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.

Wind plant interaction with series-compensated power systems

Wind power based generation has been rapidly growing world-wide during the recent past. In order to transmit large amounts of wind power over long distances, system planners may often add series compensation to existing transmission lines owing to several benefits such as improved steady-state power transfer limit, improved transient stability, and efficient utilization of transmission infrastructure. Application of series capacitors has posed resonant interaction concerns such as through subsynchronous resonance (SSR) with conventional turbine-generators. Wind turbine-generators may also be susceptible to such resonant interactions. However, not much information is available in literature and even engineering standards are yet to address these issues. The motivation problem for this research is based on an actual system switching event that resulted in undamped oscillations in a 345-kV series-compensated, typical ring-bus power system configuration. Based on time-domain ATP (Alternative Transients Program) modeling, simulations and analysis of system event records, the occurrence of subsynchronous interactions within the existing 345-kV series-compensated power system has been investigated. Effects of various small-signal and large-signal power system disturbances with both identical and non-identical wind turbine parameters (such as with a statistical-spread) has been evaluated. Effect of parameter variations on subsynchronous oscillations has been quantified using 3D-DFT plots and the oscillations have been identified as due to electrical self-excitation effects, rather than torsional interaction. Further, the generator no-load reactance and the rotor-side converter inner-loop controller gains have been identified as bearing maximum sensitivity to either damping or exacerbating the self-excited oscillations. A higher-order spectral analysis method based on modified Prony estimation has been successfully applied to the field records identifying dominant 9.79 Hz subsynchronous oscillations. Recommendations have been made for exploring countermeasures.

Law in a Linguistic Battlefield: The Language of the New State Versus the ‘Language of the Oppressors’ in Ukraine

Article 10 of the 1996 Ukrainian Constitution proclaims that “The state language of Ukraine shall be the Ukrainian language” but continues: “Free development, use, and protection of Russian and other languages of national minorities of Ukraine shall be guaranteed in Ukraine.” Consolidating the position of the state language was at the centre of the "Orange Revolution", but President Yanukovich, elected in February 2010, has committed himself to a defence of the Russian language, as a regional language of Ukraine, and the battle is on to replace the Law on Languages of the Ukrainian SSR of 1989, which is still in force. Ukraine has ratified the Council of Europe’s European Charter for Regional or Minority Languages. This article reflects on the relation between language and law, and endeavours to bring clarity to a situation which at times resembles an overheated kettle about to explode.

Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry

PURPOSE The SWISSspine registry (SSR) was launched in 2005 to assess the safety and effectiveness of balloon kyphoplasty (BKP). In the meantime, repeated reports on high rates of adjacent vertebral fractures (ASF) after BKP of vertebral insufficiency fractures were published. The causes for ASF and their risk factors are still under debate. The purpose of this study was to report the incidence and potential risk factors of ASF within the SSR dataset. METHODS The SSR data points are collected perioperatively and during follow-ups, with surgeon- and patient-based information. All patients documented with a monosegmental osteoporotic vertebral insufficiency fracture between March 2005 and May 2012 were included in the study. The incidence of ASF, significant associations with co-variates (patient age, gender, fracture location, cement volume, preoperative segmental kyphosis, extent of kyphosis correction, and individual co-morbidities) and influence on quality of life (EQ-5D) and back pain (VAS) were analyzed. RESULTS A total of 375 patients with a mean follow-up of 3.6 months was included. ASF were found in 9.9 % (n = 37) and occurred on average 2.8 months postoperatively. Preoperative segmental kyphosis >30° (p = 0.026), and rheumatoid arthritis (p = 0.038) and cardiovascular disease (p = 0.047) were significantly associated with ASF. Furthermore, patients with ASF had significantly higher back pain at the final follow-up (p = 0.001). No further significant associations between the studied co-variates and ASF were seen in the adjusted analysis. CONCLUSIONS The findings suggest that patients with a preoperative segmental kyphosis >30° or patients with co-morbidities like rheumatoid arthritis and a cardiovascular disease are at high risk of ASF within 6 months after the index surgery. In case of an ASF event, back pain levels are significantly increased. LEVEL OF EVIDENCE IV.

