Analytics and optimization for emergency healthcare processes

This thesis deals with the analysis and management of emergency healthcare processes through the use of advanced analytics and optimization approaches. Emergency processes are among the most complex within healthcare. This is due to their non-elective nature and their high variability. This thesis is divided into two topics. The first one concerns the core of emergency healthcare processes, the emergency department (ED). In the second chapter, we describe the ED that is the case study. This is a real case study with data derived from a large ED located in northern Italy. In the next two chapters, we introduce two tools for supporting ED activities. The first one is a new type of analytics model. Its aim is to overcome the traditional methods of analyzing the activities provided in the ED by means of an algorithm that analyses the ED pathway (organized as event log) as a whole. The second tool is a decision-support system, which integrates a deep neural network for the prediction of patient pathways, and an online simulator to evaluate the evolution of the ED over time. Its purpose is to provide a set of solutions to prevent and solve the problem of the ED overcrowding. The second part of the thesis focuses on the COVID-19 pandemic emergency. In the fifth chapter, we describe a tool that was used by the Bologna local health authority in the first part of the pandemic. Its purpose is to analyze the clinical pathway of a patient and from this automatically assign them a state. Physicians used the state for routing the patients to the correct clinical pathways. The last chapter is dedicated to the description of a MIP model, which was used for the organization of the COVID-19 vaccination campaign in the city of Bologna, Italy

