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Wacker apresenta um modelo para manufatura, que examina um produto por vez. Vollmann et al. Bechte , Wiendahl e Breithaupt , Breithaupt et al. Este artigo trata da segunda grandeza. Arranjos podem ser classificados em estruturas V, A, T e X.
O sistema estudado se centraliza na montadora. Na Figura 5 , surgem as retas. Este adiantamento, fora do escopo do estudo, criou mais variabilidade no sistema.
Os modelos testados foram: exponencial, gamma, Weibull, normal e lognormal.
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Despesas Operacionais-todo o dinheiro que o sistema gasta transformando Investimento em Ganho. Este fator indica o aporte de cada produto i, no Ganho total global da empresa; GTe ganho total global da empresa. Informa a taxa pela qual o Investimento da empresa esta sendo remunerado.
Segundo Oenning et al. Antunes et al. Ao analisar exclusivamente as perdas, segundo Antunes et al. O STP identifica sete tipos de perdas a seguir apresentadas. Enquanto o sistema processa um determinado valor de itens do lote por unidade de tempo, o restante dos itens permanece em estoque. Para Antunes et al.
Porto Alegre: Bookman, Estudo de movimentos e de tempos: Projeto e medida do trabalho. The Effects of Just-in-Time systems on financial accounting metrics. Improving the product mix heuristic in the Theory of Constraints.
International Journal of Production Research, v. Como elaborar projetos de pesquisa. The Goal: excellence in manufacturing. New York: North River Press, We found that women are unclear about the referral system and are sometimes uncertain where to go.
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Nearly all women went straight to a health facility, but only a third went directly to the public sector hospital, where they were ultimately treated. The rest had various care-seeking combinations involving lower health system levels that were incapable of treating complications or treatment outside the health system. Some went to facilities capable of managing complications at some moments, but not others.
Ultrasound is central to managing abortion in Brazil 9 , shortages of ultrasound professionals in the public health network at times limit care-capacity In such facilities, women may be asked to return later or be directed elsewhere. Occasionally, women went to high-risk reference hospitals, but were referred downward to less busy facilities.
Such prolonged and complex seeking-care processes have been reported for stigmatized diseases such as HIV or tuberculosis 25 , 26 and are potentially aggravated by the illegality and stigma surrounding abortion.
Each transfer, thus, added around 1. This heterogeneity reflects differences in local context, and methods such as case severity definitions, age groups studied and whether spontaneous abortions were included. However, perhaps the main difference is that the public health system is free for all Brazilians, and most abortions in Brazil are induced with misoprostol, which can be effective and safe even when used illegally 9 , 12 , 14 , resulting in shorter delays We found women who arrived at the ultimate hospital in more compromised clinical conditions were slightly more likely to have delayed care-seeking from first symptoms.
We cannot be certain when the signs of more severe complications started to emerge, but we had anticipated that women with more severe complications would have sought care earlier. The 3-hour difference seen may have been due to measurement error, or these women may have been either less likely to act or were less able to act swiftly.
In Kenya 20 , the longer women waited to seek care, the more severe their complications on admission. We also found the longer a woman delayed before seeking care, the more severe was her clinical condition when presenting to the ultimate hospital.
In contrast, those women with severe complications on arrival spent less time than the others in being admitted to a hospital, and a slightly lower percentage of them had visited a multiple hospital before being admitted.
Over a quarter of women reported difficulties in being admitted, suggesting a lack of beds and overburdened health facilities may be an important barrier, despite almost universal access to childbirth care Pregnant women were attended more quickly than women with abortion complications, a finding also reported in Ghana 8 , and Gabon 4.
Obstetrician-gynecologists in Salvador 34 , expressed their views that maternity-hospital beds should be reserved for pregnant women, although they also affirmed they would never refuse to attend women with post-abortion complications. Many thought women should not have the right to choose induced-abortion based on their needs. Women in our study faced difficulties obtaining post-abortion care, and the time taken to access an appropriate facility had consequences for the severity of complications.
The stigma surrounding abortion delayed women's care-seeking and gave them less priority in health facilities. Women also faced difficulties stemming from their less favorable life conditions and had unmet need for emergency obstetric care.
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Further research on delays is recommended in settings with restrictive laws or access to abortion to clarify the impact of abortion stigma on women's decision-making process and providers' treatment behavior.
Recommendations include continuous surveillance on death and severe abortion complications, and changes in the process of training health professionals to recognize abortion not only as a public health problem, but as issue to the field of women's sexual and reproductive health.
Furthermore, review of the Brazilian restrictive Law would contribute for reducing delays and allowing timely access to abortion-related complications. Legalization of abortion in other settings has reduced abortion-related complications and probably the time taken by women to seek care.
This is an open-access article distributed under the terms of the Creative Commons Attribution License. Campbell http: Introduction As the illegality of abortion results in unsafe procedures that pose a risk to women's health, abortion complications are common and important contributors to the global disease burden 1 , 2 , 3.
Objectives The aim of this paper is to: Box 1 Criteria used to assess the clinical condition of abortion admissions. Table 1 Place women first sought care, type of places and hospitals visited. Figure 1 Place women first sought care and places visited before arrive at the ultimate hospital. Table 2 Clinical condition on arrival at the ultimate hospital, overall and by numbers of hospitals visited. Table 3 Time from symptoms to first care seeking decision 1 st delay and from symptoms to ultimate care seeking destination 1 st and 2 nd delay.
Median interquartile range in hours. Ahman E, Shah IH. New estimates and trends regarding unsafe abortion mortality.
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Int J Gynaecol Obstet ; Singh S. Hospital admissions resulting from unsafe abortion: Lancet ; Quantifying the global burden of morbidity due to unsafe abortion: Int J Gynaecol Obstet ; Suppl 2: Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon.
Reprod Health Matters ; Journal of Operations Management, n. A revolution in manufacturing: The smed system. The Effects of Just-in-Time systems on financial accounting metrics. Automatic production control applying control theory, International Journal of Production Economics, n.
We sampled all women hospitalized for abortion-complications in the public sector and had an excellent response rate
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