Design of experiment in drug development: optimal allocations in multi-arm clinical trials and design space for multi-step processes

In this thesis, we deal with the design of experiments in the drug development process, focusing on the design of clinical trials for treatment comparisons (Part I) and the design of preclinical laboratory experiments for proteins development and manufacturing (Part II). In Part I we propose a multi-purpose design methodology for sequential clinical trials. We derived optimal allocations of patients to treatments for testing the efficacy of several experimental groups by also taking into account ethical considerations. We first consider exponential responses for survival trials and we then present a unified framework for heteroscedastic experimental groups that encompasses the general ANOVA set-up. The very good performance of the suggested optimal allocations, in terms of both inferential and ethical characteristics, are illustrated analytically and through several numerical examples, also performing comparisons with other designs proposed in the literature. Part II concerns the planning of experiments for processes composed of multiple steps in the context of preclinical drug development and manufacturing. Following the Quality by Design paradigm, the objective of the multi-step design strategy is the definition of the manufacturing design space of the whole process and, as we consider the interactions among the subsequent steps, our proposal ensures the quality and the safety of the final product, by enabling more flexibility and process robustness in the manufacturing.

New insights into vaginal environment during pregnancy: a multi-omics approach

The present thesis aims to provide a thorough comprehension of the vaginal ecosystem of pregnant women and enhance the knowledge of pregnancy pathophysiology. The first study emphasized the importance of limiting protein intake from animal sources, consuming carbohydrates, and avoiding starting pregnancy overweight to maintain a healthy vaginal environment characterized by lactobacilli and related metabolites. In the second paper, a reduction in bacterial diversity, an increase in Lactobacillus abundance, and a decrease in bacterial vaginosis-related genera were observed during pregnancy. Lactobacillus abundance correlated with higher levels of lactate, sarcosine, and amino acids, while bacterial vaginosis-related genera were associated with amines, formate, acetate, alcohols, and short-chain fatty acids. An association between intrapartum antibiotic prophylaxis for Group B Streptococcus and higher vaginal abundance of Prevotella was found. Moreover, women experiencing a first-trimester miscarriage displayed a higher abundance of Fusobacterium. The third study explored the presence of macrolides and tetracyclines resistance genes in the vaginal environment, highlighting that different vaginal microbiota types were associated with distinct resistance profiles. Lactobacilli-dominated ecosystems showed fewer or no resistance genes, while women with increased bacterial vaginosis-related genera were positive for resistance genes. The last two papers aimed to identify potential biomarkers of vaginal health or disease status. The fourth paper showed that positivity for Torquetenovirus decreased from the first to the third trimester, being more prevalent in women with higher vaginal leukocyte counts. Torquetenovirus-positive samples showed higher levels of cytokines, propionate, and cadaverine. Lactobacillus species decreased in Torquetenovirus-positive samples, while Sneathia and Shuttleworthia increased. The last work pointed out the association between clade 2 of Gardnerella vaginalis and bacterial vaginosis. Moreover, as the number of simultaneously detected G. vaginalis clades increased, bacterial vaginosis-associated bacteria also tended to increase. Additionally, sialidase gene levels negatively correlated with Lactobacillus and positively correlated with Gardnerella, Atopobium, Prevotella, Megasphaera, and Sneathia.

A binary engine fuelling HD 87643's complex circumstellar environment Determined using AMBER/VLTI imaging

Context. The star HD 87643, exhibiting the ""B[e] phenomenon"", has one of the most extreme infrared excesses for this object class. It harbours a large amount of both hot and cold dust, and is surrounded by an extended reflection nebula. Aims. One of our major goals was to investigate the presence of a companion in HD87643. In addition, the presence of close dusty material was tested through a combination of multi-wavelength high spatial resolution observations. Methods. We observed HD 87643 with high spatial resolution techniques, using the near-IR AMBER/VLTI interferometer with baselines ranging from 60 m to 130 m and the mid-IR MIDI/VLTI interferometer with baselines ranging from 25 m to 65 m. These observations are complemented by NACO/VLT adaptive-optics-corrected images in the K and L-bands, and ESO-2.2m optical Wide-Field Imager large-scale images in the B, V and R-bands. Results. We report the direct detection of a companion to HD 87643 by means of image synthesis using the AMBER/VLTI instrument. The presence of the companion is confirmed by the MIDI and NACO data, although with a lower confidence. The companion is separated by similar to 34 mas with a roughly north-south orientation. The period must be large (several tens of years) and hence the orbital parameters are not determined yet. Binarity with high eccentricity might be the key to interpreting the extreme characteristics of this system, namely a dusty circumstellar envelope around the primary, a compact dust nebulosity around the binary system and a complex extended nebula suggesting past violent ejections.

