Optimization methods for the operating room management under uncertainty: stochastic programming vs. decomposition approach

The operating theatres are the engine of the hospitals; proper management of the operating rooms and its staff represents a great challenge for managers and its results impact directly in the budget of the hospital. This work presents a MILP model for the efficient schedule of multiple surgeries in Operating Rooms (ORs) during a working day. This model considers multiple surgeons and ORs and different types of surgeries. Stochastic strategies are also implemented for taking into account the uncertain in surgery durations (pre-incision, incision, post-incision times). In addition, a heuristic-based methods and a MILP decomposition approach is proposed for solving large-scale ORs scheduling problems in computational efficient way. All these computer-aided strategies has been implemented in AIMMS, as an advanced modeling and optimization software, developing a user friendly solution tool for the operating room management under uncertainty.

Methods for the analysis of multi-scale cell dynamics from fluorescence microscopy images

La embriogénesis es el proceso mediante el cual una célula se convierte en un ser un vivo. A lo largo de diferentes etapas de desarrollo, la población de células va proliferando a la vez que el embrión va tomando forma y se configura. Esto es posible gracias a la acción de varios procesos genéticos, bioquímicos y mecánicos que interaccionan y se regulan entre ellos formando un sistema complejo que se organiza a diferentes escalas espaciales y temporales. Este proceso ocurre de manera robusta y reproducible, pero también con cierta variabilidad que permite la diversidad de individuos de una misma especie. La aparición de la microscopía de fluorescencia, posible gracias a proteínas fluorescentes que pueden ser adheridas a las cadenas de expresión de las células, y los avances en la física óptica de los microscopios han permitido observar este proceso de embriogénesis in-vivo y generar secuencias de imágenes tridimensionales de alta resolución espacio-temporal. Estas imágenes permiten el estudio de los procesos de desarrollo embrionario con técnicas de análisis de imagen y de datos, reconstruyendo dichos procesos para crear la representación de un embrión digital. Una de las más actuales problemáticas en este campo es entender los procesos mecánicos, de manera aislada y en interacción con otros factores como la expresión genética, para que el embrión se desarrolle. Debido a la complejidad de estos procesos, estos problemas se afrontan mediante diferentes técnicas y escalas específicas donde, a través de experimentos, pueden hacerse y confrontarse hipótesis, obteniendo conclusiones sobre el funcionamiento de los mecanismos estudiados. Esta tesis doctoral se ha enfocado sobre esta problemática intentando mejorar las metodologías del estado del arte y con un objetivo específico: estudiar patrones de deformación que emergen del movimiento organizado de las células durante diferentes estados del desarrollo del embrión, de manera global o en tejidos concretos. Estudios se han centrado en la mecánica en relación con procesos de señalización o interacciones a nivel celular o de tejido. En este trabajo, se propone un esquema para generalizar el estudio del movimiento y las interacciones mecánicas que se desprenden del mismo a diferentes escalas espaciales y temporales. Esto permitiría no sólo estudios locales, si no estudios sistemáticos de las escalas de interacción mecánica dentro de un embrión. Por tanto, el esquema propuesto obvia las causas de generación de movimiento (fuerzas) y se centra en la cuantificación de la cinemática (deformación y esfuerzos) a partir de imágenes de forma no invasiva. Hoy en día las dificultades experimentales y metodológicas y la complejidad de los sistemas biológicos impiden una descripción mecánica completa de manera sistemática. Sin embargo, patrones de deformación muestran el resultado de diferentes factores mecánicos en interacción con otros elementos dando lugar a una organización mecánica, necesaria para el desarrollo, que puede ser cuantificado a partir de la metodología propuesta en esta tesis. La metodología asume un medio continuo descrito de forma Lagrangiana (en función de las trayectorias de puntos materiales que se mueven en el sistema en lugar de puntos espaciales) de la dinámica del movimiento, estimado a partir de las imágenes mediante métodos de seguimiento de células o de técnicas de registro de imagen. Gracias a este esquema es posible describir la deformación instantánea y acumulada respecto a un estado inicial para cualquier dominio del embrión. La aplicación de esta metodología a imágenes 3D + t del pez zebra sirvió para desvelar estructuras mecánicas que tienden a estabilizarse a lo largo del tiempo en dicho embrión, y que se organizan a una escala semejante al del mapa de diferenciación celular y con indicios de correlación con patrones de expresión genética. También