Accessibility and demand at an Emergency Care Unit: the user's perspective

AIM: To analyze the search for Emergency Care (EC) in the Western Health District of Ribeirão Preto (São Paulo), in order to identify the reasons why users turn to these services in situations that are not characterized as urgencies and emergencies. METHODS: A qualitative and descriptive study was undertaken. A guiding script was applied to 23 EC users, addressing questions related to health service accessibility and welcoming, problem solving, reason to visit the EC and care comprehensiveness. RESULTS: The subjects reported that, at the Primary Health Care services, receiving care and scheduling consultations took a long time and that the opening hours of these services coincide with their work hours. At the EC service, access to technologies and medicines was easier. CONCLUSION: Primary health care services have been unable to turn into the entry door to the health system, being replaced by emergency services, putting a significant strain on these services' capacity.

Strong iron demand during hypoxia-induced erythropoiesis is associated with down-regulation of iron-related proteins and myoglobin in human skeletal muscle

[EN] Iron is essential for oxygen transport because it is incorporated in the heme of the oxygen-binding proteins hemoglobin and myoglobin. An interaction between iron homeostasis and oxygen regulation is further suggested during hypoxia, in which hemoglobin and myoglobin syntheses have been reported to increase. This study gives new insights into the changes in iron content and iron-oxygen interactions during enhanced erythropoiesis by simultaneously analyzing blood and muscle samples in humans exposed to 7 to 9 days of high altitude hypoxia (HA). HA up-regulates iron acquisition by erythroid cells, mobilizes body iron, and increases hemoglobin concentration. However, contrary to our hypothesis that muscle iron proteins and myoglobin would also be up-regulated during HA, this study shows that HA lowers myoglobin expression by 35% and down-regulates iron-related proteins in skeletal muscle, as evidenced by decreases in L-ferritin (43%), transferrin receptor (TfR; 50%), and total iron content (37%). This parallel decrease in L-ferritin and TfR in HA occurs independently of increased hypoxia-inducible factor 1 (HIF-1) mRNA levels and unchanged binding activity of iron regulatory proteins, but concurrently with increased ferroportin mRNA levels, suggesting enhanced iron export. Thus, in HA, the elevated iron requirement associated with enhanced erythropoiesis presumably elicits iron mobilization and myoglobin down-modulation, suggesting an altered muscle oxygen homeostasis.

Significance of non‐sinking particulate organic carbon and dark CO2 fixation to heterotrophic carbon demand in the mesopelagic northeast Atlantic

[EN] It is generally assumed that sinking particulate organic carbon (POC) constitutes the main source of organic carbon supply to the deep ocean's food webs. However, a major discrepancy between the rates of sinking POC supply (collected with sediment traps) and the prokaryotic organic carbon demand (the total amount of carbon required to sustain the heterotrophic metabolism of the prokaryotes; i.e., production plus respiration, PCD) of deep-water communities has been consistently reported for the dark realm of the global ocean. While the amount of sinking POC flux declines exponentially with depth, the concentration of suspended, buoyant non-sinking POC (nsPOC; obtained with oceanographic bottles) exhibits only small variations with depth in the (sub)tropical Northeast Atlantic. Based on available data for the North Atlantic we show here that the sinking POC flux would contribute only 4–12% of the PCD in the mesopelagic realm (depending on the primary production rate in surface waters). The amount of nsPOC potentially available to heterotrophic prokaryotes in the mesopelagic realm can be partly replenished by dark dissolved inorganic carbon fixation contributing between 12% to 72% to the PCD daily. Taken together, there is evidence that the mesopelagic microheterotrophic biota is more dependent on the nsPOC pool than on the sinking POC supply. Hence, the enigmatic major mismatch between the organic carbon demand of the deep-water heterotrophic microbiota and the POC supply rates might be substantially smaller by including the potentially available nsPOC and its autochthonous production in oceanic carbon cycling models.

A GIS based model for solving the planar Huff problem considering different demand distributions and forbidden regions

[EN] In this paper, we have used Geographical Information Systems (GIS) to solve the planar Huff problem considering different demand distributions and forbidden regions. Most of the papers connected with the competitive location problems consider that the demand is aggregated in a finite set of points. In other few cases, the models suppose that the demand is distributed along the feasible region according to a functional form, mainly a uniform distribution. In this case, in addition to the discrete and uniform demand distributions we have considered that the demand is represented by a population surface model, that is, a raster map where each pixel has associated a value corresponding to the population living in the area that it covers...