Comparison Between Single-Diode Low-Level Laser Therapy (LLLT) and LED Multi-Diode (Cluster) Therapy (LEDT) Applications Before High-Intensity Exercise

Background Data and Objective: There is anecdotal evidence that low-level laser therapy (LLLT) may affect the development of muscular fatigue, minor muscle damage, and recovery after heavy exercises. Although manufacturers claim that cluster probes (LEDT) maybe more effective than single-diode lasers in clinical settings, there is a lack of head-to-head comparisons in controlled trials. This study was designed to compare the effect of single-diode LLLT and cluster LEDT before heavy exercise. Materials and Methods: This was a randomized, placebo-controlled, double-blind cross-over study. Young male volleyball players (n = 8) were enrolled and asked to perform three Wingate cycle tests after 4 x 30 sec LLLT or LEDT pretreatment of the rectus femoris muscle with either (1) an active LEDT cluster-probe (660/850 nm, 10/30mW), (2) a placebo cluster-probe with no output, and (3) a single-diode 810-nm 200-mW laser. Results: The active LEDT group had significantly decreased post-exercise creatine kinase (CK) levels (-18.88 +/- 41.48U/L), compared to the placebo cluster group (26.88 +/- 15.18U/L) (p < 0.05) and the active single-diode laser group (43.38 +/- 32.90U/L) (p<0.01). None of the pre-exercise LLLT or LEDT protocols enhanced performance on the Wingate tests or reduced post-exercise blood lactate levels. However, a non-significant tendency toward lower post-exercise blood lactate levels in the treated groups should be explored further. Conclusion: In this experimental set-up, only the active LEDT probe decreased post-exercise CK levels after the Wingate cycle test. Neither performance nor blood lactate levels were significantly affected by this protocol of pre-exercise LEDT or LLLT.

Swarm Intelligence applied in synthesis of hunting strategies in a three-dimensional environment

Systems of distributed artificial intelligence can be powerful tools in a wide variety of practical applications. Its most surprising characteristic, the emergent behavior, is also the most answerable for the difficulty in. projecting these systems. This work proposes a tool capable to beget individual strategies for the elements of a multi-agent system and thereof providing to the group means on obtaining wanted results, working in a coordinated and cooperative manner as well. As an application example, a problem was taken as a basis where a predators` group must catch a prey in a three-dimensional continuous ambient. A synthesis of system strategies was implemented of which internal mechanism involves the integration between simulators by Particle Swarm Optimization algorithm (PSO), a Swarm Intelligence technique. The system had been tested in several simulation settings and it was capable to synthesize automatically successful hunting strategies, substantiating that the developed tool can provide, as long as it works with well-elaborated patterns, satisfactory solutions for problems of complex nature, of difficult resolution starting from analytical approaches. (c) 2007 Elsevier Ltd. All rights reserved.

A hybrid planning method for transmission networks in a deregulated environment

The reconstruction of power industries has brought fundamental changes to both power system operation and planning. This paper presents a new planning method using multi-objective optimization (MOOP) technique, as well as human knowledge, to expand the transmission network in open access schemes. The method starts with a candidate pool of feasible expansion plans. Consequent selection of the best candidates is carried out through a MOOP approach, of which multiple objectives are tackled simultaneously, aiming at integrating the market operation and planning as one unified process in context of deregulated system. Human knowledge has been applied in both stages to ensure the selection with practical engineering and management concerns. The expansion plan from MOOP is assessed by reliability criteria before it is finalized. The proposed method has been tested with the IEEE 14-bus system and relevant analyses and discussions have been presented.