Genome and transcriptome sequencing identifies breeding targets in the orphan crop tef (Eragrostis tef)

Background: Tef (Eragrostis tef), an indigenous cereal critical to food security in the Horn of Africa, is rich in minerals and protein, resistant to many biotic and abiotic stresses and safe for diabetics as well as sufferers of immune reactions to wheat gluten. We present the genome of tef, the first species in the grass subfamily Chloridoideae and the first allotetraploid assembled de novo. We sequenced the tef genome for marker-assisted breeding, to shed light on the molecular mechanisms conferring tef's desirable nutritional and agronomic properties, and to make its genome publicly available as a community resource. Results: The draft genome contains 672 Mbp representing 87% of the genome size estimated from flow cytometry. We also sequenced two transcriptomes, one from a normalized RNA library and another from unnormalized RNASeq data. The normalized RNA library revealed around 38000 transcripts that were then annotated by the SwissProt group. The CoGe comparative genomics platform was used to compare the tef genome to other genomes, notably sorghum. Scaffolds comprising approximately half of the genome size were ordered by syntenic alignment to sorghum producing tef pseudo-chromosomes, which were sorted into A and B genomes as well as compared to the genetic map of tef. The draft genome was used to identify novel SSR markers, investigate target genes for abiotic stress resistance studies, and understand the evolution of the prolamin family of proteins that are responsible for the immune response to gluten. Conclusions: It is highly plausible that breeding targets previously identified in other cereal crops will also be valuable breeding targets in tef. The draft genome and transcriptome will be of great use for identifying these targets for genetic improvement of this orphan crop that is vital for feeding 50 million people in the Horn of Africa.

Mining microsatellite markers from public expressed sequence tags databases for the study of threatened plants

Background Simple Sequence Repeats (SSRs) are widely used in population genetic studies but their classical development is costly and time-consuming. The ever-increasing available DNA datasets generated by high-throughput techniques offer an inexpensive alternative for SSRs discovery. Expressed Sequence Tags (ESTs) have been widely used as SSR source for plants of economic relevance but their application to non-model species is still modest. Methods Here, we explored the use of publicly available ESTs (GenBank at the National Center for Biotechnology Information-NCBI) for SSRs development in non-model plants, focusing on genera listed by the International Union for the Conservation of Nature (IUCN). We also search two model genera with fully annotated genomes for EST-SSRs, Arabidopsis and Oryza, and used them as controls for genome distribution analyses. Overall, we downloaded 16 031 555 sequences for 258 plant genera which were mined for SSRsand their primers with the help of QDD1. Genome distribution analyses in Oryza and Arabidopsis were done by blasting the sequences with SSR against the Oryza sativa and Arabidopsis thaliana reference genomes implemented in the Basal Local Alignment Tool (BLAST) of the NCBI website. Finally, we performed an empirical test to determine the performance of our EST-SSRs in a few individuals from four species of two eudicot genera, Trifolium and Centaurea. Results We explored a total of 14 498 726 EST sequences from the dbEST database (NCBI) in 257 plant genera from the IUCN Red List. We identify a very large number (17 102) of ready-to-test EST-SSRs in most plant genera (193) at no cost. Overall, dinucleotide and trinucleotide repeats were the prevalent types but the abundance of the various types of repeat differed between taxonomic groups. Control genomes revealed that trinucleotide repeats were mostly located in coding regions while dinucleotide repeats were largely associated with untranslated regions. Our results from the empirical test revealed considerable amplification success and transferability between congenerics. Conclusions The present work represents the first large-scale study developing SSRs by utilizing publicly accessible EST databases in threatened plants. Here we provide a very large number of ready-to-test EST-SSR (17 102) for 193 genera. The cross-species transferability suggests that the number of possible target species would be large. Since trinucleotide repeats are abundant and mainly linked to exons they might be useful in evolutionary and conservation studies. Altogether, our study highly supports the use of EST databases as an extremely affordable and fast alternative for SSR developing in threatened plants.

