Heuristic algorithms for the Capacitated Location-Routing Problem and the Multi-Depot Vehicle Routing Problem

The Capacitated Location-Routing Problem (CLRP) is a NP-hard problem since it generalizes two well known NP-hard problems: the Capacitated Facility Location Problem (CFLP) and the Capacitated Vehicle Routing Problem (CVRP). The Multi-Depot Vehicle Routing Problem (MDVRP) is known to be a NP-hard since it is a generalization of the well known Vehicle Routing Problem (VRP), arising with one depot. This thesis addresses heuristics algorithms based on the well-know granular search idea introduced by Toth and Vigo (2003) to solve the CLRP and the MDVRP. Extensive computational experiments on benchmark instances for both problems have been performed to determine the effectiveness of the proposed algorithms. This work is organized as follows: Chapter 1 describes a detailed overview and a methodological review of the literature for the the Capacitated Location-Routing Problem (CLRP) and the Multi-Depot Vehicle Routing Problem (MDVRP). Chapter 2 describes a two-phase hybrid heuristic algorithm to solve the CLRP. Chapter 3 shows a computational comparison of heuristic algorithms for the CLRP. Chapter 4 presents a hybrid granular tabu search approach for solving the MDVRP.

Design and implementation of a testbed for data distribution management

Data Distribution Management (DDM) is a core part of High Level Architecture standard, as its goal is to optimize the resources used by simulation environments to exchange data. It has to filter and match the set of information generated during a simulation, so that each federate, that is a simulation entity, only receives the information it needs. It is important that this is done quickly and to the best in order to get better performances and avoiding the transmission of irrelevant data, otherwise network resources may saturate quickly. The main topic of this thesis is the implementation of a super partes DDM testbed. It evaluates the goodness of DDM approaches, of all kinds. In fact it supports both region and grid based approaches, and it may support other different methods still unknown too. It uses three factors to rank them: execution time, memory and distance from the optimal solution. A prearranged set of instances is already available, but we also allow the creation of instances with user-provided parameters. This is how this thesis is structured. We start introducing what DDM and HLA are and what do they do in details. Then in the first chapter we describe the state of the art, providing an overview of the most well known resolution approaches and the pseudocode of the most interesting ones. The third chapter describes how the testbed we implemented is structured. In the fourth chapter we expose and compare the results we got from the execution of four approaches we have implemented. The result of the work described in this thesis can be downloaded on sourceforge using the following link: https://sourceforge.net/projects/ddmtestbed/. It is licensed under the GNU General Public License version 3.0 (GPLv3).

MongoDB: analisi e prototipazione su applicazioni di social business intelligence

L’ultimo decennio ha visto un radicale cambiamento del mercato informatico, con la nascita di un numero sempre maggiore di applicazioni rivolte all’interazione tra utenti. In particolar modo, l’avvento dei social network ha incrementato notevolmente le possibilità di creare e condividere contenuti sul web, generando volumi di dati sempre maggiori, nell’ordine di petabyte e superiori. La gestione di tali quantità di dati ha portato alla nascita di soluzioni non relazionali appositamente progettate, dette NoSQL. Lo scopo di questo documento è quello di illustrare come i sistemi NoSQL, nello specifico caso di MongoDB, cerchino di sopperire alle difficoltà d’utilizzo dei database relazionali in un contesto largamente distribuito. Effettuata l'analisi delle principali funzionalità messe a disposizione da MongoDB, si illustreranno le caratteristiche di un prototipo di applicazione appositamente progettato che sfrutti una capacità peculiare di MongoDB quale la ricerca full-text. In ultima analisi si fornirà uno studio delle prestazioni di tale soluzione in un ambiente basato su cluster, evidenziandone il guadagno prestazionale.