Improved ground motion intensity measures for reliability-based demand analysis of structures

In Performance-Based Earthquake Engineering (PBEE), evaluating the seismic performance (or seismic risk) of a structure at a designed site has gained major attention, especially in the past decade. One of the objectives in PBEE is to quantify the seismic reliability of a structure (due to the future random earthquakes) at a site. For that purpose, Probabilistic Seismic Demand Analysis (PSDA) is utilized as a tool to estimate the Mean Annual Frequency (MAF) of exceeding a specified value of a structural Engineering Demand Parameter (EDP). This dissertation focuses mainly on applying an average of a certain number of spectral acceleration ordinates in a certain interval of periods, Sa,avg (T1,…,Tn), as scalar ground motion Intensity Measure (IM) when assessing the seismic performance of inelastic structures. Since the interval of periods where computing Sa,avg is related to the more or less influence of higher vibration modes on the inelastic response, it is appropriate to speak about improved IMs. The results using these improved IMs are compared with a conventional elastic-based scalar IMs (e.g., pseudo spectral acceleration, Sa ( T(¹)), or peak ground acceleration, PGA) and the advanced inelastic-based scalar IM (i.e., inelastic spectral displacement, Sdi). The advantages of applying improved IMs are: (i ) "computability" of the seismic hazard according to traditional Probabilistic Seismic Hazard Analysis (PSHA), because ground motion prediction models are already available for Sa (Ti), and hence it is possibile to employ existing models to assess hazard in terms of Sa,avg, and (ii ) "efficiency" or smaller variability of structural response, which was minimized to assess the optimal range to compute Sa,avg. More work is needed to assess also "sufficiency" and "scaling robustness" desirable properties, which are disregarded in this dissertation. However, for ordinary records (i.e., with no pulse like effects), using the improved IMs is found to be more accurate than using the elastic- and inelastic-based IMs. For structural demands that are dominated by the first mode of vibration, using Sa,avg can be negligible relative to the conventionally-used Sa (T(¹)) and the advanced Sdi. For structural demands with sign.cant higher-mode contribution, an improved scalar IM that incorporates higher modes needs to be utilized. In order to fully understand the influence of the IM on the seismis risk, a simplified closed-form expression for the probability of exceeding a limit state capacity was chosen as a reliability measure under seismic excitations and implemented for Reinforced Concrete (RC) frame structures. This closed-form expression is partuclarly useful for seismic assessment and design of structures, taking into account the uncertainty in the generic variables, structural "demand" and "capacity" as well as the uncertainty in seismic excitations. The assumed framework employs nonlinear Incremental Dynamic Analysis (IDA) procedures in order to estimate variability in the response of the structure (demand) to seismic excitations, conditioned to IM. The estimation of the seismic risk using the simplified closed-form expression is affected by IM, because the final seismic risk is not constant, but with the same order of magnitude. Possible reasons concern the non-linear model assumed, or the insufficiency of the selected IM. Since it is impossibile to state what is the "real" probability of exceeding a limit state looking the total risk, the only way is represented by the optimization of the desirable properties of an IM.

A multimedia system to produce and deliver video fragments on demand on parliamentary websites

[EN]Parliamentary websites have become one of the most important windows for citizens and media to follow the activities of their legislatures and to hold parliaments to account. Therefore, most parliamentary institutions aim to provide new multimedia solutions capable of displaying video fragments on demand on plenary activities. This paper presents a multimedia system for parliamentary institutions to produce video fragments on demand through a website with linked information and public feedback that helps to explain the content shown in these fragments. A prototype implementation has been developed for the Canary Islands Parliament (Spain) and shows how traditional parliamentary streaming systems can be enhanced by the use of semantics and computer vision for video analytics...

