Reasoning with incomplete and imprecise preferences

Preferences are present in many real life situations but it is often difficult to quantify them giving a precise value. Sometimes preference values may be missing because of privacy reasons or because they are expensive to obtain or to produce. In some other situations the user of an automated system may have a vague idea of whats he wants. In this thesis we considered the general formalism of soft constraints, where preferences play a crucial role and we extended such a framework to handle both incomplete and imprecise preferences. In particular we provided new theoretical frameworks to handle such kinds of preferences. By admitting missing or imprecise preferences, solving a soft constraint problem becomes a different task. In fact, the new goal is to find solutions which are the best ones independently of the precise value the each preference may have. With this in mind we defined two notions of optimality: the possibly optimal solutions and the necessary optimal solutions, which are optimal no matter we assign a precise value to a missing or imprecise preference. We provided several algorithms, bases on both systematic and local search approaches, to find such kind of solutions. Moreover, we also studied the impact of our techniques also in a specific class of problems (the stable marriage problems) where imprecision and incompleteness have a specific meaning and up to now have been tackled with different techniques. In the context of the classical stable marriage problem we developed a fair method to randomly generate stable marriages of a given problem instance. Furthermore, we adapted our techniques to solve stable marriage problems with ties and incomplete lists, which are known to be NP-hard, obtaining good results both in terms of size of the returned marriage and in terms of steps need to find a solution.

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Bone-implant interface. Evaluation of osteoblastic cells behavior on nanopatterned titanium surfaces: an in vitro analysis

Protein-adsorption occurs immediately following implantation of biomaterials. It is unknown at which extent protein-adsorption impacts the cellular events at bone-implant interface. To investigate this question, we compared the in-vitro outcome of osteoblastic cells grown onto titanium substrates and glass as control, by modulating the exposure to serum-derived proteins. Substrates consisted of 1) polished titanium disks; 2) polished disks nanotextured with H2SO4/H2O2; 3) glass. In the pre-adsorption phase, substrates were treated for 1h with αMEM alone (M-noFBS) or supplemented with 10%-foetal-bovine-serum (M-FBS). MC3T3-osteoblastic-cells were cultured on the pre-treated substrates for 3h and 24h, in M-noFBS and M-FBS. Subsequently, the culture medium was replaced with M-FBS and cultures maintained for 3 and 7days. Cell-number was evaluated by: Alamar-Blue and MTT assay. Mitotic- and osteogenic-activities were evaluated through fluorescence-optical-microscope by immunolabeling for Ki-67 nuclear-protein and Osteopontin. Cellular morphology was evaluated by SEM-imaging. Data were statistically analyzed using ANOVA-test, (p<0.05). At day3 and day7, the presence or absence of serum-derived proteins during the pre-adsorption phase had not significant effect on cell-number. Only the absence of FBS during 24h of culture significantly affected cell-number (p<0.0001). Titanium surfaces performed better than glass, (p<0.01). The growth rate of cells between day3 and 7 was not affected by the initial absence of FBS. Immunolabeling for Ki-67 and Osteopontin showed that the mitotic- and osteogenic- activity were ongoing at 72h. SEM-analysis revealed that the absence of FBS had no major influence on cell-shape. • Physico-chemical interactions without mediation by proteins are sufficient to sustain the initial phase of culture and guide osteogenic-cells toward differentiation. • The challenge is avoiding adsorption of ‘undesirables’ molecules that negatively impact on the cueing cells receive from surface. This may not be a problem in healthy patients, but may have an important role in medically-compromised-individuals in whom the composition of tissue-fluids is altered.

