An evolutionary approach to the design of experiments for combinatorial optimization with an application to enzyme engineering

In a large number of problems the high dimensionality of the search space, the vast number of variables and the economical constrains limit the ability of classical techniques to reach the optimum of a function, known or unknown. In this thesis we investigate the possibility to combine approaches from advanced statistics and optimization algorithms in such a way to better explore the combinatorial search space and to increase the performance of the approaches. To this purpose we propose two methods: (i) Model Based Ant Colony Design and (ii) Naïve Bayes Ant Colony Optimization. We test the performance of the two proposed solutions on a simulation study and we apply the novel techniques on an appplication in the field of Enzyme Engineering and Design.

Synthetical engineering of supramolecular properties of large polycyclic aromatic hydrocarbons

An important property for devices is the charge-carrier mobility values for discotic organic materials like hexa-peri-hexabenzocoronenes. A close relation exists between the degree of their columnar self-arrangement of the molecules and their mobilities. Within this first step an induction of a higher order via hydrogen-bonding was considered, which mainly pointed towards the improvement of the intracolumnar stacking of the materials. For the analytics a broad range of methods was used including differential scanning calorimetry (DSC), wide-angle X-ray diffractometry (WAXS), solid-state NMR spectroscopy and scanning tunneling microscopy (STM). Indeed, a specific influence of the hydrogen-bonds could be identified, although in several cases by the cost of a severe reduction of solubility and processability. This effect was dampened by the addition of a long alkyl chain next to the hydrogen-bond exerting functional group, which resulted in an improved columnar arrangement by retention of processability. In contrast to the before mentioned example of inducing a higher intracolumnar order by hydrogen-bonding, the focus was also be set upon larger aromatic systems. The charge-carrier mobility is also in close relation to the size of the aromatic core and larger π-areas are expected to lead to improved mobilities. For photovoltaic applications a high extinction coefficient over a broad range of the spectrum is favorable, which can also be achieved by enlarging the aromatic core component. In addition the stronger π-interactions between the aromatic core components should yield an improved columnar stability and order. However the strengthening of the π-interactions between the aromatic core components led to a reduction of the solubility and the processability due to the stronger aggregation of the molecules. This required the introduction of efficiently solubilizing features in terms of long alkyl chains in the corona of the aromatic entity, in combination of a distortion of the aromatic core moiety by bulky tert-butyl groups. By this approach not only the processing and cleaning of the materials with standard laboratory techniques became possible, but moreover the first structure-rich UV/vis and a resolved 1H-NMR spectra for an aromatic system two times larger than hexa-peri-hexabenzocoronene were recorded. The bulk properties in an extruded fiber as well as on the surface showed a columnar self-assembly including a phase in which a homeotropic alignment on a substrate was observed, which turns the material into an interesting candidate for future applications in electronic devices.

Reconstructive Microsurgery and Tissue Engineering in Musculo-Skeletal Oncology - Innovative Techniques

Tumors involving bone and soft tissues are extremely challenging situations. With the recent advances of multi-modal treatment, not only the type of surgery has moved from amputation to limb-sparing procedures, but also the survivorship has improved considerably and reconstructive techniques have the goal to allow a considerably higher quality of life. In bone reconstruction, tissue engineering strategies are the main area of research. Re-vascularization and re-vitalisation of a massive allograft would considerably improve the outcome of biological reconstructions. Using a rabbit animal model, in this study we showed that, by implanting a vascular pedicle inside a weight bearing massive cortical allograft, the bone regeneration inside the allograft was higher compared to the non-vascularized implants, given the patency of the vascular pedicle. Improvement in the animal model and the addition of Stem Cells and Growth factors will allow a further improvement in the results. In soft tissue tumors, free and pedicled flaps have been proven to be of great help as reconstruction strategies. In this study we analyzed the functional and overall outcome of 14 patients who received a re-innervated vascularized flap. We have demonstrated that the use of the innovative technique of motor re-innervated muscular flaps is effective when the resection involves important functional compartments of the upper or lower limb, with no increase of post-operative complications. Although there was no direct comparison between this type of reconstruction and the standard non-innervated reconstruction, we underlined the remarkable high overall functional scores and patient satisfaction following this procedure.