Neutronics analyses for fast spectrum nuclear systems and scenario studies for advanced nuclear fuel cycles

The present PhD thesis summarizes the three-years study about the neutronic investigation of a new concept nuclear reactor aiming at the optimization and the sustainable management of nuclear fuel in a possible European scenario. A new generation nuclear reactor for the nuclear reinassance is indeed desired by the actual industrialized world, both for the solution of the energetic question arising from the continuously growing energy demand together with the corresponding reduction of oil availability, and the environment question for a sustainable energy source free from Long Lived Radioisotopes and therefore geological repositories. Among the Generation IV candidate typologies, the Lead Fast Reactor concept has been pursued, being the one top rated in sustainability. The European Lead-cooled SYstem (ELSY) has been at first investigated. The neutronic analysis of the ELSY core has been performed via deterministic analysis by means of the ERANOS code, in order to retrieve a stable configuration for the overall design of the reactor. Further analyses have been carried out by means of the Monte Carlo general purpose transport code MCNP, in order to check the former one and to define an exact model of the system. An innovative system of absorbers has been conceptualized and designed for both the reactivity compensation and regulation of the core due to cycle swing, as well as for safety in order to guarantee the cold shutdown of the system in case of accident. Aiming at the sustainability of nuclear energy, the steady-state nuclear equilibrium has been investigated and generalized into the definition of the ``extended'' equilibrium state. According to this, the Adiabatic Reactor Theory has been developed, together with a New Paradigm for Nuclear Power: in order to design a reactor that does not exchange with the environment anything valuable (thus the term ``adiabatic''), in the sense of both Plutonium and Minor Actinides, it is required indeed to revert the logical design scheme of nuclear cores, starting from the definition of the equilibrium composition of the fuel and submitting to the latter the whole core design. The New Paradigm has been applied then to the core design of an Adiabatic Lead Fast Reactor complying with the ELSY overall system layout. A complete core characterization has been done in order to asses criticality and power flattening; a preliminary evaluation of the main safety parameters has been also done to verify the viability of the system. Burn up calculations have been then performed in order to investigate the operating cycle for the Adiabatic Lead Fast Reactor; the fuel performances have been therefore extracted and inserted in a more general analysis for an European scenario. The present nuclear reactors fleet has been modeled and its evolution simulated by means of the COSI code in order to investigate the materials fluxes to be managed in the European region. Different plausible scenarios have been identified to forecast the evolution of the European nuclear energy production, including the one involving the introduction of Adiabatic Lead Fast Reactors, and compared to better analyze the advantages introduced by the adoption of new concept reactors. At last, since both ELSY and the ALFR represent new concept systems based upon innovative solutions, the neutronic design of a demonstrator reactor has been carried out: such a system is intended to prove the viability of technology to be implemented in the First-of-a-Kind industrial power plant, with the aim at attesting the general strategy to use, to the largest extent. It was chosen then to base the DEMO design upon a compromise between demonstration of developed technology and testing of emerging technology in order to significantly subserve the purpose of reducing uncertainties about construction and licensing, both validating ELSY/ALFR main features and performances, and to qualify numerical codes and tools.

Automated Analysis Methods for the Assessment of Bicycle Infrastructure and Demand

A first phase of the research activity has been related to the study of the state of art of the infrastructures for cycling, bicycle use and methods for evaluation. In this part, the candidate has studied the "bicycle system" in countries with high bicycle use and in particular in the Netherlands. Has been carried out an evaluation of the questionnaires of the survey conducted within the European project BICY on mobility in general in 13 cities of the participating countries. The questionnaire was designed, tested and implemented, and was later validated by a test in Bologna. The results were corrected with information on demographic situation and compared with official data. The cycling infrastructure analysis was conducted on the basis of information from the OpenStreetMap database. The activity consisted in programming algorithms in Python that allow to extract data from the database infrastructure for a region, to sort and filter cycling infrastructure calculating some attributes, such as the length of the arcs paths. The results obtained were compared with official data where available. The structure of the thesis is as follows: 1. Introduction: description of the state of cycling in several advanced countries, description of methods of analysis and their importance to implement appropriate policies for cycling. Supply and demand of bicycle infrastructures. 2. Survey on mobility: it gives details of the investigation developed and the method of evaluation. The results obtained are presented and compared with official data. 3. Analysis cycling infrastructure based on information from the database of OpenStreetMap: describes the methods and algorithms developed during the PhD. The results obtained by the algorithms are compared with official data. 4. Discussion: The above results are discussed and compared. In particular the cycle demand is compared with the length of cycle networks within a city. 5. Conclusions

