Multiple testing in spatial epidemiology: a Bayesian approach

In this work we aim to propose a new approach for preliminary epidemiological studies on Standardized Mortality Ratios (SMR) collected in many spatial regions. A preliminary study on SMRs aims to formulate hypotheses to be investigated via individual epidemiological studies that avoid bias carried on by aggregated analyses. Starting from collecting disease counts and calculating expected disease counts by means of reference population disease rates, in each area an SMR is derived as the MLE under the Poisson assumption on each observation. Such estimators have high standard errors in small areas, i.e. where the expected count is low either because of the low population underlying the area or the rarity of the disease under study. Disease mapping models and other techniques for screening disease rates among the map aiming to detect anomalies and possible high-risk areas have been proposed in literature according to the classic and the Bayesian paradigm. Our proposal is approaching this issue by a decision-oriented method, which focus on multiple testing control, without however leaving the preliminary study perspective that an analysis on SMR indicators is asked to. We implement the control of the FDR, a quantity largely used to address multiple comparisons problems in the eld of microarray data analysis but which is not usually employed in disease mapping. Controlling the FDR means providing an estimate of the FDR for a set of rejected null hypotheses. The small areas issue arises diculties in applying traditional methods for FDR estimation, that are usually based only on the p-values knowledge (Benjamini and Hochberg, 1995; Storey, 2003). Tests evaluated by a traditional p-value provide weak power in small areas, where the expected number of disease cases is small. Moreover tests cannot be assumed as independent when spatial correlation between SMRs is expected, neither they are identical distributed when population underlying the map is heterogeneous. The Bayesian paradigm oers a way to overcome the inappropriateness of p-values based methods. Another peculiarity of the present work is to propose a hierarchical full Bayesian model for FDR estimation in testing many null hypothesis of absence of risk.We will use concepts of Bayesian models for disease mapping, referring in particular to the Besag York and Mollié model (1991) often used in practice for its exible prior assumption on the risks distribution across regions. The borrowing of strength between prior and likelihood typical of a hierarchical Bayesian model takes the advantage of evaluating a singular test (i.e. a test in a singular area) by means of all observations in the map under study, rather than just by means of the singular observation. This allows to improve the power test in small areas and addressing more appropriately the spatial correlation issue that suggests that relative risks are closer in spatially contiguous regions. The proposed model aims to estimate the FDR by means of the MCMC estimated posterior probabilities b i's of the null hypothesis (absence of risk) for each area. An estimate of the expected FDR conditional on data (\FDR) can be calculated in any set of b i's relative to areas declared at high-risk (where thenull hypothesis is rejected) by averaging the b i's themselves. The\FDR can be used to provide an easy decision rule for selecting high-risk areas, i.e. selecting as many as possible areas such that the\FDR is non-lower than a prexed value; we call them\FDR based decision (or selection) rules. The sensitivity and specicity of such rule depend on the accuracy of the FDR estimate, the over-estimation of FDR causing a loss of power and the under-estimation of FDR producing a loss of specicity. Moreover, our model has the interesting feature of still being able to provide an estimate of relative risk values as in the Besag York and Mollié model (1991). A simulation study to evaluate the model performance in FDR estimation accuracy, sensitivity and specificity of the decision rule, and goodness of estimation of relative risks, was set up. We chose a real map from which we generated several spatial scenarios whose counts of disease vary according to the spatial correlation degree, the size areas, the number of areas where the null hypothesis is true and the risk level in the latter areas. In summarizing simulation results we will always consider the FDR estimation in sets constituted by all b i's selected lower than a threshold t. We will show graphs of the\FDR and the true FDR (known by simulation) plotted against a threshold t to assess the FDR estimation. Varying the threshold we can learn which FDR values can be accurately estimated by the practitioner willing to apply the model (by the closeness between\FDR and true FDR). By plotting the calculated sensitivity and specicity (both known by simulation) vs the\FDR we can check the sensitivity and specicity of the corresponding\FDR based decision rules. For investigating the over-smoothing level of relative risk estimates we will compare box-plots of such estimates in high-risk areas (known by simulation), obtained by both our model and the classic Besag York Mollié model. All the summary tools are worked out for all simulated scenarios (in total 54 scenarios). Results show that FDR is well estimated (in the worst case we get an overestimation, hence a conservative FDR control) in small areas, low risk levels and spatially correlated risks scenarios, that are our primary aims. In such scenarios we have good estimates of the FDR for all values less or equal than 0.10. The sensitivity of\FDR based decision rules is generally low but specicity is high. In such scenario the use of\FDR = 0:05 or\FDR = 0:10 based selection rule can be suggested. In cases where the number of true alternative hypotheses (number of true high-risk areas) is small, also FDR = 0:15 values are well estimated, and \FDR = 0:15 based decision rules gains power maintaining an high specicity. On the other hand, in non-small areas and non-small risk level scenarios the FDR is under-estimated unless for very small values of it (much lower than 0.05); this resulting in a loss of specicity of a\FDR = 0:05 based decision rule. In such scenario\FDR = 0:05 or, even worse,\FDR = 0:1 based decision rules cannot be suggested because the true FDR is actually much higher. As regards the relative risk estimation, our model achieves almost the same results of the classic Besag York Molliè model. For this reason, our model is interesting for its ability to perform both the estimation of relative risk values and the FDR control, except for non-small areas and large risk level scenarios. A case of study is nally presented to show how the method can be used in epidemiology.