Sustainable inorganic Binders and Their Applications in Building Engineering: A Green Alternative to Ordinary Portland Cement

In the last decades, the building materials and construction industry has been contributing to a great extent to generate a high impact on our environment. As it has been considered one of the key areas in which to operate to significantly reduce our footprint on environment, there has been widespread belief that particular attention now has to be paid and specific measures have to be taken to limit the use of non-renewable resources.The aim of this thesis is therefore to study and evaluate sustainable alternatives to commonly used building materials, mainly based on ordinary Portland Cement, and find a supportable path to reduce CO2 emissions and promote the re-use of waste materials. More specifically, this research explores different solutions for replacing cementitious binders in distinct application fields, particularly where special and more restricting requirements are needed, such as restoration and conservation of architectural heritage. Emphasis was thus placed on aspects and implications more closely related to the concept of non-invasivity and environmental sustainability. A first part of the research was addressed to the study and development of sustainable inorganic matrices, based on lime putty, for the pre-impregnation and on-site binding of continuous carbon fiber fabrics for structural rehabilitation and heritage restoration. Moreover, with the aim to further limit the exploitation of non-renewable resources, the synthesis of chemically activated silico-aluminate materials, as metakaolin, ladle slag or fly ash, was thus successfully achieved. New sustainable binders were hence proposed as novel building materials, suitable to be used as primary component for construction and repair mortars, as bulk materials in high-temperature applications or as matrices for high-toughness fiber reinforced composites.

Engineering Concurrent and Event-driven Web Apps: An Agent-Oriented Approach based on the simpAL Language

Web is constantly evolving, thanks to the 2.0 transition, HTML5 new features and the coming of cloud-computing, the gap between Web and traditional desktop applications is tailing off. Web-apps are more and more widespread and bring several benefits compared to traditional ones. On the other hand reference technologies, JavaScript primarly, are not keeping pace, so a paradim shift is taking place in Web programming, and so many new languages and technologies are coming out. First objective of this thesis is to survey the reference and state-of-art technologies for client-side Web programming focusing in particular on what concerns concurrency and asynchronous programming. Taking into account the problems that affect existing technologies, we finally design simpAL-web, an innovative approach to tackle Web-apps development, based on the Agent-oriented programming abstraction and the simpAL language. == Versione in italiano: Il Web è in continua evoluzione, grazie alla transizione verso il 2.0, alle nuove funzionalità introdotte con HTML5 ed all’avvento del cloud-computing, il divario tra le applicazioni Web e quelle desktop tradizionali va assottigliandosi. Le Web-apps sono sempre più diffuse e presentano diversi vantaggi rispetto a quelle tradizionali. D’altra parte le tecnologie di riferimento, JavaScript in primis, non stanno tenendo il passo, motivo per cui la programmazione Web sta andando incontro ad un cambio di paradigma e nuovi linguaggi e tecnologie stanno spuntando sempre più numerosi. Primo obiettivo di questa tesi è di passare al vaglio le tecnologie di riferimento ed allo stato dell’arte per quel che riguarda la programmmazione Web client-side, porgendo particolare attenzione agli aspetti inerenti la concorrenza e la programmazione asincrona. Considerando i principali problemi di cui soffrono le attuali tecnologie passeremo infine alla progettazione di simpAL-web, un approccio innovativo con cui affrontare lo sviluppo di Web-apps basato sulla programmazione orientata agli Agenti e sul linguaggio simpAL.

Genetic engineering and preclinical evaluation of oncolytic herpes simplex viruses retargeted to cancer-specific receptors

Oncolytic virotherapy exploits the ability of viruses to infect and kill cells. It is suitable as treatment for tumors that are not accessible by surgery and/or respond poorly to the current therapeutic approach. HSV is a promising oncolytic agent. It has a large genome size able to accommodate large transgenes and some attenuated oncolytic HSVs (oHSV) are already in clinical trials phase I and II. The aim of this thesis was the generation of HSV-1 retargeted to tumor-specific receptors and detargeted from HSV natural receptors, HVEM and Nectin-1. The retargeting was achieved by inserting a specific single chain antibody (scFv) for the tumor receptor selected inside the HSV glycoprotein gD. In this research three tumor receptors were considered: epidermal growth factor receptor 2 (HER2) overexpressed in 25-30% of breast and ovarian cancers and gliomas, prostate specific membrane antigen (PSMA) expressed in prostate carcinomas and in neovascolature of solid tumors; and epidermal growth factor receptor variant III (EGFRvIII). In vivo studies on HER2 retargeted viruses R-LM113 and R-LM249 have demonstrated their high safety profile. For R-LM249 the antitumor efficacy has been highlighted by target-specific inhibition of the growth of human tumors in models of HER2-positive breast and ovarian cancer in nude mice. In a murine model of HER2-positive glioma in nude mice, R-LM113 was able to significantly increase the survival time of treated mice compared to control. Up to now, PSMA and EGFRvIII viruses (R-LM593 and R-LM613) are only characterized in vitro, confirming the specific retargeting to selected targets. This strategy has proved to be generally applicable to a broad spectrum of receptors for which a single chain antibody is available.