Plasmonic nanorods and nanoparticle-assemblies

Die vorliegenden Dissertation beschäftigt sich mit plasmonischen Nanopartikeln, deren Wechselwirkung mit Licht in einer Plasmonenschwingung resultiert. Suspensionen dieser Partikel zeigen kräftige Farben, da sich die Resonanzfrequenz der Plasmonenschwingung im sichtbaren Bereich des elektromagnetischen Spektrum befindet. Durch die Veränderung interner (Material, Größe, Form) oder externer Parameter (Brechungsindex der Umgebung, Abstand zu anderen plasmonischen Partikeln) lässt sich die Farbe der Partikel verändern, eine Verschiebung der Resonanzfrequenz kann beobachtet werden. Ihre Sensitivität gegenüber äußeren Bedingungen ist der Grund, weshalb plasmonische Nanopartikel als Sensoren eingesetzt werden können. Wichtig ist hierbei nicht nur, dass die Partikel eine hohe Sensitivität zeigen, sondern auch die Möglichkeit, reproduzierbar Partikel zu synthetisieren, die experimentellen Anforderungen entsprechen. In der vorliegenden Arbeit wird das Wachstum von reinen Gold- und mit Silber beschichteten Goldnanostäbchen untersucht. Des Weiteren werden plasmonische Nanopartikel als Orientierungs-, Brechungsindex- und Abstandssensoren verwendet. Die Synthese von Goldnanostäbchen erfolgt auf nasschemischen Weg, ihr anisotropes Wachstum aus isotropen Keimen wird durch zahlreiche Faktoren beeinflusst. In diesem Zusammenhang wurde ein Wachstumsmodell entwickelt, das neben dem Vorhandensein eines Stabilisators auch die Rolle von Bromid- und Silberionen herausstellt, die durch selektive Adsorption das Wachstum bestimmter Kristallflächen inhibieren. Zudem konnte gezeigt werden, dass die Potentialdifferenz zwischen Reduktions- und Oxidationsmittel klein sein muss, um ein langsames selektives Wachstum zu gewährleisten. rnDurch das Aufwachsen einer dünnen Silberschicht auf Goldnanostäbchen verbessert sich deren Qualität im Bezug auf die heterogene Linienbreite. Der “Plasmonic Focusing Effect”, die Änderung der Steigung des linearen Zusammenhangs von Plasmonenresonanz und Aspektverhältnis, konnte theoretisch berechnet und experimentell verifiziert werden. Durch die Aufnahme zeitaufgelöster Spektren und die Untersuchung des Verlaufs der Reaktion wurden sowohl Reaktionsordnung, als auch Aktivierungsenergie ermittelt. Das so gefundene kinetische Model erlaubt zudem die Vorhersage des Reaktionsprodukts zu verschiedenen Zeiten. rnEinzelne Goldnanostäbchen wurden in einer Gelmatrix bei verschiedenen Temperaturen untersucht, die Aufnahme der zeitlichen Variation der polarisationsabhängigen Streuintensität konnte genutzt werden, um den Kollaps des Gels zu charakterisieren. Neben der Verwendung einzelner plasmonischer Nanopartikel wurden auch Dimere, bestehend aus zwei Goldnanokugeln, untersucht. Nach der Kalibrierung der Resonanzfrequenz gegenüber des Abstandes der beiden Partikel durch externe Methoden (Lichtstreuung, Cryo- Elektronenmikroskopie) wurde der so gefundene exponentielle Zusammenhang verwendet, um sowohl den Brechungsindex der Umgebung, als auch den Abstand der beiden Goldnanokugeln zu bestimmen. Des Weiteren wurden Goldnanopartikeldimere benutzt, um ein als Linker verwendetes thermoresponsives Elastin-Polymer bei verschiedenen Temperaturen zu charakterisieren. Neben Aggregaten aus zwei Goldnanokugeln wurden auch so genannte “core-satellite” Strukturen synthetisiert, die um einen großen Goldnanopartikelkern viele kleine Goldnanopartikel tragen. Diese Partikel haben eine theoretisch vorhergesagte höhere Sensitivität gegenüber Brechungsindexänderungen, was in ersten Experimenten gezeigt werden konnte.

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.