Models and Methods for Multi-Actor Systems

2010/2011The study of the models and methods to apply to multi-actor systems is a widely discussed research topic in the related scientific literature. The multi-actor systems are defined as systems that are characterized by the presence of several autonomous elements, of different decision makers and of complex rules that allow the communication, the coordination and the connection of the components of such systems. Commonly, the study of Multi-Actor System, MAS, recalls the well-known issues concerning the multi-agent systems. The research topic related to the multi-agent system firstly started to appear in scientific literature in 1980s, mainly in relation to the computer science and artificial intelligence. In this dissertation, in particular, the study of the multi-agent systems, and specifically of the multi-actor systems, is taken into account merely in relation to the distinctive features of complexity that characterize such systems and not to the issues concerning the agent-oriented software engineering. Therefore, the research results presented in this thesis are focused on the development and on the realization of innovative models and methodologies to face the management and the decision making mechanisms applied to complex multi-actor systems. This dissertation especially focuses on two different examples of multi-actor systems in two very diverse perspectives. The former deals with the research problem related to intermodal transportation networks, while the latter with the so called consensus problem in distributed networks of agents. Concerning the research problem related to the intermodal logistic systems, the research activity addresses the management of their more and more increasing complexity by the applications of the modern Information and Communication Technologies (ICT) tools that are key solutions to achieve the efficiency and to enhance logistics competitiveness. The related scientific literature still seems lacking in addressing with adequate attention the impact of these new techniques on the management of these complex systems and, moreover, there is an apparent lack of a systematic and general methodology to describe in detail the multiplicity of elements that can influence the dynamics and the corresponding information and decision making structure of intermodal transportation systems. The innovative results presented in this dissertation are focused on the development of an Integrated System, IS, devoted to manage intermodal transportation networks at the tactical as well as operational decision level to be used by decision makers both in off-line planning and real time management. To specify the Integrated System, a reference model is developed relying on a top-down metamodeling procedure. These innovative research results are a contribution to bridge the gap and to propose not only a systematic modeling approach devoted to describe a generic multi-actor logistic system, but also a management technique based on a closed loop strategy. The second example of application is focused on a topic that is widely discussed in scientific literature related to the study of the multi-actor collective behaviors in a distributed network. The interaction protocols that allow the agents to reach the convergence to a common value is called consensus or agreement problem. This research problem is particularly studied in the context of cooperative control of multi-agent systems because the agents are autonomous, independent and have to interact in a distributed network. The presented research results address the investigation of new and fast alignment protocols that enhance the performances of the standard iteration protocols for particular topologies of digraphs on the basis of a triangular splitting of the standard iteration matrix. The examined examples, the models and the methodologies applied to analyze them, are very different in the two cases and this testifies the large extent of research problems related to the multi-actor systems.L’analisi di modelli e metodi da sviluppare e da applicare nel contesto dei sistemi multi-attoriali costituisce un tema molto variegato e discusso nella letteratura scientifica internazionale. I sistemi multi-attoriali sono sistemi che si contraddistinguono per la presenza di molti elementi autonomi diversi tra loro, di molteplici decisori e di complesse regole che determinano la comunicazione, il coordinamento e la connessione all'interno di tali sistemi. Frequentemente, facendo riferimento a sistemi multi-attoriali, Multi-Actor Systems, si richiama il tema molto attuale dei sistemi multi agente, Multi-Agent Systems. Diffusisi a partire dal 1980, i sistemi multi agente sono spesso studiati in relazione alle metodologie di sviluppo dell'ingegneria del software. Nel presente lavoro di tesi, il tema dei sistemi multi-agente, ed in particolare di quelli multi-attoriali, non viene analizzato in questo contesto, ma in relazione alle tecniche decisionali da adottare per gestire sistemi caratterizzati da un alto livello di complessità. In tale ambito, i risultati presentati all'interno di questa dissertazione sono focalizzati sullo sviluppo e sulla realizzazione di nuovi metodi e di nuove metodologie, in grado di affrontare la gestione della complessità dei sistemi multi-attoriali. Vengono in particolare esaminate due diverse problematiche, in due contesti completamente diversi e con tecniche differenti, a testimoniare le vaste applicazioni che riguardano i sistemi multi-attoriali. I problemi analizzati sono incentrati, in primo luogo, su un'applicazione inerente la gestione di sistemi logistici intermodali ed, in secondo luogo, sullo studio delle regole o protocolli di interazione in una rete distribuita di agenti autonomi. Per quanto riguarda l'aspetto legato ai sistemi intermodali di trasporto, un tema molto discusso nella letteratura scientifica recente, l'analisi si focalizza sulla gestione della loro sempre crescente complessità, tramite l'utilizzo di sistemi dell'Information and Communication Technology, ICT. Questi strumenti richiedono metodi e modelli che sono innovativi rispetto a quanto è presente nella letteratura scientifica, all'interno della quale è stata riscontrata la mancanza di un approccio sistematico e sufficientemente ad alto livello per la realizzazione di una metodologia in grado di descrivere allo stesso tempo sia la molteplicità di elementi che influenzano le dinamiche e le informazioni, sia le strutture decisionali dei sistemi intermodali. L'innovazione dei risultati presentati in questa tesi si focalizza proprio sull'esigenza di proporre un sistema integrato, Integrated System (IS), basato su un metamodello delle reti intermodali di trasporto, che fornisca un valido supporto ai decisori sia a livello tattico che operativo. Il secondo aspetto affrontato in questa tesi riguarda un altro argomento di largo ed attuale interesse nella letteratura scientifica, che viene comunemente chiamato problema del consenso. Questo problema affronta lo studio di come diversi agenti autonomi collocati su una rete distribuita siano in grado di comunicare e di accordarsi su un valore comune, senza la presenza di un decisore centrale. A questo scopo ci sono degli algoritmi che specificano le regole o protocolli di interazione tra i diversi agenti. In tale contesto, i risultati proposti si focalizzano su alcune problematiche rappresentate dal protocollo classico del consenso e soprattutto sulla sua scarsa efficienza in particolari conformazioni delle reti di agenti. Il lavoro di tesi propone, quindi, un approccio di suddivisione, splitting, della matrice standard di iterazione, di tipo triangolare, che presenta notevoli vantaggi in termini di performance rispetto all'algoritmo classico. Lo studio di problemi multi-attoriali, pertanto, richiede lo sviluppo di innovative metodologie decisionali e di nuovi metodi di gestione delle comunicazioni, per rispondere al livello sempre crescente di complessità, offrendo in questo modo alcuni spunti molto interessanti per la ricerca.XXIV Ciclo198

Combinatorial exchange models for a user-driven air traffic flow management in Europe