Neutronics analyses for fast spectrum nuclear systems and scenario studies for advanced nuclear fuel cycles

The present PhD thesis summarizes the three-years study about the neutronic investigation of a new concept nuclear reactor aiming at the optimization and the sustainable management of nuclear fuel in a possible European scenario. A new generation nuclear reactor for the nuclear reinassance is indeed desired by the actual industrialized world, both for the solution of the energetic question arising from the continuously growing energy demand together with the corresponding reduction of oil availability, and the environment question for a sustainable energy source free from Long Lived Radioisotopes and therefore geological repositories. Among the Generation IV candidate typologies, the Lead Fast Reactor concept has been pursued, being the one top rated in sustainability. The European Lead-cooled SYstem (ELSY) has been at first investigated. The neutronic analysis of the ELSY core has been performed via deterministic analysis by means of the ERANOS code, in order to retrieve a stable configuration for the overall design of the reactor. Further analyses have been carried out by means of the Monte Carlo general purpose transport code MCNP, in order to check the former one and to define an exact model of the system. An innovative system of absorbers has been conceptualized and designed for both the reactivity compensation and regulation of the core due to cycle swing, as well as for safety in order to guarantee the cold shutdown of the system in case of accident. Aiming at the sustainability of nuclear energy, the steady-state nuclear equilibrium has been investigated and generalized into the definition of the ``extended'' equilibrium state. According to this, the Adiabatic Reactor Theory has been developed, together with a New Paradigm for Nuclear Power: in order to design a reactor that does not exchange with the environment anything valuable (thus the term ``adiabatic''), in the sense of both Plutonium and Minor Actinides, it is required indeed to revert the logical design scheme of nuclear cores, starting from the definition of the equilibrium composition of the fuel and submitting to the latter the whole core design. The New Paradigm has been applied then to the core design of an Adiabatic Lead Fast Reactor complying with the ELSY overall system layout. A complete core characterization has been done in order to asses criticality and power flattening; a preliminary evaluation of the main safety parameters has been also done to verify the viability of the system. Burn up calculations have been then performed in order to investigate the operating cycle for the Adiabatic Lead Fast Reactor; the fuel performances have been therefore extracted and inserted in a more general analysis for an European scenario. The present nuclear reactors fleet has been modeled and its evolution simulated by means of the COSI code in order to investigate the materials fluxes to be managed in the European region. Different plausible scenarios have been identified to forecast the evolution of the European nuclear energy production, including the one involving the introduction of Adiabatic Lead Fast Reactors, and compared to better analyze the advantages introduced by the adoption of new concept reactors. At last, since both ELSY and the ALFR represent new concept systems based upon innovative solutions, the neutronic design of a demonstrator reactor has been carried out: such a system is intended to prove the viability of technology to be implemented in the First-of-a-Kind industrial power plant, with the aim at attesting the general strategy to use, to the largest extent. It was chosen then to base the DEMO design upon a compromise between demonstration of developed technology and testing of emerging technology in order to significantly subserve the purpose of reducing uncertainties about construction and licensing, both validating ELSY/ALFR main features and performances, and to qualify numerical codes and tools.