Binary recombinase systems for high-resolution conditional mutagenesis.

Conditional mutagenesis using Cre recombinase expressed from tissue specific promoters facilitates analyses of gene function and cell lineage tracing. Here, we describe two novel dual-promoter-driven conditional mutagenesis systems designed for greater accuracy and optimal efficiency of recombination. Co-Driver employs a recombinase cascade of Dre and Dre-respondent Cre, which processes loxP-flanked alleles only when both recombinases are expressed in a predetermined temporal sequence. This unique property makes Co-Driver ideal for sequential lineage tracing studies aimed at unraveling the relationships between cellular precursors and mature cell types. Co-InCre was designed for highly efficient intersectional conditional transgenesis. It relies on highly active trans-splicing inteins and promoters with simultaneous transcriptional activity to reconstitute Cre recombinase from two inactive precursor fragments. By generating native Cre, Co-InCre attains recombination rates that exceed all other binary SSR systems evaluated in this study. Both Co-Driver and Co-InCre significantly extend the utility of existing Cre-responsive alleles.

Cometary Isotopic Measurements

Isotopic ratios in comets provide keys for the understanding of the origin of cometary material, and the physical and chemical conditions in the early Solar Nebula. We review here measurements acquired on the D/H, N-14/N-15, O-16/O-18, C-12/C-13, and S-32/S-34 ratios in cometary grains and gases, and discuss their cosmogonic implications. The review includes analyses of potential cometary material available in collections on Earth, recent measurements achieved with the Herschel Space Observatory, large optical telescopes, and Rosetta, as well as recent results obtained from models of chemical-dynamical deuterium fractionation in the early solar nebula. Prospects for future measurements are presented.

Caracterización molecular de variedades de vid ( Vitis vinifera L.) de calidad enológica por marcadores microsatelitales

Siete variedades de vid empleadas en Argentina para la elaboración de vinos de alta gama fueron caracterizadas molecularmente a través del empleo de microsatélites. Seis de los 8 pares de cebadores usados amplificaron patrones de bandas reproducibles. El número de alelos detectados por locus varió entre 5 y 10, con un total de 42 alelos, registrándose desde 1 a 7 alelos únicos. El número de genotipos microsatélites encontrados para cada locus osciló entre 3 y 7, con un total de 28. Las variedades Tempranillo y Chenin mostraron 6 y 5 genotipos «únicos», respectivamente, con los 6 loci analizados. La heterocigosidad observada varió entre 42,9 y 100 %, mientras que la heterocigosidad esperada osciló entre 64,3 y 87,8 %. El locus más informativo fue VrZAG79 (con un contenido de información polimórfica de 84,9 % y un número de alelos efectivos de 8,17) mientras que el menos informativo fue VrZAG62. La probabilidad acumulada de obtener genotipos idénticos fue de 7,68 x 10-05 indicando que, mediante el uso combinado de estos 6 cebadores microsatélites se pueden discriminar todas las variedades ensayadas, con alto grado de certeza. El análisis de agrupamiento por el método UPGMA separó claramente las variedades francesas (Merlot, Pinot Noir y Cabernet Sauvignon) y Syrah de los cepajes Tempranillo y Bonarda. Esta técnica podría ofrecerse como servicio a viveristas y productores vitícolas interesados en garantizar la identidad genética de sus materiales comercializados.

