Evolving decision trees with beam search-based initialization and lexicographic multi-objective evaluation

Decision tree induction algorithms represent one of the most popular techniques for dealing with classification problems. However, traditional decision-tree induction algorithms implement a greedy approach for node splitting that is inherently susceptible to local optima convergence. Evolutionary algorithms can avoid the problems associated with a greedy search and have been successfully employed to the induction of decision trees. Previously, we proposed a lexicographic multi-objective genetic algorithm for decision-tree induction, named LEGAL-Tree. In this work, we propose extending this approach substantially, particularly w.r.t. two important evolutionary aspects: the initialization of the population and the fitness function. We carry out a comprehensive set of experiments to validate our extended algorithm. The experimental results suggest that it is able to outperform both traditional algorithms for decision-tree induction and another evolutionary algorithm in a variety of application domains.

An evaluation of the distributions of polychlorinated biphenyls and organic matter in coastal sediments

The objective of this thesis is to improve the understanding of what processes and mechanism affects the distribution of polychlorinated biphenyls (PCBs) and organic carbon in coastal sediments. Because of the strong association of hydrophobic organic contaminants (HOCs) such as PCBs with organic matter in the aquatic environment, these two entities are naturally linked. The coastal environment is the most complex and dynamic part of the ocean when it comes to both cycling of organic matter and HOCs. This environment is characterised by the largest fluxes and most diverse sources of both entities. A wide array of methods was used to study these processes throughout this thesis. In the field sites in the Stockholm archipelago of the Baltic proper, bottom sediments and settling particulate matter were retrieved using sediment coring devices and sediment traps from morphometrically and seismically well-characterized locations. In the laboratory, the samples have been analysed for PCBs, stable carbon isotope ratios, carbon-nitrogen atom ratios as well as standard sediment properties. From the fieldwork in the Stockholm Archipelago and the following laboratory work it was concluded that the inner Stockholm archipelago has a low (≈ 4%) trapping efficiency for freshwater-derived organic carbon. The corollary is a large potential for long-range waterborne transport of OC and OC-associated nutrients and hydrophobic organic pollutants from urban Stockholm to more pristine offshore Baltic Sea ecosystems. Theoretical work has been carried out using Geographical Information Systems (GIS) and statistical methods on a database of 4214 individual sediment samples, each with reported individual PCB congener concentrations. From this work it was concluded that the continental shelf sediments are key global inventories and ultimate sinks of PCBs. Depending on congener, 10-80% of the cumulative historical emissions to the environment are accounted for in continental shelf sediments. Further it was concluded that the many infamous and highly contaminated surface sediments of urban harbours and estuaries of contaminated rivers cannot be of importance as a secondary source to sustain the concentrations observed in remote sediments. Of the global shelf PCB inventory < 1% are in sediments near population centres while ≥ 90% is in remote areas (> 10 km from any dwellings). The remote sub-basin of the North Atlantic Ocean contains approximately half of the global shelf sediment inventory for most of the PCBs studied.

Intangible resources and organization capital: measurement and economic evaluation

Intangible resources have raised the interests of scholars from different research areas due to their importance as crucial factors for firm performance; yet, contributions to this field still lack a theoretical framework. This research analyses the state-of-the-art results reached in the literature concerning intangibles, their main features and evaluation problems and models. In search for a possible theoretical framework, the research draws a kind of indirect analysis of intangibles through the theories of the firm, their critic and developments. The heterodox approaches of the evolutionary theory and resource-based view are indicated as possible frameworks. Based on this theoretical analysis, organization capital (OC) is identified, for its features, as the most important intangible for firm performance. Empirical studies on the relationship intangibles-firm performance have been sporadic and have failed to reach firm conclusions with respect to OC; in the attempt to fill this gap, the effect of OC is tested on a large sample of European firms using the Compustat Global database. OC is proxied by capitalizing an income statement item (Selling, General and Administrative expenses) that includes expenses linked to information technology, business process design, reputation enhancement and employee training. This measure of OC is employed in a cross-sectional estimation of a firm level production function - modeled with different functional specifications (Cobb-Douglas and Translog) - that measures OC contribution to firm output and profitability. Results are robust and confirm the importance of OC for firm performance.