Cambiamenti dello scenario epidemiologico e clinico dell'epatocarcinoma in Italia nell'ultimo ventennio

Background & Aims: This study investigates whether the aetiologic changes in liver disease and the improved management of hepatocellular carcinoma (HCC) have modified the clinical scenario of this tumour over the last 20 years in Italy. Methods: Retrospective study based on the analysis of the ITA.LI.CA (Italian Liver Cancer) database including 3027 HCC patients managed in 11 centres. Patients were divided into 3 groups according to the period of HCC diagnosis: 1987–1996 (year of the ‘‘Milano criteria’’ publication), 1997–2001 (year of release of the EASL guidelines for HCC), and 2002–2008. Results: The significant changes were: (1) progressive patient ageing; (2) increasing prevalence of HCV infection until 2001, with a subsequent decrease, when the alcoholic aetiology increased; (3) liver function improvement, until 2001; (4) increasing ‘‘incidental’’ at the expense of ‘‘symptomatic’’ diagnoses, until 2001; (5) unchanged prevalence of tumours diagnosed during surveillance (around 50%), with an increasing use of the 6- month schedule; (6) favourable HCC ‘‘stage migration’’, until 2001; (7) increasing use of percutaneous ablation; (8) improving survival, until 2001. Conclusions: Over the last 20 years, several aetiologic and clinical features regarding HCC have changed. The survival improvement observed until 2001 was due to an increasing number of tumours diagnosed in early stages and in a background of compensated cirrhosis, and a growing and better use of locoregional treatments. However, the prevalence of early cancers and survival did not increase further in the last years, a result inciting national policies aimed at implementing surveillance programmes for at risk patients.

Cooperation and competition in the air transport market: current scenario, possible evolutions and analytical tools

dall'avvento della liberalizzazione, aeroporti e vettori hanno vissuto cambiamenti. Il maggior miglioramneto nella gestione degli aeroporti è una gestione più commerciale ed efficiente. Le forme di regolazione economica e le caratteristiche della gestione manageriale sono state indagate. Dodici paesi sono stati scelti per indagare la situazione del trasporto aereo mondiale, fra questi sia paesi con un sistema maturo sia paesi emergenti. La distribuzione del traffico è stata analizzata con l'indice HHI per evidenziare aeroporti con concentrazione maggiore di 0,25 (in accordo con la normativa statunitense); il sistema aeroportuale è stato analizzato con l'indice di Gini e con l'indice di dominanza. Infine, la teoria dei giochi si è dimostrata un valido supporto per studiare il mercato del trasporto aereo anche con l'uso di giochi di tipo DP

Nonlinear constrained and saturated control of power electronics and electromechanical systems

Power electronic converters are extensively adopted for the solution of timely issues, such as power quality improvement in industrial plants, energy management in hybrid electrical systems, and control of electrical generators for renewables. Beside nonlinearity, this systems are typically characterized by hard constraints on the control inputs, and sometimes the state variables. In this respect, control laws able to handle input saturation are crucial to formally characterize the systems stability and performance properties. From a practical viewpoint, a proper saturation management allows to extend the systems transient and steady-state operating ranges, improving their reliability and availability. The main topic of this thesis concern saturated control methodologies, based on modern approaches, applied to power electronics and electromechanical systems. The pursued objective is to provide formal results under any saturation scenario, overcoming the drawbacks of the classic solution commonly applied to cope with saturation of power converters, and enhancing performance. For this purpose two main approaches are exploited and extended to deal with power electronic applications: modern anti-windup strategies, providing formal results and systematic design rules for the anti-windup compensator, devoted to handle control saturation, and “one step” saturated feedback design techniques, relying on a suitable characterization of the saturation nonlinearity and less conservative extensions of standard absolute stability theory results. The first part of the thesis is devoted to present and develop a novel general anti-windup scheme, which is then specifically applied to a class of power converters adopted for power quality enhancement in industrial plants. In the second part a polytopic differential inclusion representation of saturation nonlinearity is presented and extended to deal with a class of multiple input power converters, used to manage hybrid electrical energy sources. The third part regards adaptive observers design for robust estimation of the parameters required for high performance control of power systems.