Assessing the identity of the variety 'Pedro Giménez' grown in Argentina through the use of microsatellite markers

Pedro Giménez' is a white criolla variety cropped in Argentina, mainly in Mendoza and San Juan, being the most planted white variety destined for wine making in the country. Its origin remains unknown, as well as its relationship with Spanish variety 'Pedro Ximénez', mostly grown in Jerez, Spain. Previous works have probed that most of Criollas varieties existing in America at the moment, are the offspring of 'Muscat of Alexandria' x 'Criolla Chica'. The aim of the present work was to compare 'Pedro Giménez' with the Spanish variety 'Pedro Ximénez', and to establish its degree of relatedness to 'Muscat of Alexandria' and 'Criolla Chica'. Therefore we used a set of 18 nuclear SSR loci and 3 chloroplast SSR loci. 'Pedro Giménez' shared only 38% of the alleles under analysis with 'Pedro Ximénez', indicating that they are indeed two different varieties. In all 18 polymorphic nuclear SSR loci 'Pedro Giménez' shared 50% of its alleles with 'Muscat of Alexandria', while the other 50% of the alleles present in 'Pedro Giménez' were also present in 'Criolla Chica'. This data, along with those from the chloroplast SSR analysis, strongly suggest that 'Pedro Giménez' is the progeny of 'Muscat of Alexandria' x 'Criolla Chica', being the latest one the most likely female progenitor.

Distancias genéticas entre perfiles moleculares obtenidos desde marcadores multilocus multialélicos

Para expresar la magnitud de la identidad genética (similaridad) o su complemento (distancia) entre dos individuos caracterizados molecularmente a través de marcadores del tipo microsatélites (SSR), que son multilocusmultialélicos, es necesario elegir una métrica acorde con la naturaleza multivariada de los datos. Comúnmente, las métricas de distancias genéticas son diseñadas para expresar, en un único número, la diferencia genética entre dos poblaciones y son expresadas como función de la frecuencia alélica poblacional. Dichas métricas pueden también ser utilizadas para calcular la distancia entre perfiles individuales, pero las frecuencias alélicas no son continuas en este caso. Alternativamente, se pueden usar distancias geométricas obtenidas como el complemento del índice de similaridad para datos binarios que indican la presencia/ ausencia de cada alelo en un individuo. El objetivo de este trabajo fue evaluar simultáneamente el desempeño de ambos tipos de métricas para ordenar y clasificar individuos en una base de datos generadas a partir de loci de marcadores microsatélites SSR. Se calcularon 11 métricas de distancias a partir de 17 loci SSR obtenidos desde 17 introducciones de un banco de germoplasma de soja [Glycine max (L.) Merr.]. Se evaluó el consenso de los resultados obtenidos para la clasificación de los 17 perfiles moleculares desde varias métricas. Los resultados sugieren que los diferentes tipos de métricas producen información similar para comparar individuos. No obstante, se realizó una clasificación de las métricas que responden a diferencias entre los núcleos de las expresiones de cálculo.

Lineamientos estratégicos para la garantía de prestaciones prioritarias en materia de salud sexual y reproductiva

El presente documento contiene un conjunto de lineamientos cuyo objetivo central es servir como una herramienta orientadora a la formulación de prestaciones prioritarias e integrales en SSR y para identificar estrategias efectivas, de modo que estas prestaciones se incorporen en las políticas y sistemas de salud con solidez y sustentabilidad. También estos lineamientos tienen como propósito contribuir a impulsar o fortalecer la integración de la SSR como un eje estratégico en los procesos de cambios de los sistemas de salud desde una perspectiva que entiende la participación y la construcción de consensos como dimensiones clave de esos procesos. Este eje estratégico puede ser utilizado como un «centinela» para evaluar el adecuado funcionamiento de sistemas de salud basados en la promoción y prevención para el diseño e implementación de cambios. Este documento no pretende ser una manual. Es una guía para orientar las decisiones políticas y técnicas que deberá ser necesariamente adaptada a los contextos de cada país, dado que todo proceso de diseño e implementación de una política pública depende estrechamente del sistema administrativo, la tendencia política del gobierno, las características de los recursos físicos y humanos disponibles, y el marco normativo que regula el sistema de salud.1 Por ello, la imagen de una «ruta crítica» expresa el sentido político estratégico que esta guía pretende ofrecer.