se aplicó la metodología al estudio del tejido amnioserosa de la Drosophila (mosca de la fruta) durante el cierre dorsal, obteniendo indicios de un acoplamiento entre escalas subcelulares, celulares y supracelulares, que genera patrones complejos en respuesta a la fuerza generada por los esqueletos de acto-myosina. En definitiva, esta tesis doctoral propone una estrategia novedosa de análisis de la dinámica celular multi-escala que permite cuantificar patrones de manera inmediata y que además ofrece una representación que reconstruye la evolución de los procesos como los ven las células, en lugar de como son observados desde el microscopio. Esta metodología por tanto permite nuevas formas de análisis y comparación de embriones y tejidos durante la embriogénesis a partir de imágenes in-vivo. ABSTRACT The embryogenesis is the process from which a single cell turns into a living organism. Through several stages of development, the cell population proliferates at the same time the embryo shapes and the organs develop gaining their functionality. This is possible through genetic, biochemical and mechanical factors that are involved in a complex interaction of processes organized in different levels and in different spatio-temporal scales. The embryogenesis, through this complexity, develops in a robust and reproducible way, but allowing variability that makes possible the diversity of living specimens. The advances in physics of microscopes and the appearance of fluorescent proteins that can be attached to expression chains, reporting about structural and functional elements of the cell, have enabled for the in-vivo observation of embryogenesis. The imaging process results in sequences of high spatio-temporal resolution 3D+time data of the embryogenesis as a digital representation of the embryos that can be further analyzed, provided new image processing and data analysis techniques are developed. One of the most relevant and challenging lines of research in the field is the quantification of the mechanical factors and processes involved in the shaping process of the embryo and their interactions with other embryogenesis factors such as genetics. Due to the complexity of the processes, studies have focused on specific problems and scales controlled in the experiments, posing and testing hypothesis to gain new biological insight. However, methodologies are often difficult to be exported to study other biological phenomena or specimens. This PhD Thesis is framed within this paradigm of research and tries to propose a systematic methodology to quantify the emergent deformation patterns from the motion estimated in in-vivo images of embryogenesis. Thanks to this strategy it would be possible to quantify not only local mechanisms, but to discover and characterize the scales of mechanical organization within the embryo. The framework focuses on the quantification of the motion kinematics (deformation and strains), neglecting the causes of the motion (forces), from images in a non-invasive way. Experimental and methodological challenges hamper the quantification of exerted forces and the mechanical properties of tissues. However, a descriptive framework of deformation patterns provides valuable insight about the organization and scales of the mechanical interactions, along the embryo development. Such a characterization would help to improve mechanical models and progressively understand the complexity of embryogenesis. This framework relies on a Lagrangian representation of the cell dynamics system based on the trajectories of points moving along the deformation. This approach of analysis enables the reconstruction of the mechanical patterning as experienced by the cells and tissues. Thus, we can build temporal profiles of deformation along stages of development, comprising both the instantaneous events and the cumulative deformation history. The application of this framework to 3D + time data of zebrafish embryogenesis allowed us to discover mechanical profiles that stabilized through time forming structures that organize in a scale comparable to the map of cell differentiation (fate map), and also suggesting correlation with genetic patterns. The framework was also applied to the analysis of the amnioserosa tissue in the drosophila’s dorsal closure, revealing that the oscillatory contraction triggered by the acto-myosin network organized complexly coupling different scales: local force generation foci, cellular morphology control mechanisms and tissue geometrical constraints. In summary, this PhD Thesis proposes a theoretical framework for the analysis of multi-scale cell dynamics that enables to quantify automatically mechanical patterns and also offers a new representation of the embryo dynamics as experienced by cells instead of how the microscope captures instantaneously the processes. Therefore, this framework enables for new strategies of quantitative analysis and comparison between embryos and tissues during embryogenesis from in-vivo images.