A multi-sectorial committee in directing HIV/AIDS-specific interventions in the occupational setting: An example from South Africa

We present a descriptive analysis of a mechanism to coordinate and implement human immunodeficiency virus (HIV) prevention and care in the occupational setting. The mechanism we describe is a multidisciplinary committee composed of stakeholders in the occupational health environment including unions, management, medical researchers, and medical personnel. The site chosen for the analysis was a South African sugar mill in rural KwaZulu-Natal. The factory is situated in an area of high HIV seroprevalence and has a workforce of 400 employees. The committee was initiated to coordinate a combined prevention-care initiative. The issues that were important in the formation of the committee included confidentiality, trust, and the traditional roles of the stakeholder relationships. When these points were addressed through the focus on a common goal, the committee was able to function in its role as a coordinating body. Central to this success was the inclusion of all stakeholders in the process, including those with traditionally opposing, interests and legitimacy conferred by the stakeholders. This committee was functionally effective and demonstrated the benefit of a freestanding committee dedicated to addressing HIV/acquired immune deficiency syndrome (AIDS) issues. We describe the implementation and feasibility of a multisectoral committee in directing HIV/AIDS initiatives in the occupational setting in rural South Africa.

Is PHEEM a multi-dimensional instrument? An international perspective

Aim: To look at the characteristics of Postgraduate Hospital Educational Environment Measure (PHEEM) using data from the UK, Brazil, Chile and the Netherlands, and to examine the reliability and characteristics of PHEEM, especially how the three PHEEM subscales fitted with factors derived statistically from the data sets. Methods: Statistical analysis of PHEEM scores from 1563 sets of data, using reliability analysis, exploratory factor analysis and correlations of factors derived with the three defined PHEEM subscales. Results: PHEEM was very reliable with an overall Cronbach`s alpha of 0.928. Three factors were derived by exploratory factor analysis. Factor One correlated most strongly with the teaching subscale (R=0.802), Factor Two correlated most strongly with the role autonomy subscale (R=0.623) and Factor Three correlated most strongly with the social support subscale (R=0.538). Conclusions: PHEEM is a multi-dimensional instrument. Overall, it is very reliable. There is a good fit of the three defined subscales, derived by qualitative methods, with the three principal factors derived from the data by exploratory factor analysis.

Adaptation trials of Atriplex and Maireana species and their response to saline waterlogged conditions in Pakistan

Utilization of salt affected wasteland by growing forage shrubs has enormous economic and environmental implication for developing countries like Pakistan, where approximately 6.3 million ha of the land is salt affected. Considering the importance of Atriplex and Maireana species, research has been conducted using their different species on the salt affected soils of Faisalabad. Most of Atriplex and Maireana species survived under the environmental conditions of Faisalabad and gave the good yield in the form of forage. Some of these species are woody and can be used for fuel purposes. Sixteen genotypes of Atriplex and Maireana were tested for their tolerance to waterlogging in order to identify halophytic fodder shrubs suitable for growth on secondary salt-affected and waterlogged farmland. The physiological and morphological responses of the species tested were typical of species with a generally poor tolerance to waterlogging. Despite this, some species (eg A. Amnicola) were surprisingly resistant, surviving up to five months of waterlogging at moderate salinity and high evapotranspirational demand. The most resistant species, A amnicola maintained higher transpiration rates, leaf water potentials and shoot extension rates than most other species during five weeks of waterlogging, and a return to control levels more quickly than other species after plots were drained. Although little morphological adaptation to waterlogged conditions was detected, a shallow and extensive lateral root system and the formation of many short aerenchymatous adventitious roots from procumbent branches appeared to advantage A. Amnicola in an environment highly heterogeneous in salinity and low in oxygen concentration. Shallow fibrous rooted species were quickly killed by waterlogging, although the procumbent branches of some individuals survived as clones if they developed adventitious roots.

Predicting the mechanical behavior of amorphous polymeric materials under strain through multi-scale simulation

Polymeric materials have become the reference material for high reliability and performance applications. However, their performance in service conditions is difficult to predict, due in large part to their inherent complex morphology, which leads to non-linear and anisotropic behavior, highly dependent on the thermomechanical environment under which it is processed. In this work, a multiscale approach is proposed to investigate the mechanical properties of polymeric-based material under strain. To achieve a better understanding of phenomena occurring at the smaller scales, the coupling of a finite element method (FEM) and molecular dynamics (MD) modeling, in an iterative procedure, was employed, enabling the prediction of the macroscopic constitutive response. As the mechanical response can be related to the local microstructure, which in turn depends on the nano-scale structure, this multiscale approach computes the stress-strain relationship at every analysis point of the macro-structure by detailed modeling of the underlying micro- and meso-scale deformation phenomena. The proposed multiscale approach can enable prediction of properties at the macroscale while taking into consideration phenomena that occur at the mesoscale, thus offering an increased potential accuracy compared to traditional methods.