Development and characterization of a distributed measurement system for the evaluation of voltage quality in electric power networks

The research activity carried out during the PhD course in Electrical Engineering belongs to the branch of electric and electronic measurements. The main subject of the present thesis is a distributed measurement system to be installed in Medium Voltage power networks, as well as the method developed to analyze data acquired by the measurement system itself and to monitor power quality. In chapter 2 the increasing interest towards power quality in electrical systems is illustrated, by reporting the international research activity inherent to the problem and the relevant standards and guidelines emitted. The aspect of the quality of voltage provided by utilities and influenced by customers in the various points of a network came out only in recent years, in particular as a consequence of the energy market liberalization. Usually, the concept of quality of the delivered energy has been associated mostly to its continuity. Hence the reliability was the main characteristic to be ensured for power systems. Nowadays, the number and duration of interruptions are the “quality indicators” commonly perceived by most customers; for this reason, a short section is dedicated also to network reliability and its regulation. In this contest it should be noted that although the measurement system developed during the research activity belongs to the field of power quality evaluation systems, the information registered in real time by its remote stations can be used to improve the system reliability too. Given the vast scenario of power quality degrading phenomena that usually can occur in distribution networks, the study has been focused on electromagnetic transients affecting line voltages. The outcome of such a study has been the design and realization of a distributed measurement system which continuously monitor the phase signals in different points of a network, detect the occurrence of transients superposed to the fundamental steady state component and register the time of occurrence of such events. The data set is finally used to locate the source of the transient disturbance propagating along the network lines. Most of the oscillatory transients affecting line voltages are due to faults occurring in any point of the distribution system and have to be seen before protection equipment intervention. An important conclusion is that the method can improve the monitored network reliability, since the knowledge of the location of a fault allows the energy manager to reduce as much as possible both the area of the network to be disconnected for protection purposes and the time spent by technical staff to recover the abnormal condition and/or the damage. The part of the thesis presenting the results of such a study and activity is structured as follows: chapter 3 deals with the propagation of electromagnetic transients in power systems by defining characteristics and causes of the phenomena and briefly reporting the theory and approaches used to study transients propagation. Then the state of the art concerning methods to detect and locate faults in distribution networks is presented. Finally the attention is paid on the particular technique adopted for the same purpose during the thesis, and the methods developed on the basis of such approach. Chapter 4 reports the configuration of the distribution networks on which the fault location method has been applied by means of simulations as well as the results obtained case by case. In this way the performance featured by the location procedure firstly in ideal then in realistic operating conditions are tested. In chapter 5 the measurement system designed to implement the transients detection and fault location method is presented. The hardware belonging to the measurement chain of every acquisition channel in remote stations is described. Then, the global measurement system is characterized by considering the non ideal aspects of each device that can concur to the final combined uncertainty on the estimated position of the fault in the network under test. Finally, such parameter is computed according to the Guide to the Expression of Uncertainty in Measurements, by means of a numeric procedure. In the last chapter a device is described that has been designed and realized during the PhD activity aiming at substituting the commercial capacitive voltage divider belonging to the conditioning block of the measurement chain. Such a study has been carried out aiming at providing an alternative to the used transducer that could feature equivalent performance and lower cost. In this way, the economical impact of the investment associated to the whole measurement system would be significantly reduced, making the method application much more feasible.

