Design of experiment in drug development: optimal allocations in multi-arm clinical trials and design space for multi-step processes

In this thesis, we deal with the design of experiments in the drug development process, focusing on the design of clinical trials for treatment comparisons (Part I) and the design of preclinical laboratory experiments for proteins development and manufacturing (Part II). In Part I we propose a multi-purpose design methodology for sequential clinical trials. We derived optimal allocations of patients to treatments for testing the efficacy of several experimental groups by also taking into account ethical considerations. We first consider exponential responses for survival trials and we then present a unified framework for heteroscedastic experimental groups that encompasses the general ANOVA set-up. The very good performance of the suggested optimal allocations, in terms of both inferential and ethical characteristics, are illustrated analytically and through several numerical examples, also performing comparisons with other designs proposed in the literature. Part II concerns the planning of experiments for processes composed of multiple steps in the context of preclinical drug development and manufacturing. Following the Quality by Design paradigm, the objective of the multi-step design strategy is the definition of the manufacturing design space of the whole process and, as we consider the interactions among the subsequent steps, our proposal ensures the quality and the safety of the final product, by enabling more flexibility and process robustness in the manufacturing.

Navigation design and flight dynamics operations of the ArgoMoon cis-lunar CubeSat.

On November 16, 2022, the NASA’s Space Launch System (SLS) has been launched for the first time in the context of Artemis-1 mission where, together with the Orion Multi-Purpose Crew Vehicle, a set of 10 CubeSats have been delivered into a translunar trajectory. Among the small satellites deployed during Artemis-1 there is ArgoMoon, a 6U CubeSat built by the Italian company Argotec and coordinated by Italian Space Agency (ASI). The primary goal of ArgoMoon is to capture images of the Interim Cryogenic Propulsion Stage. The ArgoMoon trajectory has been designed as a highly elliptical geocentric orbit, with several encounters with the Moon. In order to successfully fly ArgoMoon along the designed cis-lunar trajectory, a ground-based navigation system has been developed exploiting the guidance techniques also used for regular deep space missions. The navigation process is subdivided into Orbit Determi- nation (OD) and a Flight Path Control (FPC), and it is designed to follow the reference trajectory, prevent impacts with the Earth and the Moon, intensively test the navigation techniques, and guarantee the spacecraft disposal at the end of the mission. The work done in this thesis has accomplished the navigation of ArgoMoon, covering all aspects of the project life, from pre-launch design and analysis to actual operations. Firstly, the designed navigation process and the pre-mission assessment of its performance will be presented. Then, the results of the ArgoMoon navigation operations performed after the launch in November 2022 will be described in detail by discussing the main encountered challenges and the adopted solutions. The results of the operations confirmed the robustness of the designed navigation which allowed to accurately estimate the trajectory of ArgoMoon despite a series of complex events.

Multi-pollutants impact on modern cement built heritage

It is well known that the deposition of gaseous pollutants and aerosols plays a major role in causing the deterioration of monuments and built cultural heritage in European cities. Despite of many studies dedicated to the environmental damage of cultural heritage, in case of cement mortars, commonly used in the 20th century architecture, the deterioration due to air multipollutants impact, especially the formation of black crusts, is still not well explored making this issue a challenging area of research. This work centers on cement mortars – environment interactions, focusing on the diagnosis of the damage on the modern built heritage due to air multi-pollutants. For this purpose three sites, exposed to different urban areas in Europe, were selected for sampling and subsequent laboratory analyses: Centennial Hall, Wroclaw (Poland), Chiesa dell'Autostrada del Sole, Florence (Italy), Casa Galleria Vichi, Florence (Italy). The sampling sessions were performed taking into account the height from the ground level and protection from rain run off (sheltered, partly sheltered and exposed areas). The complete characterization of collected damage layer and underlying materials was performed using a range of analytical techniques: optical and scanning electron microscopy, X ray diffractometry, differential and gravimetric thermal analysis, ion chromatography, flash combustion/gas chromatographic analysis, inductively coupled plasma-optical emission spectrometer. The data were elaborated using statistical methods (i.e. principal components analyses) and enrichment factor for cement mortars was calculated for the first time. The results obtained from the experimental activity performed on the damage layers indicate that gypsum, due to the deposition of atmospheric sulphur compounds, is the main damage product at surfaces sheltered from rain run-off at Centennial Hall and Casa Galleria Vichi. By contrast, gypsum has not been identified in the samples collected at Chiesa dell'Autostrada del Sole. This is connected to the restoration works, particularly surface cleaning, regularly performed for the maintenance of the building. Moreover, the results obtained demonstrated the correlation between the location of the building and the composition of the damage layer: Centennial Hall is mainly undergoing to the impact of pollutants emitted from the close coal power stations, whilst Casa Galleria Vichi is principally affected by pollutants from vehicular exhaust in front of the building.