Multiple Robots, Single Operator: Considerations About Information And Commanding

Multiple robot, single operator scenarios suppose a challenge in terms of human factors. Two relevant issues are keeping the situational awareness and managing the workload of operators. In order to address these problems, this work analyses the management of information and commands in multi-robot missions. About the information, this paper proposes a selection based on mission and operator states. Regarding the commands, this work reflects about the levels of automation and the methods of commanding.

REFLEXOS INDIVIDUAIS DO USO PESSOAL E EXCESSIVO DE COMUNICADORES INSTANTÂNEOS NO AMBIENTE DE TRABALHO

A Internet está inserida no cotidiano do indivíduo, e torna-se cada vez mais acessível por meio de diferentes tipos de dispositivos. Com isto, diversos estudos foram realizados com o intuito de avaliar os reflexos do seu uso excessivo na vida pessoal, acadêmica e profissional. Esta dissertação buscou identificar se a perda de concentração e o isolamento social são alguns dos reflexos individuais que o uso pessoal e excessivo de aplicativos de comunicação instantânea podem resultar no ambiente de trabalho. Entre as variáveis selecionadas para avaliar os aspectos do uso excessivo de comunicadores instantâneos tem-se a distração digital, o controle reduzido de impulso, o conforto social e a solidão. Através de uma abordagem de investigação quantitativa, utilizaram-se escalas aplicadas a uma amostra de 283 pessoas. Os dados foram analisados por meio de técnicas estatísticas multivariadas como a Análise Fatorial Exploratória e para auferir a relação entre as variáveis, a Regressão Linear Múltipla. Os resultados deste estudo confirmam que o uso excessivo de comunicadores instantâneos está positivamente relacionado com a perda de concentração, e a variável distração digital exerce uma influência maior do que o controle reduzido de impulso. De acordo com os resultados, não se podem afirmar que a solidão e o conforto social exercem relações com aumento do isolamento social, devido à ausência do relacionamento entre os construtos.

Multiple genetic modifications of the erythromycin polyketide synthase to produce a library of novel “unnatural” natural products

The structures of complex polyketide natural products, such as erythromycin, are programmed by multifunctional polyketide synthases (PKSs) that contain modular arrangements of functional domains. The colinearity between the activities of modular PKS domains and structure of the polyketide product portends the generation of novel organic compounds—“unnatural” natural products—by genetic manipulation. We have engineered the erythromycin polyketide synthase genes to effect combinatorial alterations of catalytic activities in the biosynthetic pathway, generating a library of >50 macrolides that would be impractical to produce by chemical methods. The library includes examples of analogs with one, two, and three altered carbon centers of the polyketide products. The manipulation of multiple biosynthetic steps in a PKS is an important milestone toward the goal of producing large libraries of unnatural natural products for biological and pharmaceutical applications.

Two-dimensional infrared spectroscopy of peptides by phase-controlled femtosecond vibrational photon echoes

Two-dimensional infrared spectra of peptides are introduced that are the direct analogues of two- and three-pulse multiple quantum NMR. Phase matching and heterodyning are used to isolate the phase and amplitudes of the electric fields of vibrational photon echoes as a function of multiple pulse delays. Structural information is made available on the time scale of a few picoseconds. Line narrowed spectra of acyl-proline-NH2 and cross peaks implying the coupling between its amide-I modes are obtained, as are the phases of the various contributions to the signals. Solvent-sensitive structural differences are seen for the dipeptide. The methods show great promise to measure structure changes in biology on a wide range of time scales.