Evaluation of bone strength: microtomographic tecniques

This thesis is a part of a larger study about the characterization of mechanical and histomorphometrical properties of bone. The main objects of this study were the bone tissue properties and its resistance to mechanical loads. Moreover, the knowledge about the equipment selected to carry out the analyses, the micro-computed tomography (micro-CT), was improved. Particular attention was given to the reliability over time of the measuring instrument. In order to understand the main characteristics of bone mechanical properties a study of the skeletal, the bones of which it is composed and biological principles that drive their formation and remodelling, was necessary. This study has led to the definition of two macro-classes describing the main components responsible for the resistance to fracture of bone: quantity and quality of bone. The study of bone quantity is the current clinical standard measure for so-called bone densitometry, and research studies have amply demonstrated that the amount of tissue is correlated with its mechanical properties of elasticity and fracture. However, the models presented in the literature, including information on the mere quantity of tissue, have often been limited in describing the mechanical behaviour. Recent investigations have underlined that also the bone-structure and the tissue-mineralization play an important role in the mechanical characterization of bone tissue. For this reason in this thesis the class defined as bone quality was mainly studied, splitting it into two sub-classes of bone structure and tissue quality. A study on bone structure was designed to identify which structural parameters, among the several presented in the literature, could be integrated with the information about quantity, in order to better describe the mechanical properties of bone. In this way, it was also possible to analyse the iteration between structure and function. It has been known for long that bone tissue is capable of remodeling and changing its internal structure according to loads, but the dynamics of these changes are still being analysed. This part of the study was aimed to identify the parameters that could quantify the structural changes of bone tissue during the development of a given disease: osteoarthritis. A study on tissue quality would have to be divided into different classes, which would require a scale of analysis not suitable for the micro-CT. For this reason the study was focused only on the mineralization of the tissue, highlighting the difference between bone density and tissue density, working in a context where there is still an ongoing scientific debate.

Empirical and fundamental mechanical tests in the evaluation of dough and bread rheological properties

Bread dough and particularly wheat dough, due to its viscoelastic behaviour, is probably the most dynamic and complicated rheological system and its characteristics are very important since they highly affect final products’ textural and sensorial properties. The study of dough rheology has been a very challenging task for many researchers since it can provide numerous information about dough formulation, structure and processing. This explains why dough rheology has been a matter of investigation for several decades. In this research rheological assessment of doughs and breads was performed by using empirical and fundamental methods at both small and large deformation, in order to characterize different types of doughs and final products such as bread. In order to study the structural aspects of food products, image analysis techniques was used for the integration of the information coming from empirical and fundamental rheological measurements. Evaluation of dough properties was carried out by texture profile analysis (TPA), dough stickiness (Chen and Hoseney cell) and uniaxial extensibility determination (Kieffer test) by using a Texture Analyser; small deformation rheological measurements, were performed on a controlled stress–strain rheometer; moreover the structure of different doughs was observed by using the image analysis; while bread characteristics were studied by using texture profile analysis (TPA) and image analysis. The objective of this research was to understand if the different rheological measurements were able to characterize and differentiate the different samples analysed. This in order to investigate the effect of different formulation and processing conditions on dough and final product from a structural point of view. For this aim the following different materials were performed and analysed: - frozen dough realized without yeast; - frozen dough and bread made with frozen dough; - doughs obtained by using different fermentation method; - doughs made by Kamut® flour; - dough and bread realized with the addition of ginger powder; - final products coming from different bakeries. The influence of sub-zero storage time on non-fermented and fermented dough viscoelastic performance and on final product (bread) was evaluated by using small deformation and large deformation methods. In general, the longer the sub-zero storage time the lower the positive viscoelastic attributes. The effect of fermentation time and of different type of fermentation (straight-dough method; sponge-and-dough procedure and poolish method) on rheological properties of doughs were investigated using empirical and fundamental analysis and image analysis was used to integrate this information throughout the evaluation of the dough’s structure. The results of fundamental rheological test showed that the incorporation of sourdough (poolish method) provoked changes that were different from those seen in the others type of fermentation. The affirmative action of some ingredients (extra-virgin olive oil and a liposomic lecithin emulsifier) to improve rheological characteristics of Kamut® dough has been confirmed also when subjected to low temperatures (24 hours and 48 hours at 4°C). Small deformation oscillatory measurements and large deformation mechanical tests performed provided useful information on the rheological properties of samples realized by using different amounts of ginger powder, showing that the sample with the highest amount of ginger powder (6%) had worse rheological characteristics compared to the other samples. Moisture content, specific volume, texture and crumb grain characteristics are the major quality attributes of bread products. The different sample analyzed, “Coppia Ferrarese”, “Pane Comune Romagnolo” and “Filone Terra di San Marino”, showed a decrease of crumb moisture and an increase in hardness over the storage time. Parameters such as cohesiveness and springiness, evaluated by TPA that are indicator of quality of fresh bread, decreased during the storage. By using empirical rheological tests we found several differences among the samples, due to the different ingredients used in formulation and the different process adopted to prepare the sample, but since these products are handmade, the differences could be account as a surplus value. In conclusion small deformation (in fundamental units) and large deformation methods showed a significant role in monitoring the influence of different ingredients used in formulation, different processing and storage conditions on dough viscoelastic performance and on final product. Finally the knowledge of formulation, processing and storage conditions together with the evaluation of structural and rheological characteristics is fundamental for the study of complex matrices like bakery products, where numerous variable can influence their final quality (e.g. raw material, bread-making procedure, time and temperature of the fermentation and baking).

