Efficient ultrasonic signal processing techniques for aided medical diagnostics

Ultrasound imaging is widely used in medical diagnostics as it is the fastest, least invasive, and least expensive imaging modality. However, ultrasound images are intrinsically difficult to be interpreted. In this scenario, Computer Aided Detection (CAD) systems can be used to support physicians during diagnosis providing them a second opinion. This thesis discusses efficient ultrasound processing techniques for computer aided medical diagnostics, focusing on two major topics: (i) Ultrasound Tissue Characterization (UTC), aimed at characterizing and differentiating between healthy and diseased tissue; (ii) Ultrasound Image Segmentation (UIS), aimed at detecting the boundaries of anatomical structures to automatically measure organ dimensions and compute clinically relevant functional indices. Research on UTC produced a CAD tool for Prostate Cancer detection to improve the biopsy protocol. In particular, this thesis contributes with: (i) the development of a robust classification system; (ii) the exploitation of parallel computing on GPU for real-time performance; (iii) the introduction of both an innovative Semi-Supervised Learning algorithm and a novel supervised/semi-supervised learning scheme for CAD system training that improve system performance reducing data collection effort and avoiding collected data wasting. The tool provides physicians a risk map highlighting suspect tissue areas, allowing them to perform a lesion-directed biopsy. Clinical validation demonstrated the system validity as a diagnostic support tool and its effectiveness at reducing the number of biopsy cores requested for an accurate diagnosis. For UIS the research developed a heart disease diagnostic tool based on Real-Time 3D Echocardiography. Thesis contributions to this application are: (i) the development of an automated GPU based level-set segmentation framework for 3D images; (ii) the application of this framework to the myocardium segmentation. Experimental results showed the high efficiency and flexibility of the proposed framework. Its effectiveness as a tool for quantitative analysis of 3D cardiac morphology and function was demonstrated through clinical validation.

Challenges and Opportunities of Machine Learning for Clinical and Omics Data

Clinical and omics data are a promising field of application for machine learning techniques even though these methods are not yet systematically adopted in healthcare institutions. Despite artificial intelligence has proved successful in terms of prediction of pathologies or identification of their causes, the systematic adoption of these techniques still presents challenging issues due to the peculiarities of the analysed data. The aim of this thesis is to apply machine learning algorithms to both clinical and omics data sets in order to predict a patient's state of health and get better insights on the possible causes of the analysed diseases. In doing so, many of the arising issues when working with medical data will be discussed while possible solutions will be proposed to make machine learning provide feasible results and possibly become an effective and reliable support tool for healthcare systems.

Applicazioni tecnologiche e nuovi metodi di valutazione della performance negli sport acquatici

Nello sport di alto livello l’uso della tecnologia ha raggiunto un ruolo di notevole importanza per l’analisi e la valutazione della prestazione. Negli ultimi anni sono emerse nuove tecnologie e sono migliorate quelle pre-esistenti (i.e. accelerometri, giroscopi e software per l’analisi video) in termini di campionamento, acquisizione dati, dimensione dei sensori che ha permesso la loro “indossabilità” e l’inserimento degli stessi all’interno degli attrezzi sportivi. La tecnologia è sempre stata al servizio degli atleti come strumento di supporto per raggiungere l’apice dei risultati sportivi. Per questo motivo la valutazione funzionale dell’atleta associata all’uso di tecnologie si pone lo scopo di valutare i miglioramenti degli atleti misurando la condizione fisica e/o la competenza tecnica di una determinata disciplina sportiva. L’obiettivo di questa tesi è studiare l’utilizzo delle applicazioni tecnologiche e individuare nuovi metodi di valutazione della performance in alcuni sport acquatici. La prima parte (capitoli 1-5), si concentra sulla tecnologia prototipale chiamata E-kayak e le varie applicazioni nel kayak di velocità. In questi lavori è stata verificata l’attendibilità dei dati forniti dal sistema E-kayak con i sistemi presenti in letteratura. Inoltre, sono stati indagati nuovi parametri utili a comprendere il modello di prestazione del paddler. La seconda parte (capitolo 6), si riferisce all’analisi cinematica della spinta verticale del pallanuotista, attraverso l’utilizzo della video analisi 2D, per l’individuazione delle relazioni Forza-velocità e Potenza-velocità direttamente in acqua. Questo studio pilota, potrà fornire indicazioni utili al monitoraggio e condizionamento di forza e potenza da svolgere direttamente in acqua. Infine la terza parte (capitoli 7-8), si focalizza sull’individuazione della sequenza di Fibonacci (sequenza divina) nel nuoto a stile libero e a farfalla. I risultati di questi studi suggeriscono che il ritmo di nuotata tenuto durante le medie/lunghe distanze gioca un ruolo chiave. Inoltre, il livello di autosomiglianza (self-similarity) aumenta con la tecnica del nuoto.