Nonlinear Control Strategies for Cooperative Control of Multi-Robot Systems

This thesis deals with distributed control strategies for cooperative control of multi-robot systems. Specifically, distributed coordination strategies are presented for groups of mobile robots. The formation control problem is initially solved exploiting artificial potential fields. The purpose of the presented formation control algorithm is to drive a group of mobile robots to create a completely arbitrarily shaped formation. Robots are initially controlled to create a regular polygon formation. A bijective coordinate transformation is then exploited to extend the scope of this strategy, to obtain arbitrarily shaped formations. For this purpose, artificial potential fields are specifically designed, and robots are driven to follow their negative gradient. Artificial potential fields are then subsequently exploited to solve the coordinated path tracking problem, thus making the robots autonomously spread along predefined paths, and move along them in a coordinated way. Formation control problem is then solved exploiting a consensus based approach. Specifically, weighted graphs are used both to define the desired formation, and to implement collision avoidance. As expected for consensus based algorithms, this control strategy is experimentally shown to be robust to the presence of communication delays. The global connectivity maintenance issue is then considered. Specifically, an estimation procedure is introduced to allow each agent to compute its own estimate of the algebraic connectivity of the communication graph, in a distributed manner. This estimate is then exploited to develop a gradient based control strategy that ensures that the communication graph remains connected, as the system evolves. The proposed control strategy is developed initially for single-integrator kinematic agents, and is then extended to Lagrangian dynamical systems.

Techniques and Methods for a multi-scale analysis of neuromuscular fatigue

This thesis proposes an integrated holistic approach to the study of neuromuscular fatigue in order to encompass all the causes and all the consequences underlying the phenomenon. Starting from the metabolic processes occurring at the cellular level, the reader is guided toward the physiological changes at the motorneuron and motor unit level and from this to the more general biomechanical alterations. In Chapter 1 a list of the various definitions for fatigue spanning several contexts has been reported. In Chapter 2, the electrophysiological changes in terms of motor unit behavior and descending neural drive to the muscle have been studied extensively as well as the biomechanical adaptations induced. In Chapter 3 a study based on the observation of temporal features extracted from sEMG signals has been reported leading to the need of a more robust and reliable indicator during fatiguing tasks. Therefore, in Chapter 4, a novel bi-dimensional parameter is proposed. The study on sEMG-based indicators opened a scenario also on neurophysiological mechanisms underlying fatigue. For this purpose, in Chapter 5, a protocol designed for the analysis of motor unit-related parameters during prolonged fatiguing contractions is presented. In particular, two methodologies have been applied to multichannel sEMG recordings of isometric contractions of the Tibialis Anterior muscle: the state-of-the-art technique for sEMG decomposition and a coherence analysis on MU spike trains. The importance of a multi-scale approach has been finally highlighted in the context of the evaluation of cycling performance, where fatigue is one of the limiting factors. In particular, the last chapter of this thesis can be considered as a paradigm: physiological, metabolic, environmental, psychological and biomechanical factors influence the performance of a cyclist and only when all of these are kept together in a novel integrative way it is possible to derive a clear model and make correct assessments.