Combined Evaluation of ST-segment Elevation in lead AVR and ST-segment Depression in other Leads Enhances Prediction of in-hospital Cardiovascular Death in Patients with Non ST-segment Elevation Acute Coronary Syndrome

Objective: To investigate the prognostic significance of ST-segment elevation (STE) in aVR associated with ST-segment depression (STD) in other leads in patients with non-STE acute coronary syndrome (NSTE-ACS). Background: In NSTE-ACS patients, STD has been extensively associated with severe coronary lesions and poor outcomes. The prognostic role of STE in aVR is uncertain. Methods: We enrolled 888 consecutive patients with NSTE-ACS. They were divided into two groups according to the presence or not on admission ECG of aVR STE≥ 1mm and STD (defined as high risk ECG pattern). The primary and secondary endpoints were: in-hospital cardiovascular (CV) death and the rate of culprit left main disease (LMD). Results: Patients with high risk ECG pattern (n=121) disclosed a worse clinical profile compared to patients (n=575) without [median GRACE (Global-Registry-of-Acute-Coronary-Events) risk score =142 vs. 182, respectively]. A total of 75% of patients underwent coronary angiography. The rate of in-hospital CV death was 3.9%. On multivariable analysis patients who had the high risk ECG pattern showed an increased risk of CV death (OR=2.88, 95%CI 1.05-7.88) and culprit LMD (OR=4.67,95%CI 1.86-11.74) compared to patients who had not. The prognostic significance of the high risk ECG pattern was maintained even after adjustment for the GRACE risk score (OR = 2.28, 95%CI:1.06-4.93 and OR = 4.13, 95%CI:2.13-8.01, for primary and secondary endpoint, respectively). Conclusions: STE in aVR associated with STD in other leads predicts in-hospital CV death and culprit LMD. This pattern may add prognostic information in patients with NSTE-ACS on top of recommended scoring system.

Design, implementation and evaluation of a virtual laboratory for Computer Engineering Education

Broad consensus has been reached within the Education and Cognitive Psychology research communities on the need to center the learning process on experimentation and concrete application of knowledge, rather than on a bare transfer of notions. Several advantages arise from this educational approach, ranging from the reinforce of students learning, to the increased opportunity for a student to gain greater insight into the studied topics, up to the possibility for learners to acquire practical skills and long-lasting proficiency. This is especially true in Engineering education, where integrating conceptual knowledge and practical skills assumes a strategic importance. In this scenario, learners are called to play a primary role. They are actively involved in the construction of their own knowledge, instead of passively receiving it. As a result, traditional, teacher-centered learning environments should be replaced by novel learner-centered solutions. Information and Communication Technologies enable the development of innovative solutions that provide suitable answers to the need for the availability of experimentation supports in educational context. Virtual Laboratories, Adaptive Web-Based Educational Systems and Computer-Supported Collaborative Learning environments can significantly foster different learner-centered instructional strategies, offering the opportunity to enhance personalization, individualization and cooperation. More specifically, they allow students to explore different kinds of materials, to access and compare several information sources, to face real or realistic problems and to work on authentic and multi-facet case studies. In addition, they encourage cooperation among peers and provide support through coached and scaffolded activities aimed at fostering reflection and meta-cognitive reasoning. This dissertation will guide readers within this research field, presenting both the theoretical and applicative results of a research aimed at designing an open, flexible, learner-centered virtual lab for supporting students in learning Information Security.