Engineering Agent-Oriented Technologies and Programming Languages for Computer Programming and Software Development

Mainstream hardware is becoming parallel, heterogeneous, and distributed on every desk, every home and in every pocket. As a consequence, in the last years software is having an epochal turn toward concurrency, distribution, interaction which is pushed by the evolution of hardware architectures and the growing of network availability. This calls for introducing further abstraction layers on top of those provided by classical mainstream programming paradigms, to tackle more effectively the new complexities that developers have to face in everyday programming. A convergence it is recognizable in the mainstream toward the adoption of the actor paradigm as a mean to unite object-oriented programming and concurrency. Nevertheless, we argue that the actor paradigm can only be considered a good starting point to provide a more comprehensive response to such a fundamental and radical change in software development. Accordingly, the main objective of this thesis is to propose Agent-Oriented Programming (AOP) as a high-level general purpose programming paradigm, natural evolution of actors and objects, introducing a further level of human-inspired concepts for programming software systems, meant to simplify the design and programming of concurrent, distributed, reactive/interactive programs. To this end, in the dissertation first we construct the required background by studying the state-of-the-art of both actor-oriented and agent-oriented programming, and then we focus on the engineering of integrated programming technologies for developing agent-based systems in their classical application domains: artificial intelligence and distributed artificial intelligence. Then, we shift the perspective moving from the development of intelligent software systems, toward general purpose software development. Using the expertise maturated during the phase of background construction, we introduce a general-purpose programming language named simpAL, which founds its roots on general principles and practices of software development, and at the same time provides an agent-oriented level of abstraction for the engineering of general purpose software systems.

Reverse Engineering tools: development and experimentation of innovative methods for physical and geometrical data integration and post-processing

In recent years, the use of Reverse Engineering systems has got a considerable interest for a wide number of applications. Therefore, many research activities are focused on accuracy and precision of the acquired data and post processing phase improvements. In this context, this PhD Thesis deals with the definition of two novel methods for data post processing and data fusion between physical and geometrical information. In particular a technique has been defined for error definition in 3D points’ coordinates acquired by an optical triangulation laser scanner, with the aim to identify adequate correction arrays to apply under different acquisition parameters and operative conditions. Systematic error in data acquired is thus compensated, in order to increase accuracy value. Moreover, the definition of a 3D thermogram is examined. Object geometrical information and its thermal properties, coming from a thermographic inspection, are combined in order to have a temperature value for each recognizable point. Data acquired by an optical triangulation laser scanner are also used to normalize temperature values and make thermal data independent from thermal-camera point of view.

Performance based earthquake engineering: Il metodo P.E.E.R. applicazione su un caso di studio.