On the Efficiency of the Benchmarks Used in the Asset Management

In this work we studied the efficiency of the benchmarks used in the asset management industry. In chapter 2 we analyzed the efficiency of the benchmark used for the government bond markets. We found that for the Emerging Market Bonds an equally weighted index for the country weights is probably the more suited because guarantees maximum diversification of country risk but for the Eurozone government bond market we found a GDP weighted index is better because the most important matter is to avoid a higher weight for highly indebted countries. In chapter 3 we analyzed the efficiency of a Derivatives Index to invest in the European corporate bond market instead of a Cash Index. We can state that the two indexes are similar in terms of returns, but that the Derivatives Index is less risky because it has a lower volatility, has values of skewness and kurtosis closer to those of a normal distribution and is a more liquid instrument, as the autocorrelation is not significant. In chapter 4 it is analyzed the impact of fallen angels on the corporate bond portfolios. Our analysis investigated the impact of the month-end rebalancing of the ML Emu Non Financial Corporate Index for the exit of downgraded bond (the event). We can conclude a flexible approach to the month-end rebalancing is better in order to avoid a loss of valued due to the benchmark construction rules. In chapter 5 we did a comparison between the equally weighted and capitalization weighted method for the European equity market. The benefit which results from reweighting the portfolio into equal weights can be attributed to the fact that EW portfolios implicitly follow a contrarian investment strategy, because they mechanically rebalance away from stocks that increase in price.

Investigation of the dipole response of nickel isotopes in the presence of a high-frequency electromagnetic field

The electric dipole response of neutron-rich nickel isotopes has been investigated using the LAND setup at GSI in Darmstadt (Germany). Relativistic secondary beams of 56−57Ni and 67−72Ni at approximately 500 AMeV have been generated using projectile fragmentation of stable ions on a 4 g/cm2 Be target and subsequent separation in the magnetic dipole fields of the FRagment Separator (FRS). After reaching the LAND setup in Cave C, the radioactive ions were excited electromagnetically in the electric field of a Pb target. The decay products have been measured in inverse kinematics using various detectors. Neutron-rich 67−69Ni isotopes decay by the emission of neutrons, which are detected in the LAND detector. The present analysis concentrates on the (gamma,n) and (gamma,2n) channels in these nuclei, since the proton and three-neutron thresholds are unlikely to be reached considering the virtual photon spectrum for nickel ions at 500 AMeV. A measurement of the stable 58Ni isotope is used as a benchmark to check the accuracy of the present results with previously published data. The measured (gamma,n) and (gamma,np) channels are compared with an inclusive photoneutron measurement by Fultz and coworkers, which are consistent within the respective errors. The measured excitation energy distributions of 67−69Ni contain a large portion of the Giant Dipole Resonance (GDR) strength predicted by the Thomas-Reiche-Kuhn energy-weighted sum rule, as well as a significant amount of low-lying E1 strength, that cannot be attributed to the GDR alone. The GDR distribution parameters are calculated using well-established semi-empirical systematic models, providing the peak energies and widths. The GDR strength is extracted from the chi-square minimization of the model GDR to the measured data of the (gamma,2n) channel, thereby excluding any influence of eventual low-lying strength. The subtraction of the obtained GDR distribution from the total measured E1 strength provides the low-lying E1 strength distribution, which is attributed to the Pygmy Dipole Resonance (PDR). The extraction of the peak energy, width and strength is performed using a Gaussian function. The minimization of trial Gaussian distributions to the data does not converge towards a sharp minimum. Therefore, the results are presented by a chi-square distribution as a function of all three Gaussian parameters. Various predictions of PDR distributions exist, as well as a recent measurement of the 68Ni pygmy dipole-resonance obtained by virtual photon scattering, to which the present pygmy dipole-resonance distribution is also compared.