Quantitative evaluation of household nutrition patterns: an econometric assessment of the UK 5-a-day impact on fruit and vegetable consumption

The present work provides an ex-post assessment of the UK 5-a-day information campaign where the positive effects of information on consumption levels are disentangled from the potentially conflicting price dynamics. A model-based estimate of the counterfactual (no-intervention) scenario is computed using data from the Expenditure and Food Survey between 2002 and 2006. For this purpose fruit and vegetable demand is modelled employing Quadratic Almost Ideal Demand System (QUAIDS) specification with demographic effects and controlling for potential endogeneity of prices and total food expenditure.

Eco-Management and Audit Scheme (EMAS): An evaluation of success factors in the agricultural sector. The case of Italy's Emilia Romagna region.

Different tools have been used to set up and adopt the model for the fulfillment of the objective of this research. 1. The Model The base model that has been used is the Analytical Hierarchy Process (AHP) adapted with the aim to perform a Benefit Cost Analysis. The AHP developed by Thomas Saaty is a multicriteria decision - making technique which decomposes a complex problem into a hierarchy. It is used to derive ratio scales from both discreet and continuous paired comparisons in multilevel hierarchic structures. These comparisons may be taken from actual measurements or from a fundamental scale that reflects the relative strength of preferences and feelings. 2. Tools and methods 2.1. The Expert Choice Software The software Expert Choice is a tool that allows each operator to easily implement the AHP model in every stage of the problem. 2.2. Personal Interviews to the farms For this research, the farms of the region Emilia Romagna certified EMAS have been detected. Information has been given by EMAS center in Wien. Personal interviews have been carried out to each farm in order to have a complete and realistic judgment of each criteria of the hierarchy. 2.3. Questionnaire A supporting questionnaire has also been delivered and used for the interviews . 3. Elaboration of the data After data collection, the data elaboration has taken place. The software support Expert Choice has been used . 4. Results of the Analysis The result of the figures above (vedere altro documento) gives a series of numbers which are fractions of the unit. This has to be interpreted as the relative contribution of each element to the fulfillment of the relative objective. So calculating the Benefits/costs ratio for each alternative the following will be obtained: Alternative One: Implement EMAS Benefits ratio: 0, 877 Costs ratio: 0, 815 Benfit/Cost ratio: 0,877/0,815=1,08 Alternative Two: Not Implement EMAS Benefits ratio: 0,123 Costs ration: 0,185 Benefit/Cost ratio: 0,123/0,185=0,66 As stated above, the alternative with the highest ratio will be the best solution for the organization. This means that the research carried out and the model implemented suggests that EMAS adoption in the agricultural sector is the best alternative. It has to be noted that the ratio is 1,08 which is a relatively low positive value. This shows the fragility of this conclusion and suggests a careful exam of the benefits and costs for each farm before adopting the scheme. On the other part, the result needs to be taken in consideration by the policy makers in order to enhance their intervention regarding the scheme adoption on the agricultural sector. According to the AHP elaboration of judgments we have the following main considerations on Benefits: - Legal compliance seems to be the most important benefit for the agricultural sector since its rank is 0,471 - The next two most important benefits are Improved internal organization (ranking 0,230) followed by Competitive advantage (ranking 0, 221) mostly due to the sub-element Improved image (ranking 0,743) Finally, even though Incentives are not ranked among the most important elements, the financial ones seem to have been decisive on the decision making process. According to the AHP elaboration of judgments we have the following main considerations on Costs: - External costs seem to be largely more important than the internal ones (ranking 0, 857 over 0,143) suggesting that Emas costs over consultancy and verification remain the biggest obstacle. - The implementation of the EMS is the most challenging element regarding the internal costs (ranking 0,750).