2008/2009Air Traffic Flow Management (ATFM) is the service responsible to guarantee that the available capacity of the air transportation system is efficiently used and never exceeded. It guarantees safety of air transportation by adopting a series of measures which range from strategic long-term ones to the imposition of ground delays to flights at a tactical level. These ATFM delays are imposed to individual flights at the departure airport prior to their take-off, since it is safer and less costly to anticipate on the ground any delay predicted somewhere in the system. They are assigned by a central authority according to a First-Planned-First-Served principle, without taking into account individual Airlines' preferences. This criteria of assignment can cause an aggregated cost of delay experienced by users, higher than the minimal one, due to the fact that the cost of delay is a non-linear function of the duration and it depends on many variables such as the type of aircraft, the specific origin-destination pair, ecc. This thesis tackles the issue of formalizing and analyzing alternative models for the assignment of ATFM resources which take into account individual airlines preferences. In particular mathematical programming models are analyzed, that extend the concept of ATFM slot currently adopted to the one of Target Window, as proposed in the CATS European project. Such a concept is in line with the SESAR program, recently adopted in Europe to develop the new generation system of Air Traffic Management, which imposes a direct involvement of Airspace users whenever external constraints need to be enforced that modify their original requests. The first Chapter provides a general introduction to the context of Air Traffic Management and Air Traffic Control. In the second Chapter the principles, methods and performances of the ATFM system are described according to the current situation as well as to the SESAR target concept. The problem of optimally assign ATFM resources is then described mathematically and then analyzed to uncover two fundamental structures that determine its tractability: one corresponds to the case in which there is a unique capacity constrained resource while in the second there is an unrestricted number of constrained resources. In Chapter three a number of properties are proved that give insight into the applicability of different mechanisms for a central calculation of the optimal solution by the ATFM authority. Since such mechanisms involve cost minimization for several agents they are formulated as exchanges, i.e. particular types of auctions in which each participant may buy and/or sell several indivisible goods. The last part of the thesis included in Chapter four deals with the design of iterative exchange mechanisms, whose application in real world presents several advantages with respect to centralized models, from the distribution of computational complexity among participants to the preservation of disclosure of private information by Aircraft Operators. In this case an optimal model based on the Lagrangian relaxation of the separable central problem is first formulated and analyzed. To overcome practical issues possibly deriving from its application in real operations, an heuristic iterative Market-based mechanism is finally formalized. This algorithm exploits some of the underlying characteristics specific to the problem to derive near-optimal solutions in an acceptable time. Computational results are obtained by simulating its implementation on real traffic data and they show that considerable cost savings are possible with respect to a First-Planned-First-Served central allocation. The contribute of this thesis is twofold. The first is to provide a mathematical description, modeling and analysis of the ATFM resource exchange problem faced by Airspace users when network capacity needs to be rationed among them. The second consists in the methodological innovation represented by the formulation of the Market Mechanism which is compliant with several requirements represented by legislative and practical constraints and whose simulation provided encouraging results.XXII Cicl

A Cooperative Game Theory Approach for Cost Allocation in Complex Water Resource Systems

In order to obtain an optimal water resource planning and management, a fair and efficient rule of cost allocation among the different water users has a very important function. Starting from a correct assignation of costs it is possible to establish the basis to define the pricing policy that considers the principles of cost recovery and the adequate contribution for the different water uses as required by the Directive 2000/60/EC (EU, 2000). The majority of cost allocation methods currently used in water resources system do not highlight the motivation of adopted criteria; so, we wonder why the users should accept an assignation which exceeds their opportunity cost or their willingness to pay (Young, 1985). The main problem searching for a commonly accepted division of costs is how to share the costs in a fair and just way providing an adequate justification of criteria of the adopted methods. Therefore, the aim of the research is to individuate an impartial and fair method for cost sharing for all the users who respect the principles of individual acceptability and general agreement and to argue for voluntary cooperation among the interested agents in order to maximize the efficiency of water resource management. In this thesis we present a methodology of water services cost allocation based on Cooperative Game Theory, which can be a very usable instrument for the decision makers in order to elaborate pricing policies for water resources systems, according to the principles of the Directive 2000/60/EC. The validation of the methodology has been realized for the water system Flumendosa-Campidano in Sardinia

A Cooperative Game Theory Approach for Cost Allocation in Complex Water Resource Systems

In order to obtain an optimal water resource planning and management, a fair and efficient rule of cost allocation among the different water users has a very important function. Starting from a correct assignation of costs it is possible to establish the basis to define the pricing policy that considers the principles of cost recovery and the adequate contribution for the different water uses as required by the Directive 2000/60/EC (EU, 2000). The majority of cost allocation methods currently used in water resources system do not highlight the motivation of adopted criteria; so, we wonder why the users should accept an assignation which exceeds their opportunity cost or their willingness to pay (Young, 1985). The main problem searching for a commonly accepted division of costs is how to share the costs in a fair and just way providing an adequate justification of criteria of the adopted methods. Therefore, the aim of the research is to individuate an impartial and fair method for cost sharing for all the users who respect the principles of individual acceptability and general agreement and to argue for voluntary cooperation among the interested agents in order to maximize the efficiency of water resource management. In this thesis we present a methodology of water services cost allocation based on Cooperative Game Theory, which can be a very usable instrument for the decision makers in order to elaborate pricing policies for water resources systems, according to the principles of the Directive 2000/60/EC. The validation of the methodology has been realized for the water system Flumendosa-Campidano in Sardinia

Modeling a real-time decision support system for HazMat transportation in a sustainable oriented motorway of environment