Identity Changes and Consumer Behavior. How Becoming Parents Changes Our Consumption Choices

This research aims at investigating the impact of the identity change on consumption. An identity change is defined as the acquisition of a new identity after a life change event. For instance after the birth of the first child the new identity as parent is acquired and a woman can define herself as a mother. Despite marketing research recognizes that individuals’ identity is unstable and susceptible to change, the investigation of the identity change is still in its infancy. Furthermore, marketing research did not investigate the contextual effect of the new as well as the old identity on individuals’ reaction toward identity-marketing. In order words, whether people show a more favorable reaction toward product related to their new or their old identities after an identity change is still unclear. In order to answer this question, five studies are conducted. Results show that when the new identity substitutes the old one, people show a more positive reaction toward new-identity related products, while when the new identity is added to the old ones, people show a more positive reaction toward old-identity related products. This is the case also when the new identity accounts for high levels of identification (study three) and when the old identity is squeezed by the new one (studies four and five). A new concept, the identity strain, is then introduced and discussed.

The three-dimensional single-bin-size bin packing problem: combining metaheuristic and machine learning approaches

The Three-Dimensional Single-Bin-Size Bin Packing Problem is one of the most studied problem in the Cutting & Packing category. From a strictly mathematical point of view, it consists of packing a finite set of strongly heterogeneous “small” boxes, called items, into a finite set of identical “large” rectangles, called bins, minimizing the unused volume and requiring that the items are packed without overlapping. The great interest is mainly due to the number of real-world applications in which it arises, such as pallet and container loading, cutting objects out of a piece of material and packaging design. Depending on these real-world applications, more objective functions and more practical constraints could be needed. After a brief discussion about the real-world applications of the problem and a exhaustive literature review, the design of a two-stage algorithm to solve the aforementioned problem is presented. The algorithm must be able to provide the spatial coordinates of the placed boxes vertices and also the optimal boxes input sequence, while guaranteeing geometric, stability, fragility constraints and a reduced computational time. Due to NP-hard complexity of this type of combinatorial problems, a fusion of metaheuristic and machine learning techniques is adopted. In particular, a hybrid genetic algorithm coupled with a feedforward neural network is used. In the first stage, a rich dataset is created starting from a set of real input instances provided by an industrial company and the feedforward neural network is trained on it. After its training, given a new input instance, the hybrid genetic algorithm is able to run using the neural network output as input parameter vector, providing as output the optimal solution. The effectiveness of the proposed works is confirmed via several experimental tests.

Governing the water conservation in the Urmia Lake Basin: addressing macro systems’ fit and micro users’ behavior

To change unadapted water governing systems, and water users’ traditional conducts in line with climate change, understanding of systems’ structures and users’ behaviors is necessary. To this aim, comprehensive and pragmatic research was designed and implemented in the Urmia Lake Basin where due to the severe droughts, and human-made influences, especially through the agricultural development, the lake has been shrunken drastically. To analyze the water governance and conservation issues in the basin, an innovative framework was developed based on mathematical physics concepts and pro-environmental behavior theories. Accordingly, in system level (macro/meso), the problem of fit of the early-shaped water governing system associating with the function of “political-security” and “political-economic” factors in the basin was identified through mean-field models. Furthermore, the effect of a “political-environmental” factor, the Urmia Lake Restoration Program (ULRP), on reforming the system structure and hence its fit was assessed. The analysis results revealed that by revising the provincial boundaries (horizontal alternation) for the entity of Kurdistan province to permit that interact with the headquarter of West Azerbaijan province for its water demand-supply initiatives, the system fit can increase. Also, the constitution of the ULRP (vertical arrangement) not only could increase the structural fit of the water governing system to the basin, but also significantly could enhance the system fit through its water-saving policy. Besides, in individual level (micro), the governing factors of water conservation behavior of the major users/farmers were identified through rational and moral socio-psychological models. In rational approach, incorporating PMT and TPB, the SEM results demonstrated that “Perceived Vulnerability”, “Self-Efficacy”, “Response Efficacy”, “Response Cost”, “Subjective Norms” and “Institutional Trust” significantly affect the water-saving intention/behavior. Likewise, NAM based analysis as a moral approach, uncovered the significant effects of “Awareness of Consequences”, “Appraisal of Responsibility”, “Personal Norms” as well as “Place Attachment” and “Emotions” on water-saving intention.