Nondestructive evaluation of concrete compression strength by means of Artificial Neural Network (ANN)

The evaluation of structural performance of existing concrete buildings, built according to standards and materials quite different to those available today, requires procedures and methods able to cover lack of data about mechanical material properties and reinforcement detailing. To this end detailed inspections and test on materials are required. As a consequence tests on drilled cores are required; on the other end, it is stated that non-destructive testing (NDT) cannot be used as the only mean to get structural information, but can be used in conjunction with destructive testing (DT) by a representative correlation between DT and NDT. The aim of this study is to verify the accuracy of some formulas of correlation available in literature between measured parameters, i.e. rebound index, ultrasonic pulse velocity and compressive strength (SonReb Method). To this end a relevant number of DT and NDT tests has been performed on many school buildings located in Cesena (Italy). The above relationships have been assessed on site correlating NDT results to strength of core drilled in adjacent locations. Nevertheless, concrete compressive strength assessed by means of NDT methods and evaluated with correlation formulas has the advantage of being able to be implemented and used for future applications in a much more simple way than other methods, even if its accuracy is strictly limited to the analysis of concretes having the same characteristics as those used for their calibration. This limitation warranted a search for a different evaluation method for the non-destructive parameters obtained on site. To this aim, the methodology of neural identification of compressive strength is presented. Artificial Neural Network (ANN) suitable for the specific analysis were chosen taking into account the development presented in the literature in this field. The networks were trained and tested in order to detect a more reliable strength identification methodology.

Design, development and first evaluation of a client/server system for managing and querying linguistic corpora

This thesis is concerned with the role played by software tools in the analysis and dissemination of linguistic corpora and their contribution to a more widespread adoption of corpora in different fields. Chapter 1 contains an overview of some of the most relevant corpus analysis tools available today, presenting their most interesting features and some of their drawbacks. Chapter 2 begins with an explanation of the reasons why none of the available tools appear to satisfy the requirements of the user community and then continues with technical overview of the current status of the new system developed as part of this work. This presentation is followed by highlights of features that make the system appealing to users and corpus builders (i.e. scholars willing to make their corpora available to the public). The chapter concludes with an indication of future directions for the projects and information on the current availability of the software. Chapter 3 describes the design of an experiment devised to evaluate the usability of the new system in comparison to another corpus tool. Usage of the tool was tested in the context of a documentation task performed on a real assignment during a translation class in a master's degree course. In chapter 4 the findings of the experiment are presented on two levels of analysis: firstly a discussion on how participants interacted with and evaluated the two corpus tools in terms of interface and interaction design, usability and perceived ease of use. Then an analysis follows of how users interacted with corpora to complete the task and what kind of queries they submitted. Finally, some general conclusions are drawn and areas for future work are outlined.

Lesion detection and classification in breast cancer: evaluation of approaches based on morphological features, tracer kinetic modelling and semi-quantitative parameters in MR functional imaging (DCE-MRI)

The diagnosis, grading and classification of tumours has benefited considerably from the development of DCE-MRI which is now essential to the adequate clinical management of many tumour types due to its capability in detecting active angiogenesis. Several strategies have been proposed for DCE-MRI evaluation. Visual inspection of contrast agent concentration curves vs time is a very simple yet operator dependent procedure, therefore more objective approaches have been developed in order to facilitate comparison between studies. In so called model free approaches, descriptive or heuristic information extracted from time series raw data have been used for tissue classification. The main issue concerning these schemes is that they have not a direct interpretation in terms of physiological properties of the tissues. On the other hand, model based investigations typically involve compartmental tracer kinetic modelling and pixel-by-pixel estimation of kinetic parameters via non-linear regression applied on region of interests opportunely selected by the physician. This approach has the advantage to provide parameters directly related to the pathophysiological properties of the tissue such as vessel permeability, local regional blood flow, extraction fraction, concentration gradient between plasma and extravascular-extracellular space. Anyway, nonlinear modelling is computational demanding and the accuracy of the estimates can be affected by the signal-to-noise ratio and by the initial solutions. The principal aim of this thesis is investigate the use of semi-quantitative and quantitative parameters for segmentation and classification of breast lesion. The objectives can be subdivided as follow: describe the principal techniques to evaluate time intensity curve in DCE-MRI with focus on kinetic model proposed in literature; to evaluate the influence in parametrization choice for a classic bi-compartmental kinetic models; to evaluate the performance of a method for simultaneous tracer kinetic modelling and pixel classification; to evaluate performance of machine learning techniques training for segmentation and classification of breast lesion.