L’approccio performance-based nell’Ingegneria sismica è una metodologia di progetto che tiene esplicitamente in conto la performance dell’edificio tra i criteri progettuali. Nell’ambito dei metodi PBEE (Performance-Based Earthquake Engineering) di seconda generazione, quello proposto dal PEER (Pacific Earthquake Engineering Research Center) risulta essere il più diffuso. In esso la performance dell’edificio oggetto di studio viene valutata in termini quantitativi secondo le 3D’s (dollars, deaths, downtime – soldi, decessi, inutilizzo), quantità di notevole interesse per l’utente finale. Il metodo si compone di quattro step, indipendenti tra loro fino alla sintesi finale. Essi sono: l’analisi di pericolosità, l’analisi strutturale, l’analisi di danno, l’analisi delle perdite o di loss. Il risultato finale è la curva di loss, che assegna ad ogni possibile perdita economica conseguente all’evento sismico una probabilità di superamento nell’arco temporale di riferimento. Dopo la presentazione del metodo PEER, si è provveduto ad una sua applicazione su di un caso di studio, nella fattispecie un telaio piano di quattro campate, multipiano, in calcestruzzo armato, costruito secondo le norme del ’92. Per l’analisi di pericolosità si è fatto ricorso alle mappe di pericolosità disponibili sul sito INGV, mentre per l’analisi strutturale si è utilizzato il software open-source OpenSees. Le funzioni di fragilità e quelle di loss sono state sviluppate facendo riferimento alla letteratura scientifica, in particolare il bollettino Fib numero 68 “Probabilistic performance-based seismic design”. In questa sede ci si è concentrati unicamente sulla stima delle perdite economiche, tralasciando le altre due variabili decisionali. Al termine del procedimento si è svolta un’analisi di sensitività per indagare quali parametri influenzino maggiormente la curva di loss. Data la curva di pericolosità, il legame EDP(IM) e la deformazione ultima a collasso risultano essere i più rilevanti sul risultato dell’analisi.

Complex chemical dynamics through engineering-like methods

Most of the problems in modern structural design can be described with a set of equation; solutions of these mathematical models can lead the engineer and designer to get info during the design stage. The same holds true for physical-chemistry; this branch of chemistry uses mathematics and physics in order to explain real chemical phenomena. In this work two extremely different chemical processes will be studied; the dynamic of an artificial molecular motor and the generation and propagation of the nervous signals between excitable cells and tissues like neurons and axons. These two processes, in spite of their chemical and physical differences, can be both described successfully by partial differential equations, that are, respectively the Fokker-Planck equation and the Hodgkin and Huxley model. With the aid of an advanced engineering software these two processes have been modeled and simulated in order to extract a lot of physical informations about them and to predict a lot of properties that can be, in future, extremely useful during the design stage of both molecular motors and devices which rely their actions on the nervous communications between active fibres.

Skin tissue engineering: medical problems and technological solutions.

In questo elaborato si affrontano problematiche cliniche legate ai traumi gravi della cute in cui è necessario intervenire chirurgicamente per ripristinare una situazione normale: si approfondisce lo studio della fisiologia del tessuto, la classificazione dei gradi delle ustioni della pelle, la guarigione delle ferite e la meccanica della cute. Il trapianto di tessuto autologo costituisce la soluzione più efficace e con minori complicazioni. Tuttavia il paziente potrebbe non presentare una superficie di cute disponibile sufficientemente estesa, per cui si ricorre ad altri metodi. In primo luogo, si effettuano degli allotrapianti di tessuto di donatore cadavere prelevati secondo le normative vigenti e conservati attraverso le varie tecniche, il cui sviluppo ha consentito una durata di conservazione maggiore; mentre la glicerolizzazione abbatte al 100% il rischio di trasmissione di patologie e lo sviluppo di microorganismi, la crioconservazione preserva la vitalità del tessuto. La chirurgia utilizzata per queste operazioni si avvale di tecnologie innovative come la Tecnologia a Pressione Negativa. Un'alternativa necessaria per sopperire all'ingente richiesta di tessuto di donatore sono i sostituti cutanei, che presentano un grande potenziale per il futuro. Per eliminare totalmente il rischio di rigetto sarebbe necessario personalizzare il costrutto utilizzando cellule autologhe, ma la ricerca è stata rallentata da minori investimenti da parte dell'industria biomedica, che si è maggiormente focalizzata sulla realizzazione di prodotti utilizzabili da un più ampio raggio di pazienti. Per queste ragioni, l'ingegneria tissutale della cute ha trovato più ampio campo di applicazione nel sistema dei test in vitro. A tale scopo sono stati creati dei protocolli certificati per testare la corrosività, la irritabilità e la vitalità del tessuto cutaneo, quali EpiDerm, EpiSkin e SkinEthic che si avvalgono dell'uso del metodo MMT e della spettrofotometria, che è diventata un supporto fondamentale per le scienze biologiche.