Novel Synthetic Procedures in Organocatalysis

The main aim of my PhD project was the design and the synthesis of new pyrrolidine organocatalysts. New effective ferrocenyl pyrrolidine catalysts, active in benchmark organocatalytic reactions, has been developed. The ferrocenyl moiety, in combination with simple ethyl chains, is capable of fixing the enamine conformation addressing the approach trajectory of the nucleophile in the reaction. The results obtained represent an interesting proof-of-concept, showing for the first time the remarkable effectiveness of the ferrocenyl moiety in providing enantioselectivity through conformational selection. This approach could be viably employed in the rational design of ligands for metal or organocatalysts. Other hindered secondary amines has been prepared from alkylation of acyclic chiral nitroderivatives with alcohols in a highly diastereoselective fashion, giving access to functionalized, useful organocatalytic chiral pyrrolidines. A family of new pyrrolidines bearing sterogenic centers and functional groups can be readily accessible by this methodology. The second purpose of the project was to study in deep the reactivity of stabilized carbocations in new metal-free and organocatalytic reactions. By taking advantage of the results from the kinetic studies described by Mayr, a simple and effective procedure for the direct formylation of aryltetrafluoroborate salts, has been development. The coupling of a range of aryl- and heteroaryl- trifluoroborate salts with 1,3-benzodithiolylium tetrafluoroborate, has been attempted in moderate to good yields. Finally, a simple and general methodology for the enamine-mediated enantioselective α-alkylation of α-substituted aldehydes with 1,3-benzodithiolylium tetrafluoroborate has been reported. The introduction of the benzodithiole moiety permit the installation of different functional groups due to its chameleonic behaviour.

Supernova neutrinos in AMANDA and IceCube - Monte Carlo development and data analysis

Supernovae are among the most energetic events occurring in the universe and are so far the only verified extrasolar source of neutrinos. As the explosion mechanism is still not well understood, recording a burst of neutrinos from such a stellar explosion would be an important benchmark for particle physics as well as for the core collapse models. The neutrino telescope IceCube is located at the Geographic South Pole and monitors the antarctic glacier for Cherenkov photons. Even though it was conceived for the detection of high energy neutrinos, it is capable of identifying a burst of low energy neutrinos ejected from a supernova in the Milky Way by exploiting the low photomultiplier noise in the antarctic ice and extracting a collective rate increase. A signal Monte Carlo specifically developed for water Cherenkov telescopes is presented. With its help, we will investigate how well IceCube can distinguish between core collapse models and oscillation scenarios. In the second part, nine years of data taken with the IceCube precursor AMANDA will be analyzed. Intensive data cleaning methods will be presented along with a background simulation. From the result, an upper limit on the expected occurrence of supernovae within the Milky Way will be determined.

Search for the MSSM Neutral Higgs Boson in the mu+mu- final state with the CMS experiment at LHC

In this thesis, my work in the Compact Muon Solenoid (CMS) experiment on the search for the neutral Minimal Supersymmetric Standard Model (MSSM) Higgs decaying into two muons is presented. The search is performed on the full data collected during the years 2011 and 2012 by CMS in proton-proton collisions at CERN Large Hadron Collider (LHC). The MSSM is explored within the most conservative benchmark scenario, m_h^{max}, and within its modified versions, m_h^{mod +} and m_h^{mod -}. The search is sensitive to MSSM Higgs boson production in association with a b\bar{b} quark pair and to the gluon-gluon fusion process. In the m_h^{max} scenario, the results exclude values of tanB larger than 15 in the m_A range 115-200 GeV, and values of tanB greater than 30 in the m_A range up to 300 GeV. There are no significant differences in the results obtained within the three different scenarios considered. Comparisons with other neutral MSSM Higgs searches are shown.

Partial Discharge Phenomena in Converter and Traction Transformers: Identification and Reliability

After the development of power electronics converters, the number of transformers subjected to non-sinusoidal stresses (including DC) has increased in applications such as HVDC links and traction (electric train power cars). The effects of non-sinusoidal voltages on transformer insulation have been investigated by many researchers, but still now, there are some issues that must be understood. Some of those issues are tackled in this Thesis, studying PD phenomena behavior in Kraft paper, pressboard and mineral oil at different voltage conditions like AC, DC, AC+DC, notched AC and square waveforms. From the point of view of converter transformers, it was found that the combined effect of AC and DC voltages produces higher stresses in the pressboard that those that are present under pure DC voltages. The electrical conductivity of the dielectric systems in DC and AC+DC conditions has demonstrated to be a critical parameter, so, its measurement and analysis was also taken into account during all the experiments. Regarding notched voltages, the RMS reduction caused by notches (depending on firing and overlap angles) seems to increase the PDIV. However, the experimental results show that once PD activity has incepted, the notches increase PD repetition rate and magnitude, producing a higher degradation rate of paper. On the other hand, the reduction of mineral oil stocks, their relatively low flash point as well as environmental issues, are factors that are pushing towards the use of esters as transformer insulating fluids. This PhD Thesis also covers the study of two different esters with the scope to validate their use in traction transformers. Mineral oil was used as benchmark. The complete set of dielectric tests performed in the three fluids, show that esters behave better than mineral oil in practically all the investigated conditions, so, their application in traction transformers is possible and encouraged.

