step 5 suggest that patterns in flow alteration were poorly related to fish assemblages relative to channel morphology, habitat fragmentation, temperature, and substrate. Thus, the development of patterns in hydrologic alteration using the existing frameworks (including mine) may not be ecologically-relevant. My results suggest that current regulated river restoration should not be dependent upon the development of flow-ecology relationships alone, but the interaction between flow, morphology, and temperature within a landscape disturbance context. These relationships should be incorporated within a hierarchical framework to guide restoration efforts in regulated rivers in the future. / Ph. D.

Le « transshipment (latéral) d’urgence » au sein des réseaux de distribution consiste à organiser les transferts de stocks entre les détaillants pour faire face aux situations de rupture. Sa mise en œuvre amène à arrêter une stratégie appropriée et à harmoniser ses paramètres avec la politique et paramètres de gestion des stocks, dans l’objectif de garantir un taux de satisfaction des demandes clients au moindre coût. Le présent travail se situe dans ce contexte et s’est focalisé sur l’analyse des apports de la mise en œuvre du transshipment d’urgence dans un système de pilotage de flux tirés par des demandes clients probabilistes, avec des politiques locales de gestion de stock du type (R, s, S). Notre étude a porté sur trois structures différentes de réseau : système de stock à deux échelons et à deux détaillants, avec coût unitaire de transshipment ; système de stock à deux échelons et à détaillants multiples, avec coût fixe de transshipment ; système de stock multi échelons à deux détaillants, avec coût fixe de transshipment. Pour chacune de ces structures, nous avons analysé le comportement du système pour différentes combinaisons des paramètres d’entrée (délais d’approvisionnement, écarts types de la demande et nombre des détaillants) et des paramètres de coût (commande, possession, rupture et transshipment). Nous avons visé à déterminer, sur un horizon fini de périodes, les seuils de stocks (s et S chez les détaillants et chez le centre de distribution) qui minimisent le coût total du système tout en garantissant un taux de service désiré. Dans ce cadre, quatre politiques de transshipment (« tout ou rien », « complete pooling standard », « complete pooling plafonné » et « complete pooling conditionné ») ont été explorées. L’étude est d’abord ébauchée selon une approche analytique puis approfondie par l’élaboration et l’expérimentation de modèles dont la résolution est basée sur la simulation-optimisation / The lateral emergency transshipment in distribution systems consists in organizing inventory transferts between retailers to face shortage situations. Its implementation leads to adopt an appropriate transhipment policy and harmonize its parameters with inventory policy parameters and inventory control policy. The objective is to ensure a desired service level at minimum cost. Thie work is situated in this context and focused on the analysis of emergency transhipment benefits in distribution systems faced to random customers demand. Each retailer used an (R,s,S) inventory control policy. Our study is related to three different distribution systems structure : two echelons two retailers inventory system with unit transhipment cost; two echelons multi retailers inventory system with fixed transhipment cost; multi echelons multi retailers inventory system with fixe transhipment cost. For each of these structures we analyzed the sensibility of system behaviour to input parameters. Our objective is to determine on a finite horizon the inventory parameters (s, S) that minimize total cost under service level condition.

Today, the information (signal timings, detector extension, phase sequence, etc.) to install traffic lights on the street are obtained from traffic software simulations platforms, meaning that information from simulation is not tested on the field (intersection where it will be installed) before the installation. Many installed controllers on the street use time of day (TOD) patterns due to cheaper cost than adaptive traffic control systems, but that is not the best solution for traffic volume changes that can occur during the day or even a month. To improve traffic signal operation most of the traffic signal controllers in the same corridor or zone operate in coordination mode. Furthermore, phases need to be in coordination to achieve “green wave”. Green wave is term used when in corridor traffic lights allow continues flow of traffic through intersections that are coordinated. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Most U.S. urban traffic signal systems deploy multiple signal timing plans to account for daily variability of traffic demand (i.e. morning peak, midday, afternoon peak, off peak and night). Groups of signals (belonging to the one zone or section) along an urban arterial, usually operate in a coordinated manner. This essentially means that timing plans change at the same time for all the signals in the group, so as to facilitate vehicle progression of through a series of signals. Good traffic signal timing practices assume a certain level of monitoring and maintenance in order to guarantee that they are efficient in servicing current traffic conditions. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection

Le but de ce travail est l'étude du problème de gestion de flot de conteneurs et de véhicules dans un réseau multimodal. Nous proposons une formulation du problème sous forme d'un modèle mathématique réaliste qui prend en considération les différents aspects liés au transport et au stockage des conteneurs et dont l'objectif est de minimiser le coût global de transport. Pour la résolution des grandes instances une approche de résolution bi-niveaux est proposée. Dans un premier niveau nous construisons un modèle agrégé plus facile à résoudre pour en extraire les décisions liées aux déplacements des trains et des barges ainsi qu'une borne duale de notre problème de base. Ces informations sont utilisées dans un deuxième niveau pour avoir des solutions de bonne qualité de notre problème par rapport aux solutions données par CPLEX en résolvant directement le modèle de base. Des résultats numériques sur des instances générées aléatoirement sont présentés et ils prouvent l'intérêt de l'approche de résolution proposée dans cette thèse. / The aim of this work is the study of the problem of managing the flow of containers and vehicles in a multimodal network. We propose a formulation of the problem under the form of a realistic mathematical model that takes into account the different aspects related to container transport and storage and whose objective is to minimize the overall cost of transport. For large-scale resolution, a two-level resolution approach is proposed. In a first level we build an aggregated model easier to solve to extract the decisions related to the movements of trains and barges as well as a dual terminal of our basic problem. This information is used in a second level to have good quality solutions of our problem compared to the solutions given by CPLEX by directly solving the basic model. Numerical results on randomly generated instances are presented and prove the value of the proposed resolution approach.

Made available in DSpace on 2016-06-02T19:51:34Z (GMT). No. of bitstreams: 1 1660.pdf: 940693 bytes, checksum: d22e5083ad9e958c15a2bb99a5a7056e (MD5) Previous issue date: 2007-12-18 / Cash flow management is a financial problem that involves the efficient management of cash, short-term investments and short-term loans. In this study, we formulate the cash flow problem encountered in a typical agro-industrial company as a network optimization problem. Two examples using a linear programming model were studied: in the first example, the original model were used to support operational cash flow decisions, in the second example, the model were extended to a tactical planning of loan payments. The mathematic models are resolved in the solver tool that is an add-in of Microsoft Excel. Spreadsheets are of wide applicability for analytical work in business. The model has the potential of being flexible and to maximize the cash return from the final planning period in real-life situations / Neste estudo, temos como objetivo otimizar o processo de gerenciamento financeiro do fluxo de caixa num horizonte de planejamento multi-período e finito, presente em uma empresa típica do setor agroindustrial. Procuramos maximizar o conjunto de recursos monetários ao final do período estudado. Para isso, contamos com uma abordagem simultânea dos parâmetros envolvidos no procedimento, possibilitada pelos recursos oferecidos pela Pesquisa Operacional. Como método de otimização para auxiliar as decisões do processo de fluxo de caixa, utilizamos a programação matemática linear. Avaliamos a aplicação de um modelo de gerenciamento do fluxo de caixa, baseado na teoria de fluxo em redes, que contempla os propósitos de ganhos de fluxo de dinheiro e considera os parâmetros mais importantes para a solução. Dois exemplos são estudados: no primeiro, aplicamos o modelo original para apoiar decisões operacionais na gestão do caixa da empresa; no segundo, adaptamos o modelo para abranger o planejamento tático de amortizações de financiamentos na gestão do caixa. Os dois exemplos são testados em situações reais e resolvidos por meio da ferramenta solver do Excel, amplamente utilizada nos ambientes de gestão financeira das empresas. A flexibilidade do modelo de otimização em atender mais de um tipo de situação e a capacidade de gerar soluções melhores que as praticadas na empresa, no período estudado, são evidenciadas por meio de exemplos numéricos