L'edilizia residenziale nell'era dell'economia circolare. Modelli e paradigmi per la rigenerazione delle periferie urbane

Il patrimonio residenziale italiano ammonta a 12,2 milioni di edifici, di cui il 57,5% ha più di 50 anni ed è stato costruito in assenza di normative specifiche, in termini di sicurezza sismica, resistenza al fuoco, efficienza energetica e accessibilità, e manifesta un’avanzata obsolescenza. Agire su questo patrimonio significa operare tramite le due macro categorie di intervento: demolizione/ricostruzione o riqualificazione energetica. Questa ricerca dottorale vuole indagare la demolizione/ricostruzione di comparti urbani periferici, costruiti tra 1945-1965, quale strategia di rigenerazione urbana, integrandola in un modello edilizio basato sui criteri dell’economia circolare. Vengono definite le caratteristiche costruttive e i principi di questo modello di progettazione ecosistemica, denominato Integrho, che coniuga i criteri di ecodesign nel ciclo di vita (Building in Layers, Design for Disassembly e il Design out Waste) con quelli di bioclimaticità e di adattabilità funzionale. Il lavoro è stato improntato secondo due livelli gerarchici, scala urbana e scala edilizia, tra loro correlate mediante quella intermedia dell’isolato, al fine di ottenere un obiettivo di natura metodologica: definire uno strumento di supporto decisionale, capace di indirizzare tra le categorie di intervento attraverso parametri oggettivi, valutati con analisi comparative speditive. Tale metodologia viene applicata al contesto di Bologna, e si fonda sulla creazione di un’approfondita base conoscitiva attraverso la catalogazione delle 8.209 pratiche edilizie di nuova costruzione presentate tra 1945 e il 1965. Tale strumento georeferenziato, contenente informazioni tipologiche, costruttive ecc., è impiegato per valutare in modo quantitativo e speditivo i consumi energetici, i materiali incorporati, gli impatti ambientali e i costi economici dei differenti scenari di intervento nel ciclo di vita. Infine, l’applicazione del modello edilizio Integrho e del paradigma Ri-Costruire per Ri-Generare ad uno degli isolati periferici selezionati, è impiegata come esemplificazione dell’intero processo, dalla fase conoscitiva a quella strumentale, al fine di verificarne l’attendibilità e l’applicabilità su larga scala.

Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

A regional environmental accounting matrix and integrated environmental economic analyses to support regional planning