A novel multiple affinity purification tag and its use in identification of proteins associated with a cyclin–CDK complex

A novel multiple affinity purification (MAFT) or tandem affinity purification (TAP) tag has been constructed. It consists of the calmodulin binding peptide, six histidine residues, and three copies of the hemagglutinin epitope. This ‘CHH’ MAFT tag allows two or three consecutive purification steps, giving high purity. Active Clb2–Cdc28 kinase complex was purified from yeast cells after inserting the CHH tag into Clb2. Associated proteins were identified using mass spectrometry. These included the known associated proteins Cdc28, Sic1 and Cks1. Several other proteins were found including the 70 kDa chaperone, Ssa1.

Multiple DNA and protein sequence alignment based on segment-to-segment comparison.

In this paper, a new way to think about, and to construct, pairwise as well as multiple alignments of DNA and protein sequences is proposed. Rather than forcing alignments to either align single residues or to introduce gaps by defining an alignment as a path running right from the source up to the sink in the associated dot-matrix diagram, we propose to consider alignments as consistent equivalence relations defined on the set of all positions occurring in all sequences under consideration. We also propose constructing alignments from whole segments exhibiting highly significant overall similarity rather than by aligning individual residues. Consequently, we present an alignment algorithm that (i) is based on segment-to-segment comparison instead of the commonly used residue-to-residue comparison and which (ii) avoids the well-known difficulties concerning the choice of appropriate gap penalties: gaps are not treated explicity, but remain as those parts of the sequences that do not belong to any of the aligned segments. Finally, we discuss the application of our algorithm to two test examples and compare it with commonly used alignment methods. As a first example, we aligned a set of 11 DNA sequences coding for functional helix-loop-helix proteins. Though the sequences show only low overall similarity, our program correctly aligned all of the 11 functional sites, which was a unique result among the methods tested. As a by-product, the reading frames of the sequences were identified. Next, we aligned a set of ribonuclease H proteins and compared our results with alignments produced by other programs as reported by McClure et al. [McClure, M. A., Vasi, T. K. & Fitch, W. M. (1994) Mol. Biol. Evol. 11, 571-592]. Our program was one of the best scoring programs. However, in contrast to other methods, our protein alignments are independent of user-defined parameters.

Ultra-fast excited state dynamics in green fluorescent protein: multiple states and proton transfer.

The green fluorescent protein (GFP) of the jellyfish Aequorea Victoria has attracted widespread interest since the discovery that its chromophore is generated by the autocatalytic, posttranslational cyclization and oxidation of a hexapeptide unit. This permits fusion of the DNA sequence of GFP with that of any protein whose expression or transport can then be readily monitored by sensitive fluorescence methods without the need to add exogenous fluorescent dyes. The excited state dynamics of GFP were studied following photo-excitation of each of its two strong absorption bands in the visible using fluorescence upconversion spectroscopy (about 100 fs time resolution). It is shown that excitation of the higher energy feature leads very rapidly to a form of the lower energy species, and that the excited state interconversion rate can be markedly slowed by replacing exchangeable protons with deuterons. This observation and others lead to a model in which the two visible absorption bands correspond to GFP in two ground-state conformations. These conformations can be slowly interconverted in the ground state, but the process is much faster in the excited state. The observed isotope effect suggests that the initial excited state process involves a proton transfer reaction that is followed by additional structural changes. These observations may help to rationalize and motivate mutations that alter the absorption properties and improve the photo stability of GFP.

Simultaneous assessment of loss of heterozygosity at multiple microsatellite loci using semi-automated fluorescence-based detection: subregional mapping of chromosome 4 in cervical carcinoma.