Composite materials design, manufacture and evaluation

Fibre-Reinforced-Plastics are composite materials composed by thin fibres with high mechanical properties, made to work together with a cohesive plastic matrix. The huge advantages of fibre reinforced plastics over traditional materials are their high specific mechanical properties i.e. high stiffness and strength to weight ratios. This kind of composite materials is the most disruptive innovation in the structural materials field seen in recent years and the areas of potential application are still many. However, there are few aspects which limit their growth: on the one hand the information available about their properties and long term behaviour is still scarce, especially if compared with traditional materials for which there has been developed an extended database through years of use and research. On the other hand, the technologies of production are still not as developed as the ones available to form plastics, metals and other traditional materials. A third aspect is that the new properties presented by these materials e.g. their anisotropy, difficult the design of components. This thesis will provide several case-studies with advancements regarding the three limitations mentioned. In particular, the long term mechanical properties have been studied through an experimental analysis of the impact of seawater on GFRP. Regarding production methods, the pre-impregnated cured in autoclave process was considered: a rapid tooling method to produce moulds will be presented, and a study about the production of thick components. Also, two liquid composite moulding methods will be presented, with a case-study regarding a large component with sandwich structure that was produced with the Vacuum-Assisted-Resin-Infusion method, and a case-study regarding a thick con-rod beam that was produced with the Resin-Transfer-Moulding process. The final case-study will analyse the loads acting during the use of a particular sportive component, made with FRP layers and a sandwich structure, practical design rules will be provided.

Evaluation der Langzeitcompliance lebertransplantierter Patienten mit der immunsuppressiven Therapie und eines Betreuungsmodells zur intersektoralen kooperativen pharmazeutischen Betreuung durch eine Krankenhausapotheke und öffentliche Apotheken