Search for the MSSM Neutral Higgs Boson in the mu+mu- final state with the CMS experiment at LHC

In this thesis, my work in the Compact Muon Solenoid (CMS) experiment on the search for the neutral Minimal Supersymmetric Standard Model (MSSM) Higgs decaying into two muons is presented. The search is performed on the full data collected during the years 2011 and 2012 by CMS in proton-proton collisions at CERN Large Hadron Collider (LHC). The MSSM is explored within the most conservative benchmark scenario, m_h^{max}, and within its modified versions, m_h^{mod +} and m_h^{mod -}. The search is sensitive to MSSM Higgs boson production in association with a b\bar{b} quark pair and to the gluon-gluon fusion process. In the m_h^{max} scenario, the results exclude values of tanB larger than 15 in the m_A range 115-200 GeV, and values of tanB greater than 30 in the m_A range up to 300 GeV. There are no significant differences in the results obtained within the three different scenarios considered. Comparisons with other neutral MSSM Higgs searches are shown.

Resezioni epatiche eco-guidate radicali ma conservative simultanee alle resezioni colo-rettali. Un approccio sicuro al cancro colorettale avanzato

Il cancro colorettale (CRC) rimane la prima causa di morte nei paesi occidentali.Dal 15% al 25% dei pazienti affetti da CRC presenta metastasi epatiche sincrone (CRLM) al momento della diagnosi.La resezione epatica radicale rimane l’unica terapia potenzialmente curativa in presenza di CRLM con una sopravvivenza a 5 anni compresa tra il 17% ed il 35% ed a 10 anni tra il 16% e il 23% rispettivamente. La tempistica ottimale per la resezione chirurgica in caso di presentazione sincrona di CRC è controversa.Questo studio intende dimostrare che le resezioni epatiche ecoguidate radicali ma conservative simultanee ad una resezione colorettale rappresentano una tecnica sicura ed efficace nei pazienti con CRC avanzato. 48 pazienti sono stati sottoposti ad una resezione simultanea colorettale ed epatica. L’età media +SD (range) era di 64,2+9,7 (38-84).Un solo paziente è deceduto entro 30 giorni. La mortalità post operatoria è stata complessivamente del 2,1%. Nove pazienti (18,8%) hanno sviluppato una o più complicanza ,4 (8,3%) di grado III-IV sec. Clavien-Dindo e 5 (10,4%) di grado I-II. La durata complessiva dell’intervento chirurgico simultaneo è stata di 486,6+144,0 (153-804) minuti.Questo studio conferma che le resezioni colorettali ed epatiche simultanee possono essere eseguite senza un significativo aumento della morbilità e mortalità perioperatorie, anche in pazienti sottoposti ad una resezione anteriore ultrabassa ed in quelli in cui sia indicato il clampaggio intermittente dell’ilo epatico. L’IOUS è efficace nel ridurre l’estensione della resezione epatica in pazienti sia con CRLM anche multiple e bilobari .Poichè le complicanze maggiori sono frequenti dopo resezioni epatiche maggiori simultanee, riducendo l’estensione della resezione del parenchima epatico si può avere un impatto favorevole sul decorso post operatorio.Le resezioni epatiche ecoguidate radicali ma conservative simultanee ad una resezione colorettale sono una tecnica sicura ed efficace in pazienti con carcinoma colorettale avanzato e andrebbero considerate l’opzione primaria in casi selezionati