Time-resolved surface enhanced resonance Raman spectro-electrochemistry of heme proteins

The membrane protein Cytochrome c Oxidase (CcO) is one of the most important functional bio-molecules. It appears in almost every eukaryotic cell and many bacteria. Although the different species differ in the number of subunits, the functional differences are merely marginal. CcO is the terminal link in the electron transfer pathway of the mitochondrial respiratory chain. Electrons transferred to the catalytic center of the enzyme conduce to the reduction of molecular oxygen to water. Oxygen reduction is coupled to the pumping of protons into the inter-membrane space and hence generates a difference in electrochemical potential of protons across the inner mitochondrial membrane. This potential difference drives the synthesis of adenosine triphosphate (ATP), which is the universal energy carrier within all biological cells. rnrnThe goal of the present work is to contribute to a better understanding of the functional mechanism of CcO by using time-resolved surface enhanced resonance Raman spectroscopy (TR-SERRS). Despite intensive research effort within the last decades, the functional mechanism of CcO is still subject to controversial discussions. It was the primary goal of this dissertation to initiate electron transfer to the redox centers CuA, heme a, heme a3 and CuB electrochemically and to observe the corresponding redox transitions in-situ with a focus on the two heme structures by using SERRS. A measuring cell was developed, which allowed combination of electrochemical excitation with Raman spectroscopy for the purpose of performing the accordant measurements. Cytochrome c was used as a benchmark system to test the new measuring cell and to prove the feasibility of appropriate Raman measurements. In contrast to CcO the heme protein cc contains only a single heme structure. Nevertheless, characteristic Raman bands of the hemes can be observed for both proteins.rnrnIn order to investigate CcO it was immobilized on top of a silver substrate and embedded into an artificial membrane. The catalytic activity of CcO and therefore the complete functional capability of the enzyme within the biomimetic membrane architecture was verified using cyclic voltammetry. Raman spectroscopy was performed using a special nano-structured silver surface, which was developed within the scope of the present work. This new substrate combined two fundamental properties. It facilitated the formation of a protein tethered bilayer lipid membrane (ptBLM) and it allowed obtaining Raman spectra with sufficient high signal-to-noise ratios.rnSpectro-electrochemical investigations showed that at open circuit potential the enzyme exists in a mixed-valence state, with heme a and and heme a3 in the reduced and oxidized state, respectively. This was considered as an intermediate state between the non-activated and the fully activated state of CcO. Time-resolved SERRS measurements revealed that a hampered electron transfer to the redox center heme a3 characterizes this intermediate state.rn

Multilevel Domain Decomposition Algorithms for Monolithic Fluid-Structure Interaction Problems with Application to Haemodynamics

Finite element techniques for solving the problem of fluid-structure interaction of an elastic solid material in a laminar incompressible viscous flow are described. The mathematical problem consists of the Navier-Stokes equations in the Arbitrary Lagrangian-Eulerian formulation coupled with a non-linear structure model, considering the problem as one continuum. The coupling between the structure and the fluid is enforced inside a monolithic framework which computes simultaneously for the fluid and the structure unknowns within a unique solver. We used the well-known Crouzeix-Raviart finite element pair for discretization in space and the method of lines for discretization in time. A stability result using the Backward-Euler time-stepping scheme for both fluid and solid part and the finite element method for the space discretization has been proved. The resulting linear system has been solved by multilevel domain decomposition techniques. Our strategy is to solve several local subproblems over subdomain patches using the Schur-complement or GMRES smoother within a multigrid iterative solver. For validation and evaluation of the accuracy of the proposed methodology, we present corresponding results for a set of two FSI benchmark configurations which describe the self-induced elastic deformation of a beam attached to a cylinder in a laminar channel flow, allowing stationary as well as periodically oscillating deformations, and for a benchmark proposed by COMSOL multiphysics where a narrow vertical structure attached to the bottom wall of a channel bends under the force due to both viscous drag and pressure. Then, as an example of fluid-structure interaction in biomedical problems, we considered the academic numerical test which consists in simulating the pressure wave propagation through a straight compliant vessel. All the tests show the applicability and the numerical efficiency of our approach to both two-dimensional and three-dimensional problems.