Detection of loss of heterozygosity (LOH) by comparison of normal and tumor genotypes using PCR-based microsatellite loci provides considerable advantages over traditional Southern blotting-based approaches. However, current methodologies are limited by several factors, including the numbers of loci that can be evaluated for LOH in a single experiment, the discrimination of true alleles versus "stutter bands," and the use of radionucleotides in detecting PCR products. Here we describe methods for high throughput simultaneous assessment of LOH at multiple loci in human tumors; these methods rely on the detection of amplified microsatellite loci by fluorescence-based DNA sequencing technology. Data generated by this approach are processed by several computer software programs that enable the automated linear quantitation and calculation of allelic ratios, allowing rapid ascertainment of LOH. As a test of this approach, genotypes at a series of loci on chromosome 4 were determined for 58 carcinomas of the uterine cervix. The results underscore the efficacy, sensitivity, and remarkable reproducibility of this approach to LOH detection and provide subchromosomal localization of two regions of chromosome 4 commonly altered in cervical tumors.

Aladdin's Magic Lamp: Developing Methods for Calibration and Geolocation Accuracy Assessment of the DMSP OLS

Nighttime satellite imagery from the Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS) has a unique capability to observe nocturnal light emissions from sources including cities, wild fires, and gas flares. Data from the DMSP OLS is used in a wide range of studies including mapping urban areas, estimating informal economies, and estimating urban populations. Given the extensive and increasing list of applications a repeatable method for assessing geolocation accuracy, performing inter-calibration, and defining the minimum detectable brightness would be beneficial. An array of portable lights was designed and taken to multiple field sites known to have no other light sources. The lights were operated during nighttime overpasses by the DMSP OLS and observed in the imagery. A first estimate of the minimum detectable brightness is presented based on the field experiments conducted. An assessment of the geolocation accuracy was performed by measuring the distance between the GPS measured location of the lights and the observed location in the imagery. A systematic shift was observed and the mean distance was measured at 2.9km. A method for in situ radiance calibration of the DMSP OLS using a ground based light source as an active target is presented. The wattage of light used by the active target strongly correlates with the signal measured by the DMSP OLS. This approach can be used to enhance our ability to make inter-temporal and inter-satellite comparisons of DMSP OLS imagery. Exploring the possibility of establishing a permanent active target for the calibration of nocturnal imaging systems is recommended. The methods used to assess the minimum detectable brightness, assess the geolocation accuracy, and build inter-calibration models lay the ground work for assessing the energy expended on light emitted into the sky at night. An estimate of the total energy consumed to light the night sky globally is presented.

What We Are Learning About the Diverse Backgrounds of Academic Library Users: An Overview of Research Designs and Methods in Information Behaviour Studies

Academic libraries increasingly serve a more diverse population of users not only in regard to race and ethnicity, but also to age, gender, language, sexual orientation, and national and cultural backgrounds. This papers reports the findings of the study that explored information behaviour research as a potential source of information about diversity of academic library users and examined the relationship between the use of different research designs and data collection methods and the information gathered about users’ diverse backgrounds. The study found that information behaviour research offers limited insight into the diversity of academic library users. The choice of a research design was not critical but the use of multiple data collection played a role in gathering information about culturally diverse users.

Beta diversity at multiple hierarchical levels: explaining the high diversity of scarab beetles in tropical montane forests

Aim: High gamma diversity in tropical montane forests may be ascribed to high geographical turnover of community composition, resulting from population isolation that leads to speciation. We studied the evolutionary processes responsible for diversity and turnover in assemblages of tropical scarab beetles (Scarabaeidae) by assessing DNA sequence variation at multiple hierarchical levels. Location: A 300-km transect across six montane forests (900–1100 m) in Costa Rica. Methods: Assemblages of Scarabaeidae (subfamilies Dynastinae, Rutelinae, Melolonthinae) including 118 morphospecies and > 500 individuals were sequenced for the cox1 gene to establish species limits with a mixed Yule–coalescent method. A species-level phylogenetic tree was constructed from cox1 and rrnL genes. Total diversity and turnover among assemblages were then assessed at three hierarchical levels: haplotypes, species and higher clades. Results: DNA-based analyses showed high turnover among communities at all hierarchical levels. Turnover was highest at the haplotype level (community similarity 0.02–0.12) and decreased with each step of the hierarchy (species: 0.21–0.46; clades: 0.41–0.43). Both compositional and phylogenetic similarities of communities were geographically structured, but turnover was not correlated with distance among forests. When three major clades were investigated separately, communities of Dynastinae showed consistently higher alpha diversity, larger species ranges and lower turnover than Rutelinae and Melolonthinae. Main conclusions: Scarab communities of montane forests show evidence of evolutionary persistence of communities in relative isolation, presumably tracking suitable habitats elevationally to accommodate climatic changes. Patterns of diversity on all hierarchical levels seem to be determined by restricted dispersal, and differences in Dynastinae could be explained by their greater dispersal ability. Community-wide DNA sequencing across multiple lineages and hierarchical levels reveals the evolutionary processes that led to high beta diversity in tropical montane forests through time.