Obsessed With Work: A multi-causal and multi-rater approach to workaholism

Workaholism is defined as the combination of two underlying dimensions: working excessively and working compulsively. The present thesis aims at achieving the following purposes: 1) to test whether the interaction between environmental and personal antecedents may enhance workaholism; 2) to develop a questionnaire aimed to assess overwork climate in the workplace; 3) to contrast focal employees’ and coworkers’ perceptions of employees’ workaholism and engagement. Concerning the first purpose, the interaction between overwork climate and person characteristics (achievement motivation, perfectionism, conscientiousness, self-efficacy) was explored on a sample of 333 Dutch employees. The results of moderated regression analyses showed that the interaction between overwork climate and person characteristics is related to workaholism. The second purpose was pursued with two interrelated studies. In Study 1 the Overwork Climate Scale (OWCS) was developed and tested using a principal component analysis (N = 395) and a confirmatory factor analysis (N = 396). Two overwork climate dimensions were distinguished, overwork endorsement and lacking overwork rewards. In Study 2 the total sample (N = 791) was used to explore the association of overwork climate with two types of working hard: work engagement and workaholism. Lacking overwork rewards was negatively associated with engagement, whereas overwork endorsement showed a positive association with workaholism. Concerning the third purpose, using a sample of 73 dyads composed by focal employees and their coworkers, a multitrait-multimethod matrix and a correlated trait-correlated method model, i.e. the CT-C(M–1) model, were examined. Our results showed a considerable agreement between raters on focal employees' engagement and workaholism. In contrast, we observed a significant difference concerning the cognitive dimension of workaholism, working compulsively. Moreover, we provided further evidence for the discriminant validity between engagement and workaholism. Overall, workaholism appears as a negative work-related state that could be better explained by assuming a multi-causal and multi-rater approach.

Heterogeneous Multi-core Architectures for High Performance Computing

This thesis deals with heterogeneous architectures in standard workstations. Heterogeneous architectures represent an appealing alternative to traditional supercomputers because they are based on commodity components fabricated in large quantities. Hence their price-performance ratio is unparalleled in the world of high performance computing (HPC). In particular, different aspects related to the performance and consumption of heterogeneous architectures have been explored. The thesis initially focuses on an efficient implementation of a parallel application, where the execution time is dominated by an high number of floating point instructions. Then the thesis touches the central problem of efficient management of power peaks in heterogeneous computing systems. Finally it discusses a memory-bounded problem, where the execution time is dominated by the memory latency. Specifically, the following main contributions have been carried out: A novel framework for the design and analysis of solar field for Central Receiver Systems (CRS) has been developed. The implementation based on desktop workstation equipped with multiple Graphics Processing Units (GPUs) is motivated by the need to have an accurate and fast simulation environment for studying mirror imperfection and non-planar geometries. Secondly, a power-aware scheduling algorithm on heterogeneous CPU-GPU architectures, based on an efficient distribution of the computing workload to the resources, has been realized. The scheduler manages the resources of several computing nodes with a view to reducing the peak power. The two main contributions of this work follow: the approach reduces the supply cost due to high peak power whilst having negligible impact on the parallelism of computational nodes. from another point of view the developed model allows designer to increase the number of cores without increasing the capacity of the power supply unit. Finally, an implementation for efficient graph exploration on reconfigurable architectures is presented. The purpose is to accelerate graph exploration, reducing the number of random memory accesses.

Aragonite-based scaffold for the treatment of knee osteochondral defects: results of a prospective multi-center trial at 2 years' follow-up

PURPOSE: To evaluate the clinical and MRI outcomes after the implantation of a nanostructured cell free aragonite-based scaffold in patients affected by knee chondral and osteochondral lesions. METHODS: 126 patients (94 men, 32 women; age 32.7±8.8 years) were included according to the following criteria: grade III or IV chondra/osteochondral lesions in the femoral condyles or throclea; 2) no limb axial deviation (i.e. varus or valgus knee > 5°); 3) no signs of knee instability; 4) no concurrent tibial or patellar chondral/osteochondral defects. All patients were treated by arthrotomic implantation of an aragonite based-scaffold by a press-fit technique. Patients were prospectively evaluated by IKDC, Tegner, Lysholm and KOOS scores preoperatively and then at 6, 12, 18 and 24-months follow-up. MRI was also performed to evaluate the amount of defect filling by regenerated cartilage. Failures were defined as the need for re-intervention in the index knee within the follow-up period. RESULTS: Average defect size was 2±1.3 cm2 and in most cases a single scaffold was used. A significant improvement in each clinical score was recorded from basal level to 24 months’ follow-up. In particular, the IKDC subjective score increased from 42.14±16 to 70.94±24.69 and the Tegner score improved from 2.95±1.90 to 4.82±1.85 (p<0.0005). Lysholm score and all the subscales of KOOS showed a similar trend over time. Age of the patient at implantation, size of the defect and BMI were correlated with lower clinical outcome. The presence of OA didn’t influence the clinical results. MRI evaluation showed a significant increase in defect filling over time, with the highest value reached at 24 months. Failures occurred in eleven patients (8.7%). CONCLUSION: The aragonite-based biomimetic osteochondral scaffold proved to be safe, and encouraging clinical and radiographic outcomes were documented up to 2 years’ follow-up.