Optimal Supervisory Control of Hybrid Vehicles

Hybrid vehicles (HV), comprising a conventional ICE-based powertrain and a secondary energy source, to be converted into mechanical power as well, represent a well-established alternative to substantially reduce both fuel consumption and tailpipe emissions of passenger cars. Several HV architectures are either being studied or already available on market, e.g. Mechanical, Electric, Hydraulic and Pneumatic Hybrid Vehicles. Among the others, Electric (HEV) and Mechanical (HSF-HV) parallel Hybrid configurations are examined throughout this Thesis. To fully exploit the HVs potential, an optimal choice of the hybrid components to be installed must be properly designed, while an effective Supervisory Control must be adopted to coordinate the way the different power sources are managed and how they interact. Real-time controllers can be derived starting from the obtained optimal benchmark results. However, the application of these powerful instruments require a simplified and yet reliable and accurate model of the hybrid vehicle system. This can be a complex task, especially when the complexity of the system grows, i.e. a HSF-HV system assessed in this Thesis. The first task of the following dissertation is to establish the optimal modeling approach for an innovative and promising mechanical hybrid vehicle architecture. It will be shown how the chosen modeling paradigm can affect the goodness and the amount of computational effort of the solution, using an optimization technique based on Dynamic Programming. The second goal concerns the control of pollutant emissions in a parallel Diesel-HEV. The emissions level obtained under real world driving conditions is substantially higher than the usual result obtained in a homologation cycle. For this reason, an on-line control strategy capable of guaranteeing the respect of the desired emissions level, while minimizing fuel consumption and avoiding excessive battery depletion is the target of the corresponding section of the Thesis.

Purificazione di plasminogeno con membrane di affinita'

Alcune patologie dell’occhio come la retinopatia diabetica, il pucker maculare, il distacco della retina possono essere curate con un intervento di vitrectomia. I rischi associati all’intervento potrebbero essere superati ricorrendo alla vitrectomia enzimatica con plasmina in associazione o in sostituzione della vitrectomia convenzionale. Inoltre, l’uso di plasmina autologa eviterebbe problemi di rigetto. La plasmina si ottiene attivando il plasminogeno con enzimi quali l’attivatore tissutale (tPA) e l’urochinasi ( uPA ) . La purificazione del plasminogeno dal sangue avviene normalmente attraverso cromatografia di affinità con resina. Tuttavia, le membrane di affinità costituiscono un supporto ideale per questa applicazione poiché possono essere facilmente impaccate prima dell’intervento, permettendo la realizzazione di un dispositivo monouso che fornisce un processo rapido ed economico. Obiettivo di questo lavoro è la preparazione di membrane di affinità per la purificazione del plasminogeno utilizzando L-lisina come ligando di affinità. Per questo scopo sono state usate membrane in cellulosa rigenerata ad attivazione epossidica, modificate con due diversi protocolli per l’immobilizzazione di L-lisina. La densità ligando è stata misurata mediante un saggio colorimetrico che usa l’acido arancio 7 come indicatore. La resa di immobilizzazione è stata studiata in funzione del tempo di reazione e della concentrazione di L-lisina. Le membrane ottimizzate sono state caratterizzate con esperimenti dinamici usando siero bovino e umano, i risultati sono stati confrontati con quelli ottenuti in esperimenti paralleli condotti con una resina commerciale di affinità con L-lisina. Durante gli esperimenti con siero, le frazioni provenienti da ogni fase cromatografica sono state raccolte e analizzate con HPLC ed elettroforesi SDS-PAGE. In particolare, l’elettroforesi dei campioni eluiti presenta una banda del plasminogeno ben definita indicando che le membrane di affinità con L-lisina sono adatte alla purificazione del plasminogeno. Inoltre, è emerso che le membrane hanno maggiore produttività della resina commerciale di riferimento.