Is the International Business Environment the actual context for international business research?

The International Business Environment (IBE) has been argued to be the essential context for international business (IB) studies and the distinguishing factor from other management studies and studies of large enterprises. Two content analysis show that many papers published in top tier IB journals either lack reference to any dimension of the IBE or tend to be uni-or bi-dimensional when addressing the IBE; it is not a surprise that the cultural dimension is the most often used. We suggest that: (a) there is need to developed more uni-and multi-dimensional environmental constructs; (b) a more holistic view of the IBE provides richer insights on the actual complexity underlying IB research. Future studies that provide more comprehensive models of the IBE that overcome the usual broad classifications of the international environment as undefined and uncontrollable factors are warranted to advance conceptual and empirical research.

Environmental exposure to toxicants mixtures from a multi-purpose estuary: perspectives for a biomonitoring study in Portugal

This work was focused on a multi-purpose estuarine environment (river Sado estuary, SW Portugal) around which a number of activities (e.g., fishing, farming, heavy industry, tourism and recreational activities) coexist with urban centres with a total of about 200 000 inhabitants. Based on previous knowledge of the hazardous chemicals within the ecosystem and their potential toxicity to benthic species, this project intended to evaluate the impact of estuarine contaminants on the human and ecosystem health. An integrative methodology based on epidemiological, analytical and biological data and comprising several lines of evidence, namely, human contamination pathways, human health effects, consumption of local produce, estuarine sediments, wells and soils contamination, effects on commercial benthic organisms, and genotoxic potential of sediments, was used. The epidemiological survey confirmed the occurrence of direct and indirect (through food chain) exposure of the local population to estuarine contaminants. Furthermore, the complex mixture of contaminants (e.g., metals, pesticides, polycyclic aromatic hydrocarbons) trapped in the estuary sediments was toxic to human liver cells exposed in vitro, causing cell death, oxidative stress and genotoxic effects that might constitute a risk factor for the development of chronic-degenerative diseases, on the long term. Finally, the integration of data from several endpoints indicated that the estuary is moderately impacted by toxicants that affect also the aquatic biota. Nevertheless, the human health risk can only be correctly assessed through a biomonitoring study including the quantification of contaminants (or metabolites) in biological fluids as well as biomarkers of early biological effects (e.g., biochemical, genetic and omics-based endpoints) and genetic susceptibility in the target population. Data should be supported by a detailed survey to assess the impact of the contaminated seafood and local farm products consumption on human health and, particularly, on metabolic diseases or cancer development.

Multi-agent negotiation for coalition formation and management in electricity markets

Negotiation is a fundamental tool for reaching understandings that allow each involved party to gain an advantage for themselves by the end of the process. In recent years, with the increasing of compe-titiveness in most sectors, negotiation procedures become present in practically all of them. One particular environment in which the competitiveness has been increasing exponentially is the electricity markets sector. This work is directed to the study of electricity markets’ partici-pating entities interaction, namely in what concerns the formation, management and operation of aggregating entities – Virtual Power Players (VPPs). VPPs are responsible for managing coalitions of market players with small market negotiating influence, which take strategic advantage in entering such aggregations, to increase their negotiating power. This chapter presents a negotiation methodology for the creation and management of coalitions in Electricity Markets. This approach is tested using MASCEM, taking advantage of its ability to provide the means to model and simulate VPPs. VPPs are represented as coalitions of agents, with the capability of negotiating both in the market, and internally, with their members, in order to combine and manage their individual specific characteristics and goals, with the strategy and objectives of the VPP itself.

Intelligent multi-player smart grid management considering distributed energy resources and demand response

The smart grid concept is rapidly evolving in the direction of practical implementations able to bring smart grid advantages into practice. Evolution in legacy equipment and infrastructures is not sufficient to accomplish the smart grid goals as it does not consider the needs of the players operating in a complex environment which is dynamic and competitive in nature. Artificial intelligence based applications can provide solutions to these problems, supporting decentralized intelligence and decision-making. A case study illustrates the importance of Virtual Power Players (VPP) and multi-player negotiation in the context of smart grids. This case study is based on real data and aims at optimizing energy resource management, considering generation, storage and demand response.