Reducció d'escenaris per a l'optimització de l'oferta del mercat elèctric

El Projecte Fi de Carrera presentat tracta sobre la construcció d'arbres d'escenaris i la seva aplicació en problemes de Programació Estocastica. Un arbre d'escenaris constitueix una representació discreta del conjunt de possibles estats futurs d'un procés estocastic, per exemple, la carrega electrica, el preu de I'electricitat, el preu del fuel, etc. Nonnalment els arbres generats contenen un nombre d'escenaris massa gr~ fet que comporta una costosa i poc eficient resolució dels models d'optimització on són utilitzats. Per tal d'aconseguir una eficient resolució, duem a teone una aproximació de l'arbre original amb un arbre foonat per un nombre més reduit d'escenaris. Per tal de poder realitzar aquesta reducció s'han implementat dos tipus d'algorismes de reducció d'escenaris descrits en l'artic1e de Growe-Kuska, Heitsch i Romisch [10]: Simultaneous Backward Reduction Fast Forward Selection Es tracta de dos algorismes heuristics de reducció que determinen un subconjunt del conjunt d'escenaris inicials i assignen noves probabilitats als escenaris conservats. La metodologia de Simultaneous Backward Reduction es basa en l'eliminació d'escenaris fins a que resten el nombre desitjat d'escenaris conservats. Mentre que en el cas de Fast Forward Selection es fonamenta en la selecció d'escenaris fins a obtenir el nombre desitjat d'escenaris preservats. Aquests dos algorismes han estat implementats en el lIenguatge de modelització matematica AMP

Correcció dels biaixos, relacionats amb la detecció precoç, de les funcions de supervivència del càncer de mama

S'han revisat diferents mètodes per a obtenir estimacions de la supervivència del càncer de mama lliures dels biaixos lead-time bias i length bias. S'han utilitzat dades dels registres de càncer de Girona i Tarragona i del programa de detecció precoç de l'Hospital del Mar. S'ha dut a terme un estudi de simulació per tal de reproduïr la història natural de la malaltia i estimar els paràmetres relacionats amb la detecció precoç. S'han obtingut estimacions del temps d'avenç del diagnòstic en diferents escenaris de cribratge. S'han avaluat les diferències entre els casos detectats per examen i els casos de càncer d'interval. El temps mig d'avenç del diagnòstic en les dones diagnosticades de càncer de mama per examen de cribratge es troba al voltant dels 5 anys. Els temps de sojorn en estat pre-clínic dels casos detectats per examen són superiors als de la resta de dones incidents. Exceptuant un dels mètodes, la resta han proporcionat resultats similars

Disease networks identify specific conditions and pleiotropy influencing multimorbidity in the general population

Multimorbidity is an emerging topic in public health policy because of its increasing prevalence and socio-economic impact. However, the age- and gender-dependent trends of disease associations at fine resolution, and the underlying genetic factors, remain incompletely understood. Here, by analyzing disease networks from electronic medical records of primary health care, we identify key conditions and shared genetic factors influencing multimorbidity. Three types of diseases are outlined: “central”, which include chronic and non-chronic conditions, have higher cumulative risks of disease associations; “community roots” have lower cumulative risks, but inform on continuing clustered disease associations with age; and “seeds of bursts”, which most are chronic, reveal outbreaks of disease associations leading to multimorbidity. The diseases with a major impact on multimorbidity are caused by genes that occupy central positions in the network of human disease genes. Alteration of lipid metabolism connects breast cancer, diabetic neuropathy and nutritional anemia. Evaluation of key disease associations by a genome-wide association study identifies shared genetic factors and further supports causal commonalities between nervous system diseases and nutritional anemias. This study also reveals many shared genetic signals with other diseases. Collectively, our results depict novel population-based multimorbidity patterns, identify key diseases within them, and highlight pleiotropy influencing multimorbidity.Postprint (author's final draft

Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

1) Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue burden on the individual. The aim of this study was to identify combined multimorbidity and polypharmacy patterns for the elderly population in Catalonia. (2) Methods: A cross-sectional study using electronic health records from 2012 was conducted. A mapping process was performed linking chronic disease categories to the drug categories indicated for their treatment. A soft clustering technique was then carried out on the final mapped categories. (3) Results: 916,619 individuals were included, with 93.1% meeting the authors' criteria for multimorbidity and 49.9% for polypharmacy. A seven-cluster solution was identified: one non-specific (Cluster 1) and six specific, corresponding to diabetes (Cluster 2), neurological and musculoskeletal, female dominant (Clusters 3 and 4) and cardiovascular, cerebrovascular and renal diseases (Clusters 5 and 6), and multi-system diseases (Cluster 7). (4) Conclusions: This study utilized a mapping process combined with a soft clustering technique to determine combined patterns of multimorbidity and polypharmacy in the elderly population, identifying overrepresentation in six of the seven clusters with chronic disease and chronic disease-drug categories. These results could be applied to clinical practice guidelines in order to better attend to patient needs. This study can serve as the foundation for future longitudinal regarding relationships between multimorbidity and polypharmacy