Enantioselektive Organokatalyse in Epoxidierungen und Cyanhydrinbildungen

In der vorliegenden Arbeit mit dem Titel „Enantioselektive Organokatalyse in Epoxidierungen und Cyanhydrinbildungen“ wurde die Synthese zweier Cyclophan-carbaldimine durchgeführt. Beide Verbindungen bestehen aus einem Glykosyl-Baustein und einem Paracyclophan-Baustein, die über eine Imin-Bindung verbrückt sind. Die Cyclophan-carbaldimine wurden dann als Katalysatoren in einer Reihe von enantioselektiven Reaktionen verwendet. Enantioselektive Reaktionen bilden von zwei spiegelbildlichen Produkten stets eines im Überschuss. Zu diesen Reaktionen zählen die in dieser Arbeit durchgeführten enantioselektiven Epoxidierungen und enantioselektiven Cyanhydrinsynthesen. Die enantioselektiven Epoxidierungen waren dabei als Teil der Totalsynthesen der Naturstoffe Dasyscyphin D und Caripyrin geplant. Diese beiden Naturstoffe zeigten in biologischen Tests am Institut für Biotechnologie und Wirkstoffforschung (IBWF) in Kaiserslautern Aktivität gegen den Reisbrand-Pilz Magnaporthe grisea, der für Ernteverluste in beträchtlichem Ausmaß verantwortlich ist. Das Caripyrin selbst beinhaltet eine Epoxidstruktur. Mittels der oben angeführten Katalysatoren wurde versucht, diese Epoxidstruktur selektiv einzuführen. Dies gelang nicht, aber der Naturstoff konnte mittels Epoxidierung durch m-Chlorperbenzoesäure erstmals dargestellt werden. In mehreren biologischen Vergleichstests am IBWF Kaiserslautern zeigte auch das synthetische Caripyrin mit dem natürlichen Caripyrin vergleichbare biologische Aktivität.rnDas Dasyscyphin D an sich trägt keine Epoxidfunktion. Dennoch spielt sie auch hier eine wichtige Rolle. Innerhalb der geplanten Totalsynthese von Dasyscyphin D sollte die Farnesylseitenkette eines aromatischen Ringes selektiv epoxidiert werden. Durch einen elektrophilen Angriff an dieses Epoxid sollte im Anschluss eine Cyclisierung zum Dasyscyphin-Grundgerüst eingeleitet werden, aus dem dann Dasyscyphin D dargestellt werden sollte. Im Gegensatz zur Caripyrin-Synthese, bei der die selektive Epoxidierung nicht gelang, scheint sie in der Synthese von Dasyscyphin D sattgefunden zu haben, allerdings ist eine Isolierung des Reaktionsproduktes noch nicht gelungen. Folglich konnte das Dasyscyphin D noch nicht erfolgreich synthetisiert werden.rnDie Versuche zur enantioselektiven Cyanhydrin-Synthese waren nicht Bestandteil einer Totalsynthese. Die Cyanhydrine wurden zuerst als Racemate synthetisiert und gaschromatographisch vermessen, um auf diese Weise die exakten Retentionszeiten der einzelnen Enantiomere zu ermitteln. Anschließend wurden die Cyanhydrine dann enantioselektiv dargestellt und ebenfalls gaschromatographisch vermessen. Durch den Vergleich mit den racemischen Cyanhydrinen konnte dabei direkt aus der Reaktionslösung gemessen werden, was erforderlich war, da eine Isolierung der Cyanhydrine unter den gewählten Reaktionsbedingen nicht gelang. Aus den gaschromatographischen Messungen konnten Enantiomerenüberschüsse von bis zu 95 % ermittelt werden. Weiterhin ergaben die Messungen, dass der Arabinosyl-Katalysator im Vergleich mit dem Galactosyl-Katalysator eine geringere Enantioselektivität induziert, was vermutlich auf leichte räumliche Differenzen der beiden Katalysatoren zurückzuführen ist. Ein weiteres wichtiges Ergebnis war, dass beide Katalysatoren, wie geplant, unterschiedliche Enantiomere im Überschuss bilden. Die Glykosyl- und Paracyclophan-Bausteine der beiden Katalysatoren waren so gewählt worden, dass beide Katalysatoren pseudo-Enantiomere bilden. Auf diese Weise sollte eine Einflussnahme auf das gebildete Enantiomer durch die Wahl des entsprechenden Cyclophan-carbaldimin-Katalysators möglich gemacht werden, was, wie bereits erwähnt, gelang.rn