Ottimizzazione di un sistema di tracciabilità a supporto della reliability system engineering per un produttore di beni strumentali: il caso Sacmi

Questa tesi di laurea è stata redatta presso l’azienda Sacmi Imola S.C. ed in particolare all’interno della divisione Closures, che si occupa della progettazione e della realizzazione di linee per la produzione di varie tipologie di capsule. Lo scopo dell’elaborato è descrivere lo sviluppo di un sistema di tracciabilità di prodotto; sistemi di questo tipo, adottati inizialmente nel settore alimentare, stanno acquisendo sempre maggiore importanza anche in altri campi produttivi, poiché rivestono un ruolo strategico al fine della realizzazione di prodotti caratterizzati da livelli elevati di performance e di qualità, capaci di emergere nel mercato moderno caratterizzato da una concorrenza estesa a livello mondiale e molto attento alle esigenze dei clienti. Nel caso specifico di Sacmi il sistema di tracciabilità si rivolge ad una pressa, la CCM (Continuous Compression Moulder), realizzata dall’azienda per la produzione di capsule in materiale termoplastico tramite la tecnologia dello stampaggio a compressione. In particolare il sistema si concentra sugli stampi della macchina CCM, i quali ne rappresentano gli elementi critici dal punto di vista sia tecnico che economico. A livello generale, un sistema di tracciabilità è costituito da due componenti fondamentali: il primo è un sistema di identificazione che permetta di rendere distinguibili ed individuabili le unità da tracciare, mentre il secondo è un sistema di raccolta dati in grado di raccogliere le informazioni desiderate. Queste sono poi archiviate in un apposito database ed attribuite alle entità corrispondenti sfruttando le proprietà del sistema di identificazione. Il primo passo da compiere quando si intende sviluppare un sistema di tracciabilità all’interno di un contesto produttivo già consolidato è la ricostruzione del processo produttivo presente in azienda: si tratta di individuare tutti gli enti aziendali che concorrono al processo e che saranno interessati dall’introduzione del nuovo sistema. Una volta definiti gli attori, è necessario anche capire come questi siano collegati dai flussi di materiale e di informazioni. Il processo produttivo di Sacmi era caratterizzato dalla quasi totale assenza di un flusso strutturato di informazioni a supporto di quello di materiale, ed il sistema di tracciabilità ha provveduto a colmare proprio questa mancanza. Il sistema deve essere in grado di integrarsi perfettamente nel contesto produttivo aziendale: è necessario trovare il giusto compromesso per quanto riguarda la quantità di informazioni da raccogliere, che devono garantire una corretta copertura di tutto il processo senza però appesantirlo eccessivamente. E’ bene che la raccolta dati sia basata su procedure standard che assicurino la ripetibilità delle operazioni di prelievo delle informazioni. Come è logico immaginarsi, l’introduzione di numerose novità nell’ambito di un contesto già strutturato ha fatto emergere un certo numero di problematiche, come ad esempio difficoltà nello stoccaggio e ritardi di produzione; queste devono essere risolte chiedendo uno sforzo aggiuntivo agli enti interessati o, nel medio/lungo periodo, evolvendo ed affinando il sistema con soluzioni più snelle.

Crystal Engineering of bright luminescent copper iodide clusters with phosphorus and nitrogen-based ligands

Copper(I) halide clusters are recently considered as good candidate for optoelectronic devices such as OLEDs . Although the copper halide clusters, in particular copper iodide, are very well known since the beginning of the 20th century, only in the late ‘70s the interest on these compounds grew dramatically due their particular photophysical behaviour. These complexes are characterized by a dual triplet emission bands, named Cluster Centred (3CC) and Halogen-to-Ligand charge transfer (3XLCT), the intensities of which are strictly related with the temperature. The CC transition, due to the presence of a metallophylic interactions, is prevalent at ambient temperature while the XLCT transition, located preferentially on the ligand part, became more prominent at low temperature. Since these pioneering works, it was easy to understand the photophysical properties of this compounds became more interesting in solid-state respect to solution with an improvement in emission efficiency. In this work we aim to characterize in SS organocopper(I)iodide compounds to valuate the correlation between the molecular crystal structure and the photophysical properties. It is also considered to hike new strategies to synthesize CuI complexes from the wet reactions to the more green solvent free methods. The advantages in using these strategies are evident but, obtain a single crystal suitable for SCXRD analysis from these batches is quite impossible. The structure solution still remains the key point in this research so we tackle this problem solving the structure by X-ray powder diffraction data. When the sample was fully characterized we moved to design and development of the associated OLED-device. Since copper iodide complexes are often insoluble in organic solvents, the high vacuum deposition technique is preferred. A new non-conventional deposition process have also been proposed to avoid the low complex stability in this practice with an in-situ complex formation in a layer-by layer deposition route.