Ein wichtiger Baustein für den langfristigen Erfolg einer Lebertransplantation ist die Compliance mit der lebenslang einzunehmenden immunsuppressiven Therapie. Im Rahmen der vorliegenden Arbeit wurde erstmals mittels MEMS® die Compliance bei lebertransplantierten Patienten untersucht, deren Transplantation einige Jahre zurücklag. Rekrutiert wurden Patienten, die vor 2, 5, 7 oder 10 Jahren (Gruppe 2 y.p.t., 5 y.p.t., 7 y.p.t., 10 y.p.t.) in der Universitätsmedizin Mainz lebertransplantiert wurden. 39 Patienten nahmen an der prospektiven Anwendungsbeobachtung teil. Die Compliance wurde mittels MEMS® über eine Beobachtungszeit von 6 Monaten erfasst. Bei der MEMS®-Auswertung war zu vermuten, dass 10 Patienten diese nicht wie vorgesehen verwendet hatten. Folglich konnten die mittels MEMS® gemessenen Compliance-Parameter nur für 29 Patienten valide ermittelt werden. Die mittlere Dosing Compliance betrug 81 ± 21 %, wobei die Gruppe 2 y.p.t. mit 86 ± 14 % bessere Werte zu verzeichnen hatte als die Gruppe 5 y.p.t. (75 ± 27 %) und 7 y.p.t. (74 ± 28 %). Die Ergebnisse waren jedoch nicht signifikant unterschiedlich (p=0,335, Kruskal-Wallis-Test). Unter Einbeziehung aller mittels MEMS® gemessenen Compliance-Parameter wurden 19 von 29 Patienten (66 %) als compliant eingestuft. Bei der Analyse der Gesamtcompliance basierend auf den subjektiven Compliance-Messmethoden (Morisky-Fragebogen, MESI-Fragebogen, Selbsteinschätzung), der Arzneimittel-Blutspiegel und der Anzahl an Abstoßungsreaktionen, in der alle 39 Patienten einbezogen werden konnten, wurden 35 Patienten (90 %) als compliant eingestuft. rnIm zweiten Teil der Arbeit wurde die Etablierung und Bewertung eines intersektoralen Pharmazeutischen Betreuungskonzepts für lebertransplantierte Patienten untersucht. Erstmals wurden anhand eines entwickelten schnittstellenübergreifenden, integrierten Betreuungskonzepts niedergelassene Apotheker in die Pharmazeutische Betreuung lebertransplantierter Patienten eingebunden. 20 Patienten wurden rekrutiert und während ihres stationären Aufenthaltes nach Transplantation pharmazeutisch betreut. Die Betreuung umfasste eine intensive Patientenschulung mit drei bis vier Gesprächen durch einen Krankenhausapotheker. Während des stationären Aufenthaltes wurden arzneimittelbezogene Probleme erkannt, gelöst und dokumentiert. Bei Entlassung stellte der Krankenhausapotheker einen Medikationsplan für den Hausarzt sowie für den niedergelassenen Apotheker aus und führte mit den Patienten ein ausführliches Entlassungsgespräch. Darüber hinaus wurden den Patienten Arzneimitteleinnahmepläne und eine Patienteninformation über ihr immunsuppressives Arzneimittel übergeben. 15 Patienten konnten daraufhin ambulant von niedergelassenen Apothekern pharmazeutisch weiterbetreut werden. Das kooperierende pharmazeutische Personal wurde durch ein eigens für die Studie erstelltes Manual zur Pharmazeutischen Betreuung lebertransplantierter Patienten geschult und unterstützt. Die niedergelassenen Apotheker sollten die Patienten in ihrer Arzneimitteltherapie begleiten, indem Beratungsgespräche geführt und arzneimittelbezogene Probleme erkannt und gelöst wurden. Die Nutzeffekte der intensiven Pharmazeutischen Betreuung konnte anhand verschiedener Erhebungsinstrumente dargelegt werden. Im Ergebnis resultierte eine hohe Zufriedenheit der Patienten und Apotheker mit dem Betreuungskonzept, die mittels Selbstbeurteilungsfragebögen ermittelt wurde. Die Compliance der Patienten wurde anhand des Morisky- und MESI-Fragebogens, der Selbsteinschätzung der Patienten, Blutspiegelbestimmungen sowie der Einschätzung durch den niedergelassenen Apotheker bestimmt. 86 % der Patienten wurden als compliant eingeordnet. Die Kenntnisse der Patienten über ihre immunsuppressive Therapie, welche anhand von Interviews erfragt wurden, lagen auf einem sehr hohen Niveau. Abschließend kann festgestellt werden, dass die Pharmazeutische Betreuung lebertransplantierter Patienten in den niedergelassenen Apotheken durchführbar ist. Anhand der Dokumentationsprotokolle lässt sich allerdings nur sehr schwer beurteilen, in welchem Maße die Betreuung tatsächlich erfolgte. Das tatsächliche vorliegen einer mangelnden Betreuung oder aber eine lückenhafte Dokumentation der Betreuungsleistung war nicht zu differenzieren. Ein limitierender Faktor für die intensivierte Betreuung ist sicherlich der erhebliche Aufwand für nur einen Patienten mit einem seltenen Krankheitsbild. Das Erkennen und Lösen von 48 ABP durch den Krankenhausapotheker und 32 ABP durch die niedergelassenen Apotheker, d. h. insgesamt 4,5 ABP pro Patient zeigt, dass die Pharmazeutische Betreuung einen wichtigen Beitrag für eine qualitätsgesicherte Arzneimitteltherapie leistet. Die intersektorale Pharmazeutische Betreuung stellt eine wesentliche Hilfe und Unterstützung der Patienten im sicheren Umgang mit ihrer Arzneimitteltherapie dar.rn