Pharmakovigilanz bei Patienten mit Phenprocoumon-Therapie : Untersuchungen zu potentiellen Interaktionen und Betreuungsqualität

Zur Verbesserung der Sicherheit und Effektivität der Phenprocoumon-Therapie wurden drei unterschiedliche Untersuchungen durchgeführt.rnZunächst wurde auf Grundlage bekannter Datenbanken und Informationsquellen zu Arznei-mittelinteraktionen (Drugdex, Abda Datenbank, Marcumar® Fachinformation, Coumarin-Interaktionsliste der Federatie van Nederlandse Trombosediensten, Review zu Warfarin-Interaktionen) eine handlungsorientierte Interaktionsdatenbank für Phenprocoumon erstellt. Dazu wurden in einer Übersichtstabelle relevante Informationen zu potentiellen Interaktionen für insgesamt 375 Arzneimittel zusammengestellt. Diese Tabelle wurde durch ein dreiköpfiges Expertenteam begutachtet und die potentiellen Interaktionspartner fünf verschiedenen Schweregraden und Stufen klinischer Relevanz zugeordnet. Für fast 50% der potentiellen Interaktionspartner wurden Handlungen als nicht erforderlich erachtet. Für die restlichen potentiellen Interaktionspartner wurden Handlungen zum klinischen Management der Interaktion in Abhängigkeit vom zeitlichen Zusammenhang mit der Phenprocoumon-Einnahme festgelegt. rnAnschließend wurde in einer Anwendungsbeobachtung der Zusammenhang zwischen der zusätzlichen Einnahme potentiell interagierender Arzneimittel (in der entwickelten Datenbank eingestuft mit dem Schweregrad „hoch“ und „sehr hoch“) und der Häufigkeit von Änderungen der Phenprocoumon-Wochendosis an 116 Patienten untersucht. Das relative Risiko für eine Dosisanpassung war bei Patienten in der Interaktions-Gruppe (n=23) signifikant erhöht (RR=1,9; p<0,001). Als weitere potentielle Einflussfaktoren stellten sich zunehmendes Alter (Alter 80-85 Jahre: RR=2; p<0,05), vielfache Komorbiditäten (4 Komorbiditäten: RR=2,1; p<0,05) und eingeschränkte Nieren- (RR=1,47; p>0,05) und Leberfunktion (RR=1,3; p>0,05) heraus.rnZur Untersuchung der Betreuungsqualität von VKA-Patienten im Thrombosedienst Mainz wurden retrospektiv die Daten von 118 Patienten ausgewertet. Als Qualitätsparameter wurden die prozentuale Häufigkeit von INR-Werten im Zielbereich, die TTR (Time in Therapeutic Range), die Dauer der NMH-Therapie, die Zeit bis zum Erreichen des Zielbereichs und der durchschnittliche Abstand zwischen zwei Kontrollterminen ermittelt. Im Median lag jeder Patient mit 73% der gemessenen INR-Werte und im individuellen Zielbereich. Die TTR betrug im Median 80%. Die Patienten benötigten 7 Tage zum Erreichen des Zielbereiches. Die NMH-Therapie wurde über 8 Tage durchgeführt. Die Patienten kamen im Median alle 11 Tage zu einem Kontrolltermin. Im Benchmark zu international publizierten Qualitätskenn-zahlen zur VKA-Therapie ist die Betreuungsqualität im Thrombosedienst Mainz als sehr gut einzustufen.rn