Notificação de incidentes e segurança do doente : perceção dos enfermeiros

Enquadramento: A segurança do doente é um problema internacional e uma prioridade das políticas de saúde de múltiplos organismos/instituições nacionais de saúde. Neste âmbito, surgem os sistemas de notificação de incidentes. Objetivo: Conhecer a perceção dos enfermeiros sobre a notificação de incidentes e sobre a segurança do doente. Métodos: Recorremos a uma triangulação metodológica constituída por um estudo quantitativo (estudo A) e outro qualitativo (estudo B). O estudo A é analítico, transversal, realizado com 182 enfermeiros. Os dados foram recolhidos por questionário, constituído por variáveis sociodemográficas e profissionais e escalas para avaliar doze dimensões da notificação e segurança do doente. O estudo B é exploratório, realizado com 18 enfermeiros, através de entrevista semiestruturada. Resultados: Para os enfermeiros todos os incidentes devem ser notificados, mas a frequência de notificação é baixa e diminui com a gravidade do dano, 65,0% não registou qualquer ocorrência no último ano e 82,3% desconhece o sistema de notificação. Os principais obstáculos à notificação são o receio de punição e os principais fatores facilitadores são os benefícios que advêm da notificação para o doente, a ausência de retaliações no trabalho, uma relação positiva com os superiores hierárquicos, o anonimato e a perceção de resultados da notificação. Aproximadamente 60,0% dos enfermeiros tem uma perceção geral da segurança do doente positiva. Conclusão: A perceção dos enfermeiros sobre a notificação de incidentes reflete desconhecimento da temática, elevado receio de punição, originando baixa frequência de notificação. A perceção sobre a segurança do doente é positiva. É necessário melhorar a cultura de segurança da organização e o conhecimento dos enfermeiros sobre o papel da notificação. Palavras-Chave: segurança do doente, notificação de incidentes, enfermeiros.

Using multiple landscape genetic approaches to test the validity of genetic clusters in a species characterized by an isolation-by-distance pattern

Bayesian clustering methods are typically used to identify barriers to gene flow, but they are prone to deduce artificial subdivisions in a study population characterized by an isolation-by-distance pattern (IbD). Here we analysed the landscape genetic structure of a population of wild boars (Sus scrofa) from south-western Germany. Two clustering methods inferred the presence of the same genetic discontinuity. However, the population in question was characterized by a strong IbD pattern. While landscape-resistance modelling failed to identify landscape features that influenced wild boar movement, partial Mantel tests and multiple regression of distance matrices (MRDMs) suggested that the empirically inferred clusters were separated by a genuine barrier. When simulating random lines bisecting the study area, 60% of the unique barriers represented, according to partial Mantel tests and MRDMs, significant obstacles to gene flow. By contrast, the random-lines simulation showed that the boundaries of the inferred empirical clusters corresponded to the most important genetic discontinuity in the study area. Given the degree of habitat fragmentation separating the two empirical partitions, it is likely that the clustering programs correctly identified a barrier to gene flow. The differing results between the work published here and other studies suggest that it will be very difficult to draw general conclusions about habitat permeability in wild boar from individual studies.