Development of novel multi-substituted apatite nanophases with advanced functionalities for bone regeneration

In the field of bone substitutes is highly researched an innovative material able to fill gaps with high mechanical performances and able to stimulate cell response, permitting the complete restoration of the bone portion. In this respect, the synthesis of new bioactive materials able to mimic the compositional, morphological and mechanical features of bone is considered as the elective approach for effective tissue regeneration. Hydroxyapatite (HA) is the main component of the inorganic part of bone. Additionally ionic substitution can be performed in the apatite lattice producing different effects, depending from the selected ions. Magnesium, in substitution of calcium, and carbonate, in substitution of phosphate, extensively present in the biological bones, are able to improve properties naturally present in the apatitic phase, (i.e. biomimicry, solubility e osteoinductive properties). Other ions can be used to give new useful properties, like antiresorptive or antimicrobial properties, to the apatitic phase. This thesis focused on the development of hydroxyapatite nanophases with multiple ionic substitutions including gallium, or zinc ions, in association with magnesium and carbonate, with the purpose to provide double synergistic functionality as osteogenic and antibacterial biomaterial. Were developed bioactive materials based on Sr-substituted hydroxyapatite in the form of sintered targets. The obtained targets were treated with Pulsed Plasma Deposition (PED) resulting in the deposition of thin film coatings able to improve the roughness and wettability of PEEK, enhancing its osteointegrability. Were investigated heterogeneous gas-solid reactions, addressed to the biomorphic transformations of natural 3D porous structures into bone scaffolds with biomimetic composition and hierarchical organization, for application in load-bearing sites. The kinetics of the different reactions of the process were optimized to achieve complete and controlled phase transformation, maintaining the original 3-D morphology. Massive porous scaffolds made of ion-substituted hydroxyapatite and bone-mimicking structure were developed and tested in 3-D cell culture models.

Multi-organ support device for combined extracorporeal carbon dioxide removal and hemofiltration treatments with pump-free solution for ultrafiltration

The use of extracorporeal organ support (ECOS) devices is increasingly widespread, to temporarily sustain or replace the functions of impaired organs in critically ill patients. Among ECOS, respiratory functions are supplied by extracorporeal life support (ECLS) therapies like extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), and renal replacement therapies (RRT) are used to support kidney functions. However, the leading cause of mortality in critically ill patients is multi-organ dysfunction syndrome (MODS), which requires a complex therapeutic strategy where extracorporeal treatments are often integrated to pharmacological approach. Recently, the concept of multi-organ support therapy (MOST) has been introduced, and several forms of isolated ECOS devices are sequentially connected to provide simultaneous support to different organ systems. The future of critical illness goes towards the development of extracorporeal devices offering multiple organ support therapies on demand by a single hardware platform, where treatment lines can be used alternately or in conjunction. The aim of this industrial PhD project is to design and validate a device for multi-organ support, developing an auxiliary line for renal replacement therapy (hemofiltration) to be integrated on a platform for ECCO2R. The intended purpose of the ancillary line, which can be connected on demand, is to remove excess fluids by ultrafiltration and achieve volume control by the infusion of a replacement solution, as patients undergoing respiratory support are particularly prone to develop fluid overload. Furthermore, an ultrafiltration regulation system shall be developed using a powered and software-modulated pinch-valve on the effluent line of the hemofilter, proposed as an alternative to the state-of-the-art solution with peristaltic pump.