This research deals with the deepening and use of an environmental accounting matrix in Emilia-Romagna, RAMEA air emissions (regional NAMEA), carried out by the Regional Environment Agency (Arpa) in an European project. After a depiction of the international context regarding the widespread needing to integrate economic indicators and go beyond conventional reporting system, this study explains the structure, update and development of the tool. The overall aim is to outline the matrix for environmental assessments of regional plans, draw up sustainable reports and monitor effects of regional policies in a sustainable development perspective. The work focused on an application of a Shift-Share model, on the integration with eco-taxes, industrial waste production, energy consumptions, on applications of the extended RAMEA as a policy tool, following Eurostat guidelines. The common thread is the eco-efficiency (economic-environmental efficiency) index. The first part, in English, treats the methodology used to build a more complete tool; in the second part RAMEA has been applied on two regional case studies, in Italian, to support decision makers regarding Strategic Environmental Assessments’ processes (2001/42/EC). The aim is to support an evidence-based policy making by integrating sustainable development concerns at all levels. The first case study regards integrated environmental-economic analyses in support to the SEA of the Regional Waste management plan. For the industrial waste production an extended and updated RAMEA has been developed as a useful policy tool, to help in analysing and monitoring the state of environmental-economic performances. The second case study deals with the environmental report for the SEA of the Regional Program concerning productive activities. RAMEA has been applied aiming to an integrated environmental-economic analysis of the context, to investigate the performances of the regional production chains and to depict and monitor the area where the program should be carried out, from an integrated environmental-economic perspective.

Fine tuning of on-growing diets for farmed marine fish species as a key tool to sustain the aquaculture development

The aim of this thesis was to investigate some important key factors able to promote the prospected growth of the aquaculture sector. The limited availability of fishmeal and fish oil led the attention of the aquafeed industry to reduce the dependency on marine raw materials in favor of vegetable ingredients. In Chapter 2, we reported the effects of fishmeal replacement by a mixture of plant proteins in turbot (Psetta maxima L.) juveniles. At the end of the trial, it was found that over the 15% plant protein inclusion can cause stress and exert negative effects on growth performance and welfare. Climate change aroused the attention of the aquafeed industry toward the production of specific diets capable to counteract high temperatures. In Chapter 3, we investigated the most suitable dietary lipid level for gilthead seabream (Sparus aurata L.) reared at Mediterranean summer temperature. In this trial, it was highlighted that 18% dietary lipid allows a protein sparing effect, thus making the farming of this species economically and environmentally more sustainable. The introduction of new farmed fish species makes necessary the development of new species-specific diets. In Chapter 4, we assessed growth response and feed utilization of common sole (Solea solea L.) juveniles fed graded dietary lipid levels. At the end of the trial, it was found that increasing dietary lipids over 8% led to a substantial decline in growth performance and feed utilization indices. In Chapter 5, we investigated the suitability of mussel meal as alternative ingredient in diets for common sole juveniles. Mussel meal proved to be a very effective alternative ingredient for enhancing growth performance, feed palatability and feed utilization in sole irrespectively to the tested inclusion levels. This thesis highlighted the importance of formulating more specific diets in order to support the aquaculture growth in a sustainable way.

Analytical instrumental approaches and strategies to support the sensory assessment of virgin olive oils

At the beginning, this Ph.D. project led to an overview of the most common and emerging types of fraud and possible countermeasures in the olive oil sector. Furthermore, possible weaknesses in the current conformity check system for olive oil were highlighted. Among those, despite the organoleptic assessment is a fundamental tool for establishing the virgin olive oils (VOOs) quality grade, the scientific community has evidenced some drawbacks in it. In particular, the application of instrumental screening methods to support the panel test could reduce the work of sensory panels and the cost of this analysis (e.g. for industries, distributors, public and private control laboratories), permitting the increase in the number and the efficiency of the controls. On this basis, a research line called “Quantitative Panel Test” is one of the main expected outcomes of the OLEUM project that is also partially discussed in this doctoral dissertation. In this framework, analytical activities were carried out, within this PhD project, aimed to develop and validate analytical protocols for the study of the profiles in volatile compounds (VOCs) of the VOOs headspace. Specifically, two chromatographic approaches, one targeted and one semi-targeted, to determine VOCs were investigated in this doctoral thesis. The obtained results, will allow the possible establishment of concentration limits and ranges of selected volatile markers, as related to fruitiness and defects, with the aim to support the panel test in the commercial categorization of VOOs. In parallel, a rapid instrumental screening method based on the analysis of VOCs has been investigated to assist the panel test through a fast pre-classification of VOOs samples based on a known level of probability, thus increasing the efficiency of quality control.