Electrospun Polymeric Scaffolds with Enhanced Biomimetic Properties for Tissue Engineering Applications

This PhD Thesis is focused on the development of fibrous polymeric scaffolds for tissue engineering applications and on the improvement of scaffold biomimetic properties. Scaffolds were fabricated by electrospinning, which allows to obtain scaffolds made of polymeric micro or nanofibers. Biomimetism was enhanced by following two approaches: (1) the use of natural biopolymers, and (2) the modification of the fibers surface chemistry. Gelatin was chosen for its bioactive properties and cellular affinity, however it lacks in mechanical properties. This problem was overcome by adding poly(lactic acid) to the scaffold through co-electrospinning and mechanical properties of the composite constructs were assessed. Gelatin effectively improves cell growth and viability and worth noting, composite scaffolds of gelatin and poly(lactic acid) were more effective than a plain gelatin scaffold. Scaffolds made of pure collagen fibers were fabricated. Modification of collagen triple helix structure in electrospun collagen fibers was studied. Mechanical properties were evaluated before and after crosslinking. The crosslinking procedure was developed and optimized by using - for the first time on electrospun collagen fibers - the crosslinking reactant 1,4-butanediol diglycidyl ether, with good results in terms of fibers stabilization. Cell culture experiments showed good results in term of cell adhesion and morphology. The fiber surface chemistry of electrospun poly(lactic acid) scaffold was modified by plasma treatment. Plasma did not affect thermal and mechanical properties of the scaffold, while it greatly increased its hydrophilicity by the introduction of carboxyl groups at the fiber surface. This fiber functionalization enhanced the fibroblast cell viability and spreading. Surface modifications by chemical reactions were conducted on electrospun scaffolds made of a polysophorolipid. The aim was to introduce a biomolecule at the fiber surface. By developing a series of chemical reactions, one oligopeptide every three repeating units of polysophorolipid was grafted at the surface of electrospun fibers.

Role of outgrowth endothelial cells for applications in tissue engineering

Co-culture systems, consisting of outgrowth endothelial cells (OEC) and primary osteoblasts (pOB), represent a prom¬ising instrument to mimick the natural conditions in bone repair processes and provide a new concept to develop constructs for bone replacement. Furthermore, co-culture of OEC and pOB could provide new insights into the molecular and cellular mechanisms that control essential processes during bone repair. The present study described several advantages of the co-culture of pOB and OEC for bone tissue engineering applications, including beneficial effects on the angiogenic activation of OEC, as well as on the assembly of basement membrane matrix molecules and factors involved in vessel maturation and stabilization. The ongoing angiogenic process in the co-culture system proceeded during the course of co-cultivation and correlated with the upregulation of essential angiogenic factors, such as VEGF, angiopoietins, basement membrane molecules and mural cell-specific markers. Furthermore the co-culture system appeared to maintain osteogenic differentiation capacity.rnrnAdditional treatment of co-cultures with growth factors or morphogens might accelerate and improve bone formation and furthermore could be useful for potential clinical applications. In this context, the present study highlights the central role of the morphogen, sonic hedgehog, which has been shown to affect angiogenic activation as well as osteogenic differentiation in the co-culture model of OEC and pOB. Treatment of co-cultures with sonic hedgehog resulted in an increased formation of microvessel-like structures as early as after 24 hours. This proangiogenic effect was induced by the upregulation of the proangiogenic factors, VEGF, angiopoietin1 and angiopoietin 2. In contrast to treatment with a commonly used proangiogenic agent, VEGF, Shh stimulation induced an increased expression of factors associated with vessel maturation and stabilization, mediated through the upregulation of growth factors that are strongly involved in pericyte differentiation and recruitment, including PDGF-BB and TGFbeta. In addition, Shh treatment of co-cultures also resulted in an upregulation of osteogenic differentiation markers like alkaline phosphatase, osteocalcin, osteonectin and osteopontin, as well as an increased matrix calcification. This was a result of upregulation of the osteogenic differentiation regulating factors, BMP2 and RUNX2 which could be assessed in response to Shh treatment. rn