Tumor burden as assessed by 18 F FDG PET scan as predictive biomarker for immune checkpoint blockers in advanced NSCLC - a multi centric study

Introduction Only a proportion of patients with advanced NSCLC benefit from Immune checkpoint blockers (ICBs). No biomarker is validated to choose between ICBs monotherapy or in combination with chemotherapy (Chemo-ICB) when PD-L1 expression is above 50%. The aim of the present study is to validate the biomarker validity of total Metabolic Tumor Volume (tMTV) as assessed by 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography ([18F]FDG-PET) Material and methods This is a multicentric retrospective study. Patients with advanced NSCLC treated with ICBs, chemotherapy plus ICBs and chemotherapy were enrolled in 12 institutions from 4 countries. Inclusion criteria was a positive PET scan performed within 42 days from treatment start. TMTV was analyzed at each center based on a 42% SUVmax threshold. High tMTV was defined ad tMTV>median Results 493 patients were included, 163 treated with ICBs alone, 236 with chemo-ICBs and 94 with CT. No correlation was found between PD-L1 expression and tMTV. Median PFS for patients with high tMTV (100.1 cm3) was 3.26 months (95% CI 1.94–6.38) vs 14.70 (95% CI 11.51–22.59) for those with low tMTV (p=0.0005). Similarly median OS for pts with high tMTV was 11.4 months (95% CI 8.42 – 19.1) vs 33.1 months for those with low tMTV (95% CI 22.59 – NA), p .00067. In chemo-ICBs treated patients no correlation was found for OS (p = 0.11) and a borderline correlation was found for PFS (p=0.059). Patients with high tMTV and PD-L1 ≥ 50% had a better PFS when treated with combination of chemotherapy and ICBs respect to ICBs alone, with 3.26 months (95% CI 1.94 – 5.79) for ICBs vs 11.94 (95% CI 5.75 – NA) for Chemo ICBs (p = 0.043). Conclusion tMTV is predictive of ICBs benefit, not to CT benefit. tMTV can help to select the best upfront strategy in patients with high tMTV.

Toxic cyanobacteria in water intended for drinking purpose: improvement of cells and toxins’ analyses and of treatments for their removal

Massive proliferations of cyanobacteria in freshwaters have recently increased, causing ecological and economic losses. Their ever-increasing presence in water sources destined to potabilization has become a major threat for public health, since several species can produce harmful toxins (cyanotoxin). Therefore, additional specific measures to improve management and treatment of drinking water(s) are required. The PhD thesis investigates toxic cyanobacteria in drinking waters with a special focus on Emilia-Romagna (Italy), throughout three separated chapters, each with different specific objectives. The first chapter aims at improving the fast monitoring of cyanobacteria in drinking water, which was investigated by testing different models of multi-wavelength spectrofluorometers. Inter-laboratories calibrations were conducted using mono-specific cultures and field samples, and both the feasibility and the technical limitations of such tools were illustrated. The second chapter evaluates the effectiveness of drinking water treatments in removing cyanobacterial cells and toxins. Two chlorinated oxidants (sodium hypochlorite and chlorine dioxide) already in use for pre-oxidation during water potabilization, were tested on cultures of the toxic cyanobacterium Microcystis aeruginosa posing a specific focus on toxin removal and revealing that pre-oxidation can cause the release of toxins and unknown metabolites. Innovative treatments based on non-thermal plasma were also tested, observing an effective and rapid inactivation of cyanobacterial cells. The third chapter presents a study on a cyanobacterium isolated from a drinking water reservoir of Emilia-Romagna and investigated by combining biological, chemical, and genomic methods. Although the strain did not produce any known cyanotoxin, high toxicity of water-extract was observed in bioassays and potential implications for drinking water were discussed. Overall, the PhD thesis offers new insights into toxic cyanobacteria management in drinking water, highlighting best practices for drinking water managers regarding their detection and removal. Additionally, the thesis provides new contributions to the understanding of the freshwater cyanobacteria community in the Emilia-Romagna region.