2007/2008The combined effects of economic globalization, development of transport systems and new communication techniques have had a profound infuence on world development. The expansion of transport systems favors the increase of geographic mobility so that the existence of a complete highways network, adequately managed and maintained and with sufficient capacity, is essential for the good progress of the national economy. The expansion of transport systems is coupled with the rise in land prices and the increase of air and noise pollution. In this development, we observe that dangerous goods are used in many processes in industries all over the world and this has been justified by the economic revenue which is generated by their use. A dangerous good is any solid, liquid, or gas that can harm people, other living organisms, property, or the environment. They are often subject to chemical regulations. An equivalent term, used almost exclusively in the United States, is hazardous material (hazmat or HAZMAT). Due to its nature, every production, storage, and transportation activity related to the use of HAZMAT has many risks for both society and the environment. HAZMAT are transported throughout the world in a great number of road shipments. In spite of HAZMAT accidents being rare events, the commercial transport of HAZMAT can be catastrophic in nature and poses risks to life, health, property, and the environment due to the possibility of an unintentional release. In this scenario, a new factor has acquired more and more importance: sustainability. As a consequence, it is necessary to integrate risk mitigation and prevention measures into transport management in order to avoid the risks turning into real events. Three different topics are developed within the above framework. 1 - A business approach, named corporate sustainability, that creates longterm shareholder value by exploiting opportunities and managing risks deriving from economic, environmental and social developments. 2 - An assessment of risk and accident impacts related to dangerous goods transport with particular attention paid to HAZMAT on the road in a motorway environment. 3 - A DSS (Decision Support System) model for the management of the HAZMAT transportation.XXI Ciclo195

Rapporto 2013 sullo stato della ricerca scientifica all’Università di Trieste

Università degli Studi di Trieste Commissione per la Valutazione della ricerca "Rapporto 2013 sullo stato della ricerca scientifica all’Università di Trieste. Primo esercizio di valutazione delle pubblicazioni scientifiche 2008-2011", Trieste, EUT Edizioni Università di Trieste, 201

IPOTESI DI MODELLO ORGANIZZATIVO E GESTIONALE DELL'AREA DELLE PROFESSIONI SANITARIE SULLA BASE DEL VIGENTE STATUS NORMATIVO, CON SPECIFICO RIFERIMENTO ALL'AREA PROFESSIONALE DIETISTICA

La rapida evoluzione negli ultimi anni dello status delle professioni sanitarie ha determinato la nascita di nuovi modelli assistenziali integrati nelle strutture sanitarie pubbliche, con caratteristici connotati di tipo manageriale. Sulla base di ciò le strutture ospedaliere e territoriali hanno istituito nuove aree funzionali, forti già della loro organizzazione interna, ma non senza alcune difficoltà in quanto il ruolo centrale attribuito dalla normativa ai professionisti non medici ha comportato cambiamenti significativi nell’assetto aziendale di ognuna. Inoltre la brevità dei tempi con cui è andato istaurandosi il nuovo modello organizzativo ha determinato adattamenti particolari e in alcuni casi non ottimali in rapporto ad un risultato di un assistenza efficace, efficiente ed economica che si vorrebbe ottenere. Non per questo l’importanza di una modifica epocale deve essere sminuita e sottovalutata, anzi, queste proposte neo-formate stanno già subendo notevoli miglioramenti ed integrazioni che vengono inserite al momento del rinnovo periodico degli atti regionali, locali e aziendali al fine di valorizzare al meglio il senso di ruolo nevralgico nella gestione delle politiche sanitarie. Proprio per questo è necessario analizzare nello specifico il fenomeno e capirne l’essenza per cui è stato pensato e pianificato, perché il ruolo della dirigenza delle professioni sanitarie in prospettiva di medio termine potrebbe rivelarsi importante se non essenziale al fine di una corretta gestione dell’assistenza all’utente sanitario, considerando anche il potenziale sviluppo sul territorio. Di fronte a questi presupposti abbiamo immaginato, secondo i termini di legge, un modello ipotetico di organizzazione, coordinamento e gestione dell’area delle professioni sanitarie nella sua completezza, per poi addentrarsi nello specifico professionale ed arrivare all’area dietistica analizzando le implicazione che comporta una corretta conduzione tecnico-amministrativa della stessa e su quale può essere il ruolo dell’operatore sanitario a capo di tale area. La sperimentazione del modello deriva anche dall’analisi di altre esperienze proposte e già affermate in Italia dove lo staff aziendale apicale ha attribuito notevole rilevanza alla funzione delle professioni sanitarie per competenze, professionalità e funzione specifica