Operational research applied to regional healthcare system

In this thesis we focus on optimization and simulation techniques applied to solve strategic, tactical and operational problems rising in the healthcare sector. At first we present three applications to Emilia-Romagna Public Health System (SSR) developed in collaboration with Agenzia Sanitaria e Sociale dell'Emilia-Romagna (ASSR), a regional center for innovation and improvement in health. Agenzia launched a strategic campaign aimed at introducing Operations Research techniques as decision making tools to support technological and organizational innovations. The three applications focus on forecast and fund allocation of medical specialty positions, breast screening program extension and operating theater planning. The case studies exploit the potential of combinatorial optimization, discrete event simulation and system dynamics techniques to solve resource constrained problem arising within Emilia-Romagna territory. We then present an application in collaboration with Dipartimento di Epidemiologia del Lazio that focuses on population demand of service allocation to regional emergency departments. Finally, a simulation-optimization approach, developed in collaboration with INESC TECH center of Porto, to evaluate matching policies for the kidney exchange problem is discussed.

Multi-Country Event Study Methods

Which event study methods are best in non-U.S. multi-country samples? Nonparametric tests, especially the rank and generalized sign, are better specified and more powerful than common parametric tests, especially in multi-day windows. The generalized sign test is the best statistic but must be applied to buy-and-hold abnormal returns for correct specification. Market-adjusted and market-model methods with local market indexes, without conversion to a common currency, work well. The results are robust to limiting the samples to situations expected to be problematic for test specification or power. Applying the tests that perform best in simulation to merger announcements produces reasonable results.

Evaluation of energy level to be absorbed by tractor ROPS: Actual Tests, Simulation and Computation

A highly dangerous situations for tractor driver is the lateral rollover in operating conditions. Several accidents, involving tractor rollover, have indeed been encountered, requiring the design of a robust Roll-Over Protective Structure (ROPS). The aim of the thesis was to evaluate tractor behaviour in the rollover phase so as to calculate the energy absorbed by the ROPS to ensure driver safety. A Mathematical Model representing the behaviour of a generic tractor during a lateral rollover, with the possibility of modifying the geometry, the inertia of the tractor and the environmental boundary conditions, is proposed. The purpose is to define a method allowing the prediction of the elasto-plastic behaviour of the subsequent impacts occurring in the rollover phase. A tyre impact model capable of analysing the influence of the wheels on the energy to be absorbed by the ROPS has been also developed. Different tractor design parameters affecting the rollover behaviour, such as mass and dimensions, have been considered. This permitted the evaluation of their influence on the amount of energy to be absorbed by the ROPS. The mathematical model was designed and calibrated with respect to the results of actual lateral upset tests carried out on a narrow-track tractor. The dynamic behaviour of the tractor and the energy absorbed by the ROPS, obtained from the actual tests, showed to match the results of the model developed. The proposed approach represents a valuable tool in understanding the dynamics (kinetic energy) and kinematics (position, velocity, angular velocity, etc.) of the tractor in the phases of lateral rollover and the factors mainly affecting the event. The prediction of the amount of energy to be absorbed in some cases of accident is possible with good accuracy. It can then help in designing protective structures or active security devices.