Assessing the impact of early detection biases on breast cancer survival of Catalan women

Survival estimates for women with screen-detected breast cancer are affected by biases specific to early detection. Lead-time bias occurs due to the advance of diagnosis, and length-sampling bias because tumors detected on screening exams are more likely to have slower growth than tumors symptomatically detected. Methods proposed in the literature and simulation were used to assess the impact of these biases. If lead-time and length-sampling biases were not taken into account, the median survival time of screen-detected breast cancer cases may be overestimated by 5 years and the 5-year cumulative survival probability by between 2.5 to 5 percent units

Validation of an electronic frailty index with electronic health records: eFRAGICAP index

Objective: To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institutionalization and mortality in the elderly. Additionally, to assess its concurrent validity compared to other standardized measures: the Clinical Frailty Scale (CFS) and the Risk Instrument for Screening in the Community (RISC). Methods: The eFRAGICAP was based on the electronic frailty index (eFI) developed in United Kingdom, and includes 36 deficits identified through clinical diagnoses, prescriptions, physical examinations, and questionnaires registered in the EHR of primary health care centres (PHC). All subjects > 65 assigned to a PHC in Barcelona on 1st January, 2016 were included. Subjects were classified according to their eFRAGICAP index as: fit, mild, moderate or severe frailty. Predictive validity was assessed comparing results with the following outcomes: institutionalization, homecare need, and mortality at 24 months. Concurrent validation of the eFRAGICAP was performed with a sample of subjects (n = 333) drawn from the global cohort and the CFS and RISC. Discrimination and calibration measures for the outcomes of institutionalization, homecare need, and mortality and frailty scales were calculated. Results: 253,684 subjects had their eFRAGICAP index calculated. Mean age was 76.3 years (59.5% women). Of these, 41.1% were classified as fit, and 32.2% as presenting mild, 18.7% moderate, and 7.9% severe frailty. The mean age of the subjects included in the validation subsample (n = 333) was 79.9 years (57.7% women). Of these, 12.6% were classified as fit, and 31.5% presented mild, 39.6% moderate, and 16.2% severe frailty. Regarding the outcome analyses, the eFRAGICAP was good in the detection of subjects who were institutionalized, required homecare assistance, or died at 24 months (c-statistic of 0.841, 0.853, and 0.803, respectively). eFRAGICAP was also good in the detection of frail subjects compared to the CFS (AUC 0.821) and the RISC (AUC 0.848). Conclusion: The eFRAGICAP has a good discriminative capacity to identify frail subjects compared to other frailty scales and predictive outcomes

Contribution of frailty to multimorbidity patterns and trajectories: Longitudinal dynamic cohort study of aging people

Background: Multimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people. Objective: This study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older. Methods: Longitudinal data were drawn from electronic health records through the SIDIAP (Sistema d’Informació pel Desenvolupament de la Investigació a l’Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period. Results: The study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern. Conclusions: Our results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.The project received a research grant from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded in 2019 under the Health Strategy Action 2013-2016, within the National Research Programme oriented to Societal Challenges, within the Technical, Scientific and Research National Plan 2013-2016 (reference PI19/00535), and the PFIS Grant FI20/00040, co-funded with European Union ERDF (European Regional Development Fund) funds.Peer ReviewedPostprint (published version

patterns of multimorbidity in a population based cohort of older people sociodemographic lifestyle clinical and functional differences

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Prognostic Implications of the Residual Tumor Microenvironment after Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer Patients without Pathological Complete Response

Neoadjuvant therapy; Relapse; Triple-negative breast cancerTerapia neoadyuvante; Recaída; Cáncer de mama triple negativoTeràpia neoadjuvant; Recaiguda; Càncer de mama triple negatiuWith a high risk of relapse and death, and a poor or absent response to therapeutics, the triple-negative breast cancer (TNBC) subtype is particularly challenging, especially in patients who cannot achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). Although the tumor microenvironment (TME) is known to influence disease progression and the effectiveness of therapeutics, its predictive and prognostic potential remains uncertain. This work aimed to define the residual TME profile after NAC of a retrospective cohort with 96 TNBC patients by immunohistochemical staining (cell markers) and chromogenic in situ hybridization (genetic markers). Kaplan–Meier curves were used to estimate the influence of the selected TME markers on five-year overall survival (OS) and relapse-free survival (RFS) probabilities. The risks of each variable being associated with relapse and death were determined through univariate and multivariate Cox analyses. We describe a unique tumor-infiltrating immune profile with high levels of lymphocytes (CD4, FOXP3) and dendritic cells (CD21, CD1a and CD83) that are valuable prognostic factors in post-NAC TNBC patients. Our study also demonstrates the value of considering not only cellular but also genetic TME markers such as MUC-1 and CXCL13 in routine clinical diagnosis to refine prognosis modelling.This research was supported by grants from the Instituto de Salud Carlos III (PI13/02501 and PI11/0488) co-financed by the European Regional Development Fund (ERDF). ML acknowledges support from the “PATH-IMAGE” project, which was funded by ERDF